Episode 134: Sensory Processing, Cranial Nerve Integration & Orofacial Myofunctional Therapy

Hi and welcome to episode 134 of the Untethered podcast. Today we have Dr. Marielle Mitchell joining us. Upon discovering what orofacial myofunctional therapy had to offer, Dr. Marieli was blown away combining it with the frameworks she'd already learned. As an OT with expertise in feeding, swallowing, cranial nerve integration, sensory processing, OMT opened new doors for treatment. As soon as she started implementing her combined framework, her outcomes improved and she became the go to expert on tongue tie release, long standing sensory issues, and ongoing swallowing and feeding difficulties. Her passion for OT and OMT comes from her experience as a child experiencing underlying issues that never got recognized or addressed until adulthood. She feels so fortunate to have access to knowledge so few people know about. It has completely transformed her life and her treatment methods. She strives to find and connect the missing dots between oral rest, posture, sensory processing, the nervous system, sleep, cranial nerve dysfunction, swallowing and feeding. These various facets of the human experience impact daily function much more than people realize and Dr. Marieli is excited to be a pioneer in the field to bring these issues to light.

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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 healthcare provider.

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I am your host, Hallie Balkan.

I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your.

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Information in the orofacial myofunctional therapy, tethered.

Oral tissue and airway space.

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This information out to the masses.

Let's get started. Marielle, thank you so much for joining me today. I'm really excited to chat with you.

Yeah, me too. Thank you for having me.

You're a doctor of ot, which is I think phenomenal because there are not a lot of OTs who who are present online in the Mayo world. And so I know you do much more than just Mayo, but how did you come into this space?

Yeah, that's a really good question. So when I got out of school I basically kind of like full charged ahead on a lot of different types of specialties that I want to get into and sensory processing was one of them and I was really, really into it. I got trained under people who learned under Jane Eyre's and I was really into sense integration for the first, like, two to three years of my career. And I got into feeding after that. And what I realized with, like, regulation, organization, behavior, and, like, level of arousal, I was plateauing. With a lot of kids, I could get them a trampoline at their house. I could get them on a swing all day. I could do the ball pit. I could do, you know, things at their desk that would, like, give them the tactile input that they were looking for. But there were still kids that were really, really dysregulated. And I was kind of. As a clinician, I was getting really frustrated, and I was starting to get into feeding at that point in time when I was taking my. You have five years to get an SWC as a ot. So I was in all these feeding courses. And one of my feeding courses was about early intervention and NICU babies. And this woman was talking about the feedback loop between mothers who nurse and when they're breastfeeding their baby. And then she kind of got into osteopathy. And I was like, huh, okay, That's a really interesting profession I haven't really heard too much about. And I kind of started looking into it. And then I met an osteopath who, ironically, was working, like, a block and a half away from my house. And we actually shared a patient. And when he met me, we just started, like, nerding out and talking and talking all this, like, neuro stuff. And we just really, like, got along really well. And he's like, you know, I really think that you should look into this tongue therapy. And I was like, what? And he was like, you have to. You have to meet this woman, Joy Muller. And this is, like, seven, eight years ago. And I was like, okay. And so when someone just tells me I should just go do something, I'm the kind of person to ask. I'm like, here, let's just go. Take my card. Where do I sign? Let's just go. I just follow, like, the breadcrumbs. And so as I went to go meet Joy Mueller, I just asked her, and I was like, hey, I'm an occupational therapist. I'm a feeding specialist. I'd like to kind of just get to know what you do. She was like, come into my office. Just observe me for a few hours. And I was like, okay, sure. And my. That day, I felt like I got hit by a car when I met her back then. And the way she described the function of the tongue, the way it impacts the airway, the way it can block the Airway, how it can be dysfunctional and how it impacts sleep. And my, and how I knew sleep impacted like sensory processing and attention and all these higher executive issues that we work with with kids. I was like, oh my God, I was so, I was so in shock that day. And I personally also have my own mild issues. I had ear infections my entire life until I was like 30 and I had a really narrow, like a really bad one. And I'm currently, I have two alpha in my mouth. Like I'm, I've been on the other side of it too. And so when I learned this stuff, I went back to my clinic and I was opening every kid's mouth and like 40% of them had big tonsils. And I was like, oh my gosh, how did I, how did I know? Because you just like you don't know until you know. And I was looking for tongue ties as well. And so many of them also had that. All these kids were in speech. They had been in speech since they were like two. Now they're in speech for five years doing all these drills and not make plateauing, not making much progress. They were in feeding and having crazy cross bites and the tongue wasn't able to move. And I was like, how are they even going to chew these molars that don't even align? And my mind was just blown that day. And ever since then I've just been kind of digging through the myofunctional world more and more and more as I can. And that's kind of how it evolved. And I've been taking courses like in the oral facial malfunctional world, a little bit outside of it too as well, combining my frameworks with sensory processing, neuro and then myo. I take a very sensory myo based approach and I think that's why I can work with a lot of younger populations because it's not necessarily asking them for a motor response, it's more stimulating the actual nerves. And so there's like a lot of different frameworks that I kind of just combine to make kind of a method that I use. And it's been, I've at least been able to work with little ones really effectively in that sense and adults too, because they just listen, so it's easier. But you know, and the motor response is there a lot of the time, so. And, but I have to do a habit that's 37 years in place, 40 to 50, what, you name it, right? And someone who hasn't been sleeping well for a long time. So I got into it through, like, lots of different places. And, you know, I had one patient specifically that before I even got into myo, was kind of like a. A huge. Kind of like, almost like a. A big breadcrumb. And I had a little girl who was a preemie twin, and she was really aggressive and really, like, almost violent intercessions. And I knew that wasn't who she was. I knew something was going on, but I could put her on a swing all day. Parents, but everything. They had a sensory gym at home, like, so. And, like, people were there daily giving her the input, but she still was just so falling asleep every day on the car ride home, sweating profusely when she was sleeping, and I just didn't know what it was. And mom talked to me, like, should I get her tonsils out? Should I not? Blah, blah, blah. And at the time, I was like, well, it's a surgery, and I didn't know anything. And I was like, but if she can't breathe, and, like, I can't hear her snoring when I go to, like, with you to take her out of the car, like, maybe you should. And that little girl got her tonsils out. And then I saw her two weeks later, and she was like, mary Ellie, like, what game do you want to play? And I was like, are you okay? Like, it was like. It was. It was. I was like, oh, there's something here. And then that's when I also kind of was, like, starting to talk to pediatricians. And I was like, well, why are there tonsils getting big? And no one could really, like, answer me. They were like, well, we're not sure. Like, they're just breathing through their mouth, you know, like, nothing more to that. And I was like, okay. Then I met Joy Moeller. And I was like, oh, okay. Like, these kids aren't breathing. This is a problem. This is, like, a basic need. And that's where I kind of. Any person who comes into my office, I kind of always just explain it to them. I'm like, if you don't have this basic need met, you can't function. And there's no. I don't have a right to label any. Anything else unless we get this basic need met. It's like, you're not eating, you know, or you're not eliminating. Yeah, one of the three. So it's kind of how I got into it. It's an interesting little story with a lot of different turns.

