Episode 144: The Importance of Thriving with Jonelle Anamelechi MPH, DDS

Hi and welcome to episode 144 of the Untethered podcast. Today we have Dr. Jonelle Animalechi joining us. Dr. Jonelle is a mom of two. She's a board certified pediatric dentist, a speaker, an author, a professor and serial entrepreneur. She obtained her undergrad degree from Duke University and started her own path in dentistry at the University of North Carolina at Chapel Hill Adams School of Dentistry. She completed her Master's of Public Health and Maternal and Child Health at the UNC Ch School of Global Health. Dr. Animalechi attended St Joseph Regional Medical center for her P Dental Residency program and she opened Children's Choice Pediatric Dentistry and Orthodontics in New Carrollton, Maryland in 2014 and Washington, D.C. in 2019. Completely from scratch and she built the practice of her dreams. She's also the Co Director of Thrive, a specialty pediatric airway center in Washington, dc. She's attending faculty at Children's National Hospital in the Division of Oral Health, MedStar Georgetown Hospital in the Department of Pediatric Medicine, and guest faculty at Georgetown School of Law. Her national and international work has focused on children with craniofacial abnormalities, tethered oral tissues, and their link to poor oral health and health equity for children with special challenges. Dr. Anna Malachi has been featured in Dental Town, NPR, ABC, CBS and NBC. She recently launched Innovative Women in Healthcare with All Women co author team and in spring 2022 she's co launching a book titled what Should Mommy do for Their Child's Oral Health?

Quick Disclaimer 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 substit for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host Hallie Balkan. I'm a certified orofacial myologist, Feeding Specialist 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, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Well Jonelle, thank you so much for joining me on the podcast today. I am excited to talk about what you've created.

I'm excited to be here. Thank you for the invitation.

Of course. So I know we've got some shared patients together and I've been starting to learn a bit about your pediatric airway Center Thrive. And I would love for you to start there and tell us about how you came to create Thrive. You know, where was this born out of?

Well, you know, as a parent, it's always some sort of parent intuition that drives you to do a lot of things right? So I have a six year old, new six year old, I was going to say five, but he just turned six last week and a two year old. And it's my six year old who's kind of the whole reason for why thrives in existence. And so I had a little one whom at about 2, we were noticing weird sleeping patterns. He was on the curve, but kind of just teetering up the curve. And then we were like, oh, he's just a skinny kid, it's fine, you know, and then we noticed snoring, and then we noticed this kind of irritability and inattention, even though he'd been asleep for asleep for 10 hours, all these things. And I said, you know, something's wrong, something's wrong, I don't know, something's wrong. And as a healthcare provider, right, I'm like, something's wrong. So I kept asking our pediatrician, you know, what do you think? He at that time was two, maybe three. And like, no, no big deal. The snoring is not a big deal. Don't worry about it, you'll grow out of it. And I said, okay, all right, I'll be patient, I'll be patient. And this was right around the time also in pediatric dentistry, where all the kind of correlations are starting to be made right, between sleep and, you know, the article that we were talking about regarding ADHD and sleep and all these things and leaning more toward thinking about ADHD in the black community, My black son and I kept having these like nightmares of like, okay, what if this kid really just can't breathe? And what if like some of this irritability and attention and some of these things that I'm catering to, maybe just be a toddler, may just be a kid, may not be at all, maybe something more than that. And so that made me just start digging. I started taking more classes and I started just really digging into the conferences, thinking about it. And I sat in one class and literally diagnosed my son. And I was like, this kid has sleep apnea. No matter what they tell me, this kid has sleep apnea. So literally that week I went back to the pediatrician and I videotaped him sleeping. And I said, all I want is a sleep study. That's all I want. Non invasive not asking for any surgery, just want a sleep study. Because at that point even the ents wouldn't see that. They were like, he's too young, he's fine, don't worry about it. My kid went for a sleep study. His numbers really totaled up to like almost the highest scale severe sleep apnea that a kid could have. They called me in 24 hours and said, this kid's got to go to surgery like now. And I said, oh really? This is what I've been telling you for a year and a half. It's giving me chills and it's crazy, right? And so as a healthcare provider, I was able to get him in, counseling adenoids out, get some on T. And in a month he gained five pounds. He was sleeping. I can't even, I can't even tell he's in the room at this point. I have a video on my website about it. I was like, you can't even tell this kid is in the room anymore still. Because he had irritable leg syndrome. He was all on the bed, he was all off the bed, in the bed, I mean, all kinds of things, totally different kids. And I said at that point, if as a healthcare provider I had to advocate for my kid like this and I can scooch the lines, what are other families going to do when they're having these same problems? What are they going to do when they have that parent intuition that says something is not right? And so that's thrive. We want our kids to feed better, breathe clear, speak freer and smile brighter. That's where we are. And I'm doing it for my kid. And I want other families to be able to experience honestly that pure, just joy and satisfaction, right? Because you know when you as a parent you feel like you've done something like, check, I did it. Like I figured this out when everyone else was saying, I don't know, I figured it out. And so here he is as a six year old, thriving. And I'm super proud of that and I'm super proud of the story. But then it also just encouraged me to then push my team even further because then during the pandemic we were closed for three months. We didn't shut down. I asked my hygienist, I said, your fate, the face of pediatric dental hygiene is changing. What do you want to do? And they said, well, we heard about this LMT thing and we, we really know that you've been starting this and you've been really airway centric. Like we want opportunity to do something too. Fine, let's do it. You got time? What else do you have time? And so two. Two budding on T's now out of my office into the world to do so much, so many other things. Like, we're currently waiting on AAPD to hopefully approve myself and my hygienist to co. Speak on this in the spring 2022 conference. Like, it's just exciting to be able to spread the word and to see parents have that aha moment where you're talking like, yeah, you like, how was breastfeeding? Like, they're like six and they're like, how was breastfeeding? And they're like, oh, we couldn't, you know, well, this was happening. Or how asleep. Like, are they still supposed to be bedwetting at this date? Like, are they really? Oh, yeah. No, that's not supposed to be happening. Oh, we thought it wasn't, and so we didn't. As pediatric dentists, people kind of say, well, you're pediatric dentist. Like, why are you. Like, what are you. Why are you doing this? Like, what. What's that? That's kind of, like, quirky a little bit. And we sort of. We don't even sort of. We do partner as that relationship. We know that our pediatricians have tons to do. Don't even blame them. They have tons of doing a, well, child visit. Sometimes some kids who are maybe even borderline may slip through the cracks. And so we're here to kind of fill in. Fill in those gaps. Fill in those gaps of information that maybe need it from a family or may, you know, we say, hey, go back to your pediatrician and talk to them about this. What do they think about this? Here's what we found. And we can be advocates, too, for them. So all the things that we're doing, it's just. I mean, it's exciting to me. And it's brand new from bread and butter cleaning and drilling and filling. As a pediatric dentist, it's just. It's given me, like, a whole new part of my career too. So I'm really excited.