Well, and I love it. You said a couple things that, like, made my brain just go like yes, for one, I love that you can work with the little ones because traditional myofunctional therapy, people hear me preach this all the time. It's really geared for like, you need to have the cognitive ability of a four year old to truly engage in traditional myo. But when you're an SLP or an OT who has additional training and like feeding and you've got even additional training beyond that, you know, we can work with these little ones and we should not be waiting. We need to be working with them as soon as the issue is identified. And I am like on this like new like rampage of like we need to be screening these kids at birth. Like this needs to be done in the hospital and then we should be screening them, you know, the pediatrician should be screening them at well, checks every, you know, at least every year we, or we should be screening them in the preschool. So like when we do speech, language, OT screens through my private practice and preschools, we do a myo screen which is like kind of a sleep screen. It's kind of our window into being able to open that conversation with parents. And you know, we need to be, we walk into classrooms where children are taking naps to drop off one kid and pick up our next little one that we might work with. And we see a kid who's not a kid we're working with with their mouth open and they're audibly breathing or snoring and you know, we can say, hey, is this common? Like, do they do this all the time? And they'll say, yeah, you know, and we can then have them reach out to the parents and have the parents connect with us. And so there's so many different avenues that like we, to try and get in with these kids. Because this whole wait and see approach, it's not just unfortunate, it's dangerous. It is downright dangerous. We actually have these kids who are struggling to breathe in their sleep. And I don't say that to alarm or scare parents. But you know, if you are lacking oxygen, right, if someone's putting you in a chokehold, how does that feel? And to think that some of these kids are sleeping like that at night is, it's scary. And it should be more mainstream knowledge that like you can have your child checked and we should not wait until they're old enough to do traditional myo. We need, I call it like feeding with a twist of myo when there are little ones that like we can get in there and we can work with them and we don't need that deliberate response, that oral motor response necessarily like, you know, that volitional response. It can be automatic, it can be through using reflexes. And you know, and I know this, I'm preaching to the choir here. So I love that you said that.

It's just so exciting to hear someone else say that too. And I really think, you know, like people are always like, well my dentist said it, just wait and see. And I'm like jaw development kind of like takes a massive pause around 6 and 7. Like you need to get in there was like molars. Like you need to get a device in your mouth. And you know, I think a lot of things that people also kind of jump the gun on not to kind of like steer us another way is like they'll do a release but they won't do any of this habitual retraining. And there'll be a pacifier in the picture. There'll be thumb sucking or there'll be excessive bottle use. And I get so many cases where the reattachment is way worse. I mean I didn't see the pre, but maybe I'll see a video or a photo. And the reattachment is so high and so much more intense because that negative pressure that's put on the bottle from that bottle or pacifier thumb. And it's just the, the way that people just think that like oh, we'll just release them when they're little and they're like it's going to all get better. And it's. No, it's not a magic bullet. It's not that at all. It's the function of a very large puzzle. Yeah.

And we therapies in order for it to be successful in most cases.

Yeah. Unless they're, unless they're like infants and they're exclusively nursing. Right. And that's kind of like where I started to work with super, super little ones. Six days old, three weeks old, six weeks old, that kind of profile. And it's. I can see therapists who used to do a lot of like ndt, cme, all of like the neuro based handling techniques. Those kids, those babies who we work with really early on and they get their tongue up to their palate and they exclusively nurse for a while and then they move on to feeding. And I do, I personally have like, I love my pediatricians that I work with, but not all the kids that I work with. I'm super, super close to those pediatricians because I see people from all over now, which is like amazing because of zoom and like, a silver lining of, you know, Covid. I do my own wellness checks. 3, 6, 9, 12. I check on them the first month, first year, because it's so important for that oral motor, like, development to happen. And when no one else is doing that, I get. I get nervous. And I've. When I wasn't doing that, I would get these cases that would relapse, and I'd be like, okay, I have to, like, take it upon myself to do this, because I don't know if anyone else is. And I'm so with you about the school thing. I would love to create some type of, like, national international program, get in with the school districts where it's like, why do we check their ears for hearing and their eyes were seen and we're not taking them their way?

Why?

Like, we need a screening tool where it's like, the teachers can be like, oh, there's two golf balls in the mouth. Yeah, you go to the right side, and if they're not, you go to the left side. Great. Okay.

Well, I mean, hi. We know that hearing and vision are also impacted by neurofacial myofunctional disorder. So if that's the root cause of a lot of these, I'm not saying all of them, but we know it's all interconnected. Why are we not screening for the root cause? Right. Like that. It's funny, I just had this conversation on the panel. I was like, we screen for vision. We screen for hearing. We screen for speech and language sometimes. And ot, you know, fine motor, gross motor, sometimes in the preschools, like, it should be mandatory that we're screening for airway first and foremost ahead of everything else.

I totally agree. I feel like this is what I love about our, like, little niche group of people in the world, is that it's such a basic need. And I think it's so great also that that book Breath came out James Nestor and like, someone who's not vested in this at all, like, just completely objective opinion, brought this information to the forefront. And I. When I. When I give parents that book and Gas or Jaws and things like that, or those chapters four and five, especially of Gas, like, that's when people really resonate and they're like, oh, okay. And it's this. Like, they finally get it. And I really hope and wish. And that's kind of like why I was like, okay, there's no Otis doing this. No one's really like, the. The having taken the opportunity for this, like, mission to come from an occupational therapist and I really wanted. I feel really strongly about it because I've seen it for so long and I've had to argue with. Not argue, but I've had to kind of inform people about. No, this is a really big issue. These are things that, like, I can do occupational therapy with your kid, no problem. That's fine. But you're going to be in therapy for like five years because they're not sleeping. Like, another thing was, like, I would teach these kids, like, the Alphabet, their name and, like, not switching the D and the B and like, all these things. And it would like, he knew it one week and then didn't the other. And I was like, this is. You knew that. Sticking. You knew this. Like, what, like, what am I? And I would, like, try different modalities and all these different things. And like, maybe I did it in a bean pit. Maybe we do it in the swing. No, the kid just wasn't sleeping, you know, And I always tell people, like, especially like moms, I think they can really resonate with this and make you remember your fourth trimester. Do you remember how sleep deprived you were and how, like, you would cry at a commercial or anything? You know, like, that's your kid.

That's like in fight or flight. Yeah, totally.

Yeah. Or freeze, you know, and they're just like. And they can't answer a question. Like, that's, that's how people, I think, can relate to it. And they just think that. I think we've. I think what you were saying to in one of your post, like, we've normalized these things because the occurrence of it has increased. But. Yeah, but that doesn't mean it's normal. And I think that we need to get back to a baseline of true anatomy. And like, the thing about orofacial malfunctional therapy is like, we're not reinventing the wheel here. Like, it's anatomy. What we're doing is we're respecting and honoring the, like, synergy of proper anatomy. And people kind of, like, overthink it, I think, sometimes. And it's. No, this is a. This is anatomy, and this is what it needs to be. And when your anatomy doesn't function, you're going to have dysfunction somewhere else. And when grandma gets a hip replacement, they get therapy. You know, when you tell your ACL or when you have a rotator cuff injury, trust me, I know. I used to work with geriatrics when I begin my career, like, it's Medicare pays for, like, therapy, you know, and it's like, it should be A thing like nobody should be releasing anybody unless there's pre and post out, like therapeutic intervention. I always call it, like, okay, the, the surgeon, whether it's the ent or the dentist, is the person who hands them the driver's license. I'm driver Z. Can they park the car in the garage? Can they drive the car to move the food over to their molars? Like, I don't know, I have to teach them that first. But if you just give someone a license without them like learning how to drive, you know, and like, I feel like, you know, like, I don't ever want to scare parents. I don't ever want to scare people. But it's so true what you're saying about how this is an actual true, true issue. And I feel like when people are releasing and there's no therapeutic intervention, like you are now giving a tongue that has absolutely no coordination, the ability to blow block an airway so much more than you ever had before. And if you can't like prevent that, I think a lot of us are, we're. There's, there's a. Statistically I hope it never happens, but there's the propensity for some type of issue to arise with these types of releases or just in general, like lack of therapeutic intervention to strengthen the tongue coordination, whatever it is, is really high and it's scary. I. And like, I think a lot of them are also just reattaching. So they're.

Than they were before with worse with additional symptoms arising as a result. So then we get this whole, you know, online discussion in parent groups of, oh, tongue tie releases don't work. Ours failed. This happened afterwards. And you know, you ask them question like, well, who did you work with? Did you have support? Did you. And I'm not saying this to shame a parent or to make it seem like they didn't do their job. They were probably failed by the medical system. It's not oftentimes parents go, no. You know, I mean, there are some parents saying, no, we're just going to do the release. We're not going to do that. And well, they've made their decision for themselves and their child. But most families are not even given that discussion or that information or the opportunity to have the support. And that's why that's like one of my other big platforms of like, I will die on this hill. We need. If you have an infant who's five days old, maybe they don't get the pre, but they need to immediately get the post. Like they are like I've had kids who, okay, great, we're going to go straight to the surgeon, release that tongue, get them on the breast and. But they need to be getting that bodywork. At the very least. They need, I think every newborn needs body work because they've just gone through a very traumatic birth experience, whether it's vaginal delivery or C section. But that's a whole other conversation. You know, these babies though, if they've been, you know, I was just sharing this with the group of dentists. This weekend we develop our swallow by 12 weeks in utero. And that's a swallow we're going to have for life unless we intervene. And so, so these children, it's not that they're just born with the improper swallow. No, they've been already been doing it for two trimesters. Like we're entering, we're headed into the fourth trimester like you said, and it's only going to continue to get worse. And so if it's not functional now, it's not just going to magically become functional itself. And so there was an interesting dialogue about thumb sucking going on. I know you saw on my Instagram page when I posted that reel. And, and you know, I say we can agree to disagree and I can still love my colleagues even if they don't agree with this. But in my opinion, and based on the conversations I've had, the research, I've read the kind of research that's being done now, you know, I know that we've, we were discussing how, you know, Kevin Boyd and Mariana Evans are looking at prehistoric skulls. And there's even some research being done looking at babies in utero via ultrasound. And with these babies, if they have their thumb, we can see retrognathic jaws. Okay, that's the first point. But if these babies have their thumb and in their mouth, they're, they're acting as a mandibular advancement device in utero. They're bringing their jaw forward and I get, okay, they're. The argument is that their brains aren't developed yet at so many, you know, and so it's not a brain based function and it's just natural is what people say. No, I'm sorry, the brain is not. The brain does not need to be fully intact to say, hey, we can't breathe. Put the thumb in there. That's my opinion.

Brainstem. Very basic need. Brainstem. And those are swallow. Right. It's an instinctive, like primal, like primitive thing that we do. It doesn't require a lot of cognitive function to do it. People can be in a coma and they can still be swallowing, you know, so I totally agree with you on that. And it's something that needs there. It needs. And I think we can start like, you know, at least informing people a lot earlier with what their options are for this so that they're not facing this journey of like difficult sleep or difficult breathing or difficult behavior and really kind of like, like pulling in anything that they can because they're so desperate later when this child is like five or six and having these behaviors and they can't figure out what preschool or kindergarten class they should be in because no one can accommodate these needs.

And then they're putting on ADHD medications because nobody child. And they think they have adhd and you know, and I'm like, no child should ever be put on ADHD medication without a sleep study. Yeah, I don't care if it's a home based sleep study. I don't care if it's, you know. Yeah, I don't. You better be looking at it that sleep before you put a upper in a child's body.

I totally. You're preaching to the choir with that. I've been saying that forever and I, I, you know, some parents are super on board with that and then some, you know, this is like a tough journey and it requires a lot of parent involvement. And unfortunately we have the infrastructure of a society where like not everyone can stay home with their kids and not everybody can do the repetition and the intensity of the exercises that's required for my functional therapy. That's the thing where I think is also a huge. There's a discrepancy in why there's. It's harder to successful cases at times because as an occupational therapist I can tell you if I teach a kid shoe tying, it's going to be really tricky for three weeks. But once they get it, they get it.