So exciting.

Sorry for the long story. Right. I was like, great.

I love hearing the whole story. And I'm sitting here just thinking, like, wow, we're leading parallel lives. Like, we were both, you know. Were you in the DMV the whole time? Like, in that since, like, your kids have been born?

Yes, yes. Yep. We've been in DMV for 10 years.

Okay. My youngest is 6. She just turned 6 in August. And the reason why I got into This I was like, horrible breastfeeding experience. I was already a pediatric feeding therapist, but I was working mostly with toddlers on up and a lot of autism back when I first got into feeding. And then I switched with like picky eaters where, like, it persisted. And that threw me into working with infants because then I had a baby who was not feeding well and who was breastfeeding for 45 minutes on. And then we get an hour break and then we breastfed again for 45.

Minutes and it was like, that was my life. That was mine too.

In the car or put her in the stroller. She would sleep for three hour naps in the stroller. I'd have to be like walking around and I would go to Nordstrom because I knew they had a great breastfeeding. And I was like, do. By the way, I only worked two part days a week treating and then ran my practice from home with a baby on me because all she did was feed and she wouldn't drink from a bottle. And, you know, I took her to lactation and we had lactation in the hospital. She was that baby who was failure to thrive when she left the hospital. Lost too much weight. We were going for weight checks. They put her, wanted her to take formula. She screamed and cried. I was like, we're not doing this. Like, I, I'm not anti formula, but I'm anti screaming crying baby. So we're just going to make this work. But first percentile, never over the first percentile until after her first birthday. I think she jumped to the fifth percentile. But she was also eating some solids at that point, right? And then she really kind of were there for a while and they were always like, well, she's on her own growth curve, so she's fine. And I was like, okay. I mean, I literally can't keep pants on this child. But, like, all she can wear are leggings. Kat and Jack from Target, because, like, nothing else seems to stay up on her. But that's fine, we'll just run with it. I mean, it was like, you know, and then I go and I take this course, my mayo course, and I come back and I flip her upside down and I look under her lip and her tongue and I was like, why did nobody that I took her to ever look inside her mouth like.

What is going on? I know.

And even I, as an slp, a pediatric feeding therapist, was never trained to do that. And so that made me go, okay, halt. Something has got to change. Like, what is going on? And it really Just like you. It threw me down this, like, rabbit hole of if I had jumped through this many hoops as a therapist in this space and didn't even have the answers for my own child and couldn't get help around me from the people who are supposed to be specialized in this area, how are other families going to navigate this? Like, they don't know the question ask or the courses to take. And they shouldn't have to go and pay to take courses. They should be able to go to their providers and get answers. And maybe that's not every provider, but we need to at least have some people around here who can help. I mean, it was so there I went down the rabbit hole. And that. That literally changed my practice overnight too. I mean, it went from. Even the way I look at kids with speech, sound issues, even, you know, about sleep. We had always asked about behavior, but we had never asked about sleep. We had never asked about. We had always asked about feeding because we were feeding therapists. And even for people who came for just speech or OT or language, we always got a really comprehensive intake. But it shifted. We started asking more questions, better questions, questions that would give us insight into, like, does your child wet the bed? Can your child ride a bike? All these different developmental things that, you know, we start. Started to see these interesting patterns with. And like you said, with adhd, I started thinking about, well, what about all these kids with language delays? I mean, why is it that sometimes they go from, like, appearing to not have language, but. And really not understanding much at all, not just not talking, but then like, overnight the kid starts talking, like, what happened? What changed? Right? I mean, it's not some, like, I mean, there's something going on here, right? And everyone just goes, oh, that sometimes happens.