Yeah.

And they do it like maybe 14 times a week, twice a day if we're lucky.

Right.

Most of the time they do it 10 times. This is breathing. Breathing and swallowing. They do it a million thousand times a day. And for us to change it so much practice with that and that falls on the parent or the nanny or whoever's with them the most. And I think that's where there's. It's difficult for a lot of parents to jump on board sometimes because if you really. I always try to like make it tangible and like inch stones. Right. Not milestones. I don't, I don't like go like, hey, we're gonna have to do this like surgery potentially. And I don't like overwhelm people. But even then, like it's so hard for people to get in their kid's mouth sometimes. Or like. Yeah, we were just never able to brush his teeth. And now he's eight and you're like, okay, so we're gonna start here. And you know, it's just so. I think it can be really intimidating for some parents. I think they want to do it so much and it's just, it's hard sometimes and. But the parents, the families that juice to. They get the sleep study or we monitor the sleep in some sort of way. And even then, I mean, I've had parents myself too, where I like had kids in my clinic and we had like the NEST camera before, like all these new like cool technology came out the last year or so. This is like five years ago, four, whatever. And we had no idea this kid was waking up from 4 to 7am like scaling the walls. Nobody knew. No parents were earplugs, eye masks, like no one knew. And this kids are just climbing everywhere, like playing. And everyone thought these kids were sleeping. And I was like, this doesn't look right. You know, like, like the allergic shiners, like they've just like they're like in and like their regulations all over the place. And once you start looking at their sleep, people are like, oh yeah, they're not sleeping. And you're like, yeah, like, this is, this is. I can put them on a swing for as long as you want. Sure. But we're not going to get to the bottom of this. And that's one of my like biggest things is that OTs, I think sometimes and I, I have so much respect and I. Sensory processing is so effective when you're working with the child that sleeps. You can really, really work on some things and you can get them regulated. You can really. If you, especially if you do an intense kind of model, you can really improve motor skills. There's no doubt about that. But for things to stick and for it to actually work, they need to be sleeping. And the kids, at least in my practice and I'm based in la, it's a pretty like metropolitan area. Like there's like, like statistically I get all kinds of people. It's not sticking, it's not working. And I think as occupational therapists it's our duty to kind of start like diving a little bit deeper and looking into that. And I'm happy to see and I've been contacted by some ots now, and they want some guidance with it. And I'm like, yes, like, we need to be their screening. Like, we need to be like, we're the ones that get the kids who first. Oh, can't sit still, put them in ot. Oh, you know, it's kind of like, you guys, like, oh, they got a list. Send them a speech. Like, like, we're the first screeners. We really are with the most advanced training to be able to, like, understand this from a, like, craniofacial side, neurological side, and, like, you know, sensory, motor. And it's just I. I'm excited for the momentums with it that's with this. And I just really think that there's a huge advancement to be made in our fields. And I'm happy to, like, talk to you and meet you and, like, see that people are doing that and, like, doing the, like, the work with it and, like. Like, I don't know. I just. I feel like we're at a turning point a bit, but it's taking some time. Like you were just saying, right? Like, you push back with CEUs and all that kind of stuff. And it's like, why are we so stuck in our ways? And why do we have to sacrifice so much time and so many people? Like, if we would have waited for research on Tongue ties when, like, a lot of research for the kids that I was working with seven years ago, those kids would have all been on meds by now, and they would have had a completely different route, right? And they would have been, like, what, nine now? And it's just like, it's. So why do we have to sacrifice so many people's, like, lives and, like, livelihood and quality of life just because, you know, we have to wait for things. If we just wait, wait, wait, and, like, don't follow what we're seeing anecdotally and clinically, I think there's some major issues. Of course I want research, too. I'm not making, like, misinformed decisions. But there was enough research back then, too. It wasn't huge, like, RCTs or anything like that, but enough to, like, bring up some concern of, like, okay, these kids aren't sleeping and they have, like, a 60% chance of going into special ed. Like, that was the one that. That study.

Yes.

That was like. I was like, oh, my God.

Well, we have research that shows, like, you know, and usually it's obstructive sleep apnea in the research, but that OSA will decrease your IQ by 10 to 16 points compared to your same age, typically developing peers. And like, I know that might not sound like a lot, but for a child who's in the average range to then be decreased, that's going to knock you down quite a bit. I mean, and that's going to make school really challenging for you because especially in this day and age, schools like you got to fit it into a box. Most schools don't do various, various learning styles. So if you already are coming in with, I always say, like, we've got 10 buckets, right? And if you have sleep disorder breathing, knock three of those buckets out. So if you're coming in at 70% capacity and then let's say something else is challenging now we're down to 60%. And then you've got a sensory processing disorder, let's knock that down. And then you've got your mouth breathing and you're turned around at circle time and it's like you start to knock these buckets off with every little thing. What do we have left energy wise? How many energy buckets do we have left to actually attend to school and absorb the information that's being taught? It's not that these children are stupid, they're just not being given the opportunity to fully function in order to absorb what's being taught in school. And even when you try to teach from different modalities and you put some of these kids in a special ed classroom where they really probably don't always belong, they just haven't been given the opportunity to learn with their, alongside their typically developing peers. It's frustrating. As we were talking, I was just googling, I was like, incidence of pediatric sleep disorders. And it says, according to a recent study, this was in 2017, the prevalence of sleep related diseases in children and adolescents was determined to be approximately 43%. If 43% of our children back in 2017 have sleep disorders and this could be just, you know, it doesn't have to be obstructive, this could be mild, which is still a big problem.

Right?

You know, we always, if you've heard me talk, you've heard me say that. Guillemot did not mean for that mild to be a written off diagnosis. He meant for that to be, no, no, there's a problem here. We need to address this. And you know, there's other things that happen in women, it's uars, in, you know, children. We see mouth breathing and they might just be going like with slightly audible breathing. It doesn't have to be snoring. These kids, you can have sleep apnea without snoring. You know, there's all kinds of things that I think are also just not mainstream knowledge. And we were actually talking a lot about this this weekend and it's just incredible to see how we are still, how we are still so far away from helping our children because our children, you know, it's like, this is so cliche, but our children are our future and they're developing at such rapid rates that if we don't intervene now, it continues to get worse. Our jaws continue to shrink, which means our airway continues to be more greatly impacted as jaws impinge on the airway. And so if we're not working to not just expand like traditional orthodontics expand, you know, laterally, but also grow anteriorly, we have like these mid, you know, this mid face deficiency. We've got these issues. And the thing that gets me is, you know, like one of my friends and colleagues who works with me has an underbite. And she's in her late 20s and she had all that traditional ortho. And she's got a beautifully wide U shaped palate, except for her mandible, sits too far back. One of the things I've never heard anybody talk about, and I actually just did an assessment on her this morning for my MYO course in person because she happens to be in Boca right now, was I said, you know, she's, she's. And she's an adult and she treats myo. So she's like really with it, right? And so we had a really cool conversation and you know, we got into talking about these kids who have beautiful U shaped palates, but who have deficient mandibles. They're just. Or maxilla, sorry, the maxilla, their upper jaw is just sits too far back. They can't suction their tongue properly. It's not a lateral tongue space issue. The tongue fits according to what most people look for, but doesn't fit anteriorly. So then it has to slide backwards. And what happens, you could be sitting with your lips closed together and your tongue on your palate, but guess what, you're now impinging on the airway. That tongue is still blocking the airway even though you quote, unquote have what most people will consider proper oral rest posture. No, no, it's not proper unless it's sitting. Your mandible and your maxilla are far enough forward. And so that's just that' conversation I don't ever hear anybody having. And so it's one of those things where like when you start to really nerd out and go deeper into this stuff, and you look at these kids who slide their tongue back when they're suctioning, yes, it can be due to weakness, and maybe it's a novel task for them, but after we've been working on this for a couple of months, they're still doing that. Then that begs the question, like, are they tied? Do we need to grow their face forward? Do we, you know, which many of us also can identify on day one. But it's just, it's a very fascinating thing because some of my most complex cases had this issue going on, but nobody ever taught me to look to see if they can suction far enough forward and not far enough forward to have it sit 2 to 3 millimeters behind their, you know, their upper central incisors on the alveolar ridge so that it's not touching the teeth. No, far enough forward. Meaning does their maxillus sit far enough forward? Because we work with soft tissue. We don't work with, you know, we look at anatomy, but we're not moving bone. So it's. But we need to know enough to be able to know who to refer, when to refer, and who to refer to so that we can give these children a new lease on life. And it's just, it's one of those things where I don't think parents realize 43% of our children have sleep disordered breathing. That makes me sick to my stomach.

Yeah, I couldn't agree with you more. I really. It kind of scares me, to be honest. I don't think as a country, we're ready for. We don't have infrastructure appropriate programs for people who will age out of the school district and their IEPs and have, like, functional employment for them. Like, to take a more traditional occupational therapy perspective from this, we have such a rise in autism as well. All the ones that I know in my clinic have had some type of sleep issue, whether it's neurological with seizures, or there is some type of. Typically there is an orofacial malfunctional issue going on as well. Or there's a cranial nerve dysfunction with that specific population that I've noticed. And the rise of autism and the rise with the sleep disordered breathing is, is just astounding. And it's like, oh, like, what are we going to do with all these kids? We're in their 20s. Like, what do these people do? They compensate in some way, right? They look for some type of way to regulate themselves. What are they going to be doing Behaviorally at that point in time, how are they going to employ themselves? How are they going to wake up to go to employment? All of these executive functioning skills of money management and like schedule management, all those things makes me really, really, really nervous. And I, I don't have the answer to it other than early intervention and working on it and getting into like the school districts and getting into like hospitals and educating the people at the front lines of like, okay, have you seen infant that can latch? We need to get them intervention. If there's a preemie, they need to be seen by a dentist. As soon as those molars come in to help with that cranial facial development. Preemies, of course they needed to like be on a pacifier, bottle fed, of course. But why is no one in there? Why aren't they being monitored? Why aren't they being monitored? As soon as their molars come in, why can't someone get an alpha in them? They're going to be sensory seeking kids. They've had a pacifier in their mouth for at least a first 12 months of their life. They're going to need that input. I know exactly what an owl feels like. It feels incredible when it pops in and it locks in. It's like having a weighted blanket on your body, but one of the most like neurodense parts of your body. And for me it's like any kid that was ever preemie, I was like, okay, you got to go to dentist. Like I, we, I can start with you, sure, but we really like, this is, this is more, this is structural at this point. I'm just a functional part of it. Please go see this dentist who, we'll get the process started. Come back to me. We can work in the same time in conjunction or let this like get in north first and then we'll kind of go from there. There's just so many populations that we could really start kind of like putting, not necessarily in buckets, but to a sense saying like, okay, you need to go to the dentist, you need to go to ortho, like, you need to be in osteopathy, those kinds of things. And really just being, I think I kind of, I don't, again, I don't like to overwhelm parents and things. But I also like, I don't like to withhold information and I'm very transparent with them and I'm very educational because I feel if people understand what they're doing, they're more likely to do it rather than just kind of being like oh yeah, I'm at therapy but I don't really like know what's happening and I drop her off and. Or I'm going to this ent, but I don't really know why. I need them to like, I almost like quiz them. I'm like, so we're going here. Do you know why we're going here? Like, what, what are we asking for? And it might seem like a kind of an intense approach, but that's the best way to get compliance too. And it's, it's just something for me that I. We're almost as a society and over our heads literally like in our heads are shrinking and it's just kind of like mind blowing.

Smaller brains.

Yeah, it's like, it's, it just really. I mean like I was. Kevin Boyd was at AMPD and like, you know, I've loved and respect his work for so long and it's just like absolutely mind shattering how much our schools have changed because of the mandible and the recession of it and how people just think this is like typical and all that.

I mean there's so much that we can't control. And as a mother, you know, if we put Lily, my now 6 year old, into an ALF at 4 years and she was, she really only needed it for about nine months but the pandemic hit and so we kept her in it for a year. You know, we're like, it's not going to hurt her. So. But she was that sensory kid who. Picky eater, had the tongue tie, you know, feeding some feeding stuff, like horrible infant feeding experience, very painful breastfeeding, you know. But everybody told me she was fine. Failure to thrive first pretend be to her whole first year, like all the things, right? So fast forward to getting the alpha. So the day after she got her tongue tie released, her bowel issues like disappeared. She was no longer constipated. I was like, tell me that the tongue is not connected, you know, the tip of the tongue isn't connected from the tongue to her toes. Tell me that, please. I was like. Because there she goes. It was. I was like, wow. Well, I wasn't expecting that really. I mean this is like a child who really, really struggled with bowel movements and was uncomfortable and you know, and didn't have anything else going on that made sense as to why, like no allergies were coming up. No one's, you know, maybe some inflammation from dairy or something. And she was a kid who left her dairy and her, you know, gluten, because that's what these kids do, right? So anyways, but I'm also that mom where like I know epigenetically we have glycophosphates, we've got all these things going on. We've got just. There's so much we can't control. Right. We can, I can feed my children pasture raised organic, you know, non gmo, make sure they're eating a healthy diet to the extent that, you know, they'll eat it. And my kids eat plenty of fruits and veggies and you know, Lily just eats just a couple proteins but a pretty well balanced diet for a picky eater. And it just, it was really interesting to see how things really changed about halfway through her. So her tonsils shrunk. They pretty much went from like really inflamed size 3 plus to down around size 1 within three months of being in the ALF. And I got people jumping down my throat for sharing that story. But we changed nothing else. And it was the middle of cold and flu season, she went into it in August and this was three months later. And I was like, tell me why in the middle of cold and flu season her tonsils have shrunk. Like and we've changed nothing about her diet, nothing else. Right. But also a sensory kid who doesn't like how socks, the seams of socks feel and she won't wear tagged shirts and you know, just all these little things that even as a mom in this space, I never really put together that she was truly a sensory kid kid because I was so focused on like what was going on in her mouth and I was not really paying attention to full body impact. And it dawned on me when the thing started to go away that they were issues for her. And I was like, how did I miss this as a mom in this? I mean I'm not an ot, that's how I missed it. But you know, I had my OT look at her and she was like, oh, she's like super advanced in all her motor skills. Like she's, you know, fine motor looks great, gross motor looks great. Like no concerns, but we never really looked at at sensory as it related to everything going on in her mouth and that like could have been a total game changer in infancy. Now, thankfully she's a six year old, she's very smart. Like she sleeps with her mouth closed unless she's sick. Like she's got a correct oral rest posture. We're fixing her lisp and myo right now. But other than that it's like, why are people not talking about this stuff. Why is it that like these moms and, and that's the other side of it too. I've become so passionate that anytime a mom dm's me and says, hey, who do you know in this area? I've now created groups where I can go and say, hey, which of you amazing specialists are in this area or who do you know? Because it's my goal to connect parents with providers who can actually help them in this, you know, in this arena. So that's fine. My soapbox.

Yeah, no, totally. And I like that you're talking about the sensory part of how it's connected to myo and all that kind of stuff as well. And I think that's something that I, that a lot of people overlook a lot of the time. And I put it simply, you know, I mean, I don't have like research behind this yet, but it's more of like, okay, if you. Chicken or the egg. Was this child, did they have a sensory profile already that required that were they were hypersensitive or they were hypo responsive and they needed more input, Like, I don't know, but. Or did they have MYO stuff? And then this profile kind of like became and like emerged from that because they were put in fight or flight and they have sleep deprivation. So now they're trying to regulate themselves. Like, I don't know which one it was. But the thing is, is that when, regardless when you have a child who has MYO issues, they typically have sensory issues because they're trying to compensate for what their nervous system is in this dysfunctional, like, state because of the way that they're breathing and the way that they're sleeping. So what is any nervous system going to do? They're going to like, look for proprioceptive input to regulate themselves. They're going to look for vestibular input. They're going to rock, they're going to spin. They're going to put something in their mouth. They're going to try to stimulate trigeminal. They're going to try to stimulate their vagus nerve. They're going to hum all day. They're going to do all kinds of, of things that are like, oh yeah, they just want input. Like, let's give them a chewy. No, it's not that. Like you can give them a chewy. But like, what, like why, why are we giving this kid a chewing? Like, why are they chewing through like one a day? That's the thing.

Why? Yes.

Yeah. And it's like we have to like. There's like an. A synergy between those two things that I think a lot of people are kind of like, missing with that. And it's just. I think it's really important to connect them. And I think it's also really important for people to notice when you do address the malfunctional issues at the same. Either before, at the same time, when you're working with sensory processing, how you see sensory needs decrease. That's what I've always seen. The sensory needs go down when they start to sleep better. The intensity and the frequency of their sensory needs really, really goes down quite significantly. They don't magically become coordinated. That's. That's. That doesn't. They didn't just like, magically like, develop their corpus callosum because they're crawling all of a sudden. That. That doesn't happen. But if you get them to crawl in therapy, that actually sticks. Like, they don't really, like, flip their Bs and their Ds anymore. They actually organically start crossing midline. There's a lot of things that happen that you work on.

Yeah, yeah.

And it's so. They're so complimentary to one another and they're kind of like, you can't just like, have one without the other. In my opinion, you kind of have to address both of them. And not every sensory kid has myo, but like, most ones I see do. But I mean, it's also because I like, I do it, you know. But it's. It's just really, really unfortunate that some people just kind of see one side of it sometimes, but they have to see both. And like you were seeing both of them, which was your daughter, which is great. And motor skills are often a reflection of sensory integration and that child sensory processing, but they're not the end all be all of that. Right. That's actually like, how does that sensory system function? So how is that cranial nerve functioning and sending that message to that of that sensory system? Right. Vestibular, cochlear. Like there's. I call this like the Bermuda Triangle of the body. Because so much happens and there's so many things that can, like, manifest in a different way depending on that person's anatomy. And no one's. Sometimes we. At this point in time, it's like, not to say this, but like, we don't have normal anatomy anymore. We just don't. With the craniofacial differences that everybody has and the like, oral history and development that everyone has, you know, if you were a kid of the 80s or the 70s or 60s. Like, we all had some type of, like, oral issue with our mouth or some type of thing in our mouth bottles, pacifier, thumb sucking, whatever it was, unless it was, like, an indigenous culture. And then they have beautiful white teeth and they have their wisdom teeth intact and beautiful bite, all that kind of stuff, but most of us don't. And then that child was, you know, in that mother's stomach. She probably has some asymmetries. Like, it's just kind of, like, trickling down. And I think it's. I just think it's something that we really need to start addressing. I don't know. And I can't also. Birth, right. Like, of course, you just want a healthy baby and you want the birth to be as smooth as possible. But a cesarean versus a natural birth or vaginal birth, I should say, not just natural, but, like.

Considering all the medications they put moms on, I mean, I wasn't happy to have them. I'm not judging it. I was like, give me all the epidural. But, like, you know, at the same time, that also changes the birth experience for the baby. And it takes longer. Sometimes it can be more traumatic for the baby. So, like, just, you know, I keep going back to, like, we need to be adjusting these kids at birth. We need to be giving them some sort of homeostasis from day one, not waiting until something's wrong. Anyway, that's a whole other conversation.

Yeah, I totally agree with you. Like, they're so smush. They're, like, made out of play. D'oh. They're, like, been smushed for nine months, and they go through their traumatic thing, and they're either pulled out. Right. Which is a very different sensory experience than being pushed out, which is a ton of proprioceptive, like, input and so much cranial nerve activation through their scalp. Right. When you're pulled out. It's a very different thing not to. I mean, with the microbiome and, like, all the bacteria. Like, there's so many other ways this conversation could go, but from a sensory perspective. And the activation of what that does on the nerves is also very, very different. And when kids get stuck in the birth canal, like cord wrapping to. People aren't asking these questions. It's one of my, like, all my questions are, like, really intimate about the birth. And it's not because I want parents to relive trauma, but I'm trying to. Like, I have my, like, little. I'm like, where was the damage? Like, why, like, what is being damaged here? Like, what nerve and the, what cranial nerve? What brachial plexus? Like, what, where, where is this happening? Like, why are the traps like this? Like during a quarter of mastery? Like, why can't it coke on track? Like, why is this baby just flopping? Like, you know, and that's where I have to kind of like try to figure these things out. But 100% bodywork. But it's also like you have to get the structure right. And that's where I think the body professionals come into play. And I have so much respect for what they do. And it's. I really wish that it was something like you said, like they come out and everybody should get it, the mom and the baby, because they have this like in. The umbilical cord was cut, but it's like, still, it's just invisible at this point. The CO regulation between the two and the amount of stress the moms go through when they've been informed. Like, this isn't typical. Like, you are having trouble breastfeeding now there she's in this feedback loop. She's stressed out. She's going to get. Her cortisol levels are going to go up and she's going to nurse her pump. It's going to go right into the breast milk, it's going to go into the baby. And it's like they really just need that, like what you said, homeostasis. They need to be brought back to that point in time together. And I think, I think people are catching on to that and I think people are seeing that. But I hope that people really start to see, like, you know, there's that one picture. Make sure that is like your fascial. The fascia. Fascial tissue straight from the. Underneath, the tongue, all the toes.

Was it the frontal plane or the front something line? Front central line or something.

Yeah.

Wrong. But it's from fashion. It's from that textbook.

Yeah. And it's like, it's like, this is why we have body professionals. This is why I can't, I don't do that. Like, I can't. This. I, I can only do what I can do. I, like, I'm not. I shouldn't be wearing every hat, you know, and it's like, I think really frustrating and really, like, it's really, it's difficult for parents. It's a lot of professionals to deal with and stuff. But I have to remind them. I'm like, there's a lot of stuff happening in this part of the body. Tell me Another part of your body where it talks and where it swallows and where it breathes and where it does all these things. And when you're an infant, that's all you do. Right.

So like, we talked about how, like, the mouth breathing, right. And sleep and everything to some extent impacts the nervous system. But what about nasal breathing? Right. Because that's what we want everybody doing, like, let's pull it kind of like full circle back to, like, okay, correct oral rest, posture, tongue up, lips closed, teeth or gum line slightly apart, you know, an infants, and then breathing through our nose. So, like, what is. I mean, I know it helps the nervous system, but can you explain to everybody, like, what does it do for the nervous system when we're actually nasal breathing properly?

Yeah. So from my perspective. And so cranial nerves, right? First one is olfactory. And in my kind of what I've kind of noticed and like in my trainings with cranial nerves, they work it in order, right? Cranial Nerve 1 is the first one. And when that one's not on, it's affecting the other ones. It's kind of like when you've got a vestibular system that's not working, it's going to affect something else. Tactile, proprioceptive, potentially the visual system, I don't know, but it affects something else. So when you don't have cranial nerve one on, it's going to impact 2, 3, 4, and 5, or potentially other ones. And so you're kind of already, like, at a disadvantage. Like, you talked about your bucket. Buckets. One of your buckets is gone.

Yeah.

And then also it warms all of the air coming in, right? Warms all the air. It develops nitrous oxide, helps with your oxygen absorption in your blood. It really, really is the most effective way to have the most oxygenated oxygen come into your body. And more than anything, it puts you in a state of rest and digest. When you're. I just say it simply. Like, when you're breathing through your mouth, you're gasping. Whether your lips are minimally apart or whether your mouth. Mouth is like wide open, your tongue's hanging out, your brain perceives that as gasping. Parents are always like, oh, yeah, but his mouth is just like, a little open. I'm like, it's still open. That's gasping. His brain stem knows the difference. It doesn't care. It just knows that it's like this human struggling to breathe. And so when you do nasal breathe, it does so many different functions. And also, I mean, the filtration System alone, like the three filters in your nose that collect all of the bacteria, all the gug, all the grossness and create boogers to expel it out of your body. Body. That is something that really protects your immune system too, from being like attacked at your tonsils and all the inflammation and having them get inflamed. I mean, nasal breathing is kind of the most, to me, one of the most important things for the nervous system. The way it impacts the nervous system and the way it impacts the immune system and the way that it impacts the oxygen absorption. There's so many. I mean, Patrick may have been probably tell you like another bajillion things, but.

Yeah, yeah, he's been on it. He's been on the podcast, he's taught in the membership. He's amazing. I always tell people makoclinic.com.org I always for you. But he's got so much great information, especially for pediatrics. And he's got free stuff for pediatrics, which is nice. But yeah, I mean, I love this conversation because we know that nasal breathing warms, moisten, filters. It does all the important things. It's kind of like your air doctor, right? People have these air doctors for their houses. And I'm like, that's your nose for your body. That is your air doctor for your body. And if you aren't using it right, then you're basically inhaling through your mouth all the stuff that you shouldn't be bringing in. That's why we get these kids that are chronically ill in preschool. Yes, they have to build immune systems. Yes, Children in preschool are going to get sick more frequently the first year they're exposed to all kinds of new germs versus, like year two and beyond. But why are some of these kids sick chronically year after year after year? They shouldn't be. They are now exposed to those types of, you know, and yes, we have new germs and viruses and everything, but the same kids who have constant runny nose, you know, mouth open, like we've talked about those allergic shiners. They just, they look tired and they don't look like they feel 100%. We need to be looking at these kids. And of course, like, these mask mandates have only hurt this further. That definitely has not helped either because now let's put a mask on a kid who's mouth breathing. That's gonna really, you know, give us a nice, warming, fun bacteria to play with. But yeah, I always, I always say if that child is chronically ill, and you had mentioned you have a history of ear infections. I did too, as a child. And I had one actually after one of my daughters was born. I think it was MIA a couple of years ago. They are painful. I thought I was gonna go to the hospital. I was like. And I can tolerate high levels of pain. That was horrible. Horrible as an adult, like. And I was like, gosh, was it this bad when I was a kid? And the PA was like, no, usually it's actually a lot worse than adults. Oh, lucky me. So I relate to that pain. But I actually haven't had any issues with my ears since going through expansion myself because I went into the DNA appliance for two years and, you know, I now have 38 millimeters between my, my back molars. I kind of am at a standstill because I need to work on my septum or my turbinates before I think I can get my maxilla to turn properly. It's turned in a little bit on the left side and it won't hold. No matter how much body work or appliance work I do, it's just not holding. And I was very lucky to get to spend the weekend with some dentists and orthos who have all kinds of advice for me. One of the first things they said was don't go correct the deviated septum. Actually just go like, let's go see if we can shave down the turbinates and see what that does for your septum and for your ability to nasal breathe. Because I guess when you correct the deviated septum actually can do more harm than good in some patients. And so that's a whole topic I don't fully understand yet, but I was like, oh my gosh. Okay, well, nasal breathing is important, so we want to protect that. And I think it just goes back to, you know, I got diagnosed with ADHD at 19 and put on Ritalin when I had never had that diagnosis. Diagnosis before. They did allude to it when I was five and it's, I think been there all along, but I did well enough in school that it was like a non discussed issue. Had typical RPE braces, all the things upper, lower, you know, permanent retainers. Those got taken out at age 30 and then my teeth started to shift. I was like, whoa, what's going on in a. So, yeah, I mean, it's, it's, it impacts you across the lifespan. But I think I love how you pointed out, you know, know with, you know, cranial nerve number one or olfactory nerve, how that is, if that's impacted, then it has this, like, ripple effect down the line of cranial nerves and cranial nerve number two. Right. It's our optic nerve. So. Hi. I wonder why vision is impaired when we have an orofacial myofunctional disorder. Like, everything starts to collapse on itself. So just, it's such a fascinating topic. So thank you. Thank you for sharing your wisdom with us.

Yeah, of course. And like, I mean, I, I speaking from both sides as a professional and also as a patient, like, I can't emphasize to people enough when they're like, well, they're just going to grow out of this. I'm like, no, I had an ear infection at 30 where I lost 20% of my hearing for, like, six months and had tinnitus for two years. Like, you don't want that. It's awful. And it's all related to my cranial facial development. It was related to my swallow. I dove super deep into, like, the mile for myself and then got two Alps put in. And that's the only thing that's really, like, helped me. And I have so much more space now. And. And that's really what changed my ear function. And you can't ignore the pain here. You cannot. And it's like TMJ pain. Unless people know what TMJ or tooth pain is like, they don't understand an ear infection. It's like the worst headache in the world. But there's a nerve there. And I just really tell people all the time, they're like, like, well, do you think, like, this will get better? And I'm like, no. And the longer you wait, the more it's going to cost you our bodies.

But the more compensating we have to do, the more of those energy buckets, they get taken away from other areas of life. And so our quality of life just gets further and further impacted. And that's why it's like, I don't like to be alarmist, but we should be addressing these things in our infants. And you know what? If it's not today, but it's two months from now, that's okay. Don't make it 20 years from now. Don't make it 10 years from now. Don't make it two years from now. I am so tired of hearing pediatricians say, oh, that's fine. Mouth breathing is fine. That's normal. It's never fine. Oh, they'll get their thumb out when they're ready. That's fine. Until they're three or four dentists. Some dentists say that too. And they're not in this area. Airway centric space.

No.

If our tongue is doing its job, if our body is doing its job. Let's think about this. When were these things invented? We have not always needed these. So why do we think it's normal to need a thumb in our mouth? You know, there's no discussion of thumb sucking when we go back in ancient history. No, if the tongue is on the palate, it fills it, it does its job, and nothing else is needed. It adds that natural palate expander. It gives the bright input that's needed for the body to feel, like, nice and calm and cool and collected. We're able to nasal breathe. Our lips are closed, our teeth are slightly apart.

It's.

It's really amazing how our body will do these really cool things when it's given the opportunity to function the way it's supposed to. And then you, you know, that's.

Yeah.

Anyways, we've been preaching this.

Yeah, it's great. When I told you, like, we're not re. Running the wheel, we're just getting the anatomy right.

We're just trying. And it's like, we can only do so much with what we have. We already know that our jaws are smaller. We know that things that are. Our skulls are shrinking. So let's at least take the anatomy that we can work with and maximize our opportunity to function as humans. Like, why don't we want that for? I mean, I know I want that for my children. I know I want that for myself even in my 30s. And I know that there is individuals in their 60s and their 70s who are getting treated for this. So it's never too late. But don't wait is my message. If you're hearing it now, don't wait.

Absolutely. Yeah.

Anything else you want to add in that we didn't cover? I think we've talked about so much.

I mean, I feel like I could talk to you forever, you know, honestly, I mean, not really nothing in particular. I just. I really hope that for any, like, the professionals who are listening that, like, if you're an ot, like, look into this stuff, open your kid's mouth, look at the airway. If you're a speech therapist, same thing if you're working in the school districts, like, look in there. Like, you might get some pushback. But, like, this is a kid's life on the line. Like, this is not something to be taken lightly. And it's. And if you're an older person, like, that's the beauty of neuroplasticity. You can rewire these things. It might take a little bit of time, but you can. The human is amazing. You can do so many things. Sure, it'll be easier if you're younger, but you can still do it. And I just want people to have hope in that. And it takes a lot of time, it takes a lot of work, but you can do it. And it's just, it's habit retraining and getting your structure right. It doesn't have to be so complicated. So.

Yeah. Well, thank you.

Thank you for joining me. Yeah, absolutely. It's been a pleasure. So it's been great.

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