And I'm like, no, no, not the answer. Not the answer isn't simple.

My child didn't talk until they were three. It's okay. Your child will be fine. No, why are these acceptable answers? I mean, and you see this in mom groups all the time online. Like, I get it from one mom to another. It's like you want to instill hope and you don't want other parents to worry. But I'm like, sometimes maybe a little worrying is warranted so that we can get our child the services they actually need, you know, and the struggle is then, like you said, like, having providers who can provide these services, having the team that fully understands it. And so I know I was talking before we recorded. I was like, super excited, jumping up and down in my Chair because we have shared patients. I know your team gets it. And I've seen the excitement from a couple families, one of which is a therapist on my team, come back and be like, hallie, it was so good, like, going to their office. They knew. They understood. They opened my eyes even further to what you've been telling me and what we do with our families. And I feel like I have hope, I feel like I have answers, I have action to actually help my child. And I was like, this gives me goosebumps and makes me want to cry, because how frequently do parents usually come back to us and go, well, that provider said they're fine, so what's next? And I'm like.

I know, I know. That's what I was just thinking when you said that. I was like, it's so disheartening because sometimes, like, families play this almost like this game of, like, let's see if we can get the best two out of three answers or the best four, you know, and you're like, oh, this has got to be so time consuming, so exhausting. Like, just bring it all together. Like, you know, I was on a call the other day with two SLPs. I was like, we need to have a unified, you know, presentation as family. We can't give them, you know, different answers or what we want to help me understand what you do. I'll help you understand what I do, and then let's see how we do it together. And I think that's just the way it should be. And I hope that just, you know, just in us talking and talking about how much is needed, this is our future. Like, this is the future of what medicine looks like, where you can do those things and you can help families put the pieces of the puzzle together without them having to come in with a notebook of consults. And you're, like, going through, okay, okay, let me see what they said. Oh, my gosh. It's a lot. And, you know, as a young child, time matters. Those stages matter. You know, I was big on. I didn't want him to go to kindergarten like that, because that's where the testing begins and all the assessments begin. And, you know, then. Then it's a record, right? It's a record. And I just. I want to figure if it's something. If there's something. Right. And it has to be anything, but if there's something, I want to figure it out before.

Yeah, well. And, you know, I was just actually talking recently in another one of the episodes about this. I was that kid Right. So my mom was told when I was in preschool to start getting me tested for ADHD. And I think around age 5 or so she said she told me, she's like, I took you to three different neuropsychologists because the first one diagnosed you with ADHD without ever meeting you, just from having a conversation on the phone with me. And she was like, that didn't sit well. So that was like, I think she was like, the second one had you come into the office, had not tested you yet, saw you, talked to me and was like, yep, she's fine. Like, don't worry about it. Like, she's good. But like, didn't actually test you. She's like. And the third one, it was kind of like they were like borderline, like incomplete. She's like, nobody could really give me good answers. Like, but you were also like five, right? So, you know, fast forward. They didn't put me on medication. My mom was like, I'm not getting good answers here. I'm not going to put my child on meds. And I did, you know, I did do well grade wise throughout school, but I always got like S's on my report card for like talks too much.

I am hosting a podcast and here I am.

But fast forward to my freshman year of college. Like, oh, I tanked. I tanked. And I was like, what happened? I was getting good grades and I blamed it on. Nobody taught me how to study the way I needed to learn how to study in college, which is true, but also sleep partying. I'm trying to navigate a new space. And it was like, that was the last straw. So trying to be in this new environment and things are being taught differently, tested differently. I'm staying out late. My sleep was already probably really impacted before that. And it was like, I think that was probably now that I look back, like, that was the last straw. And so I went and got tested, like again officially. And they said, well, your IQ's high, so you know, I'm not going to say you have ADHD because you made it this far in life doing really well up until this point. And I was like, what? Okay, sure. And they were like, but you're a candidate for Ritalin. And I was like, okay, so what does that mean? And so they put me on Ritalin. And I mean, I saw my grades go from like 6c average CB to like straight A's. I went from like up to like a 3,8 to like a 4.0 throughout the rest of school and grad school. Mind you like, when I looked at my notes both on and off meds, it was like, skeleton notes versus, like, I wrote down everything they said verbatim. And then I taught myself how to study. I had to, like, put certain things in place. And so I'm like, do I believe that I'm ADHD or that I have ADHD like, qualities? Yeah, I do. As an adult, I think the damage that was done to my brain, whether it's truly ADHD or it was sleep deprivation that killed brain cells over a certain period of time. Like, I have a really hard time getting started in the morning. It could be 11:00am before, like, I'm up and rearing and ready to go on days where I don't have, like, earlier scheduled appointments. And as an adult, like, I sit here going, like, wow. But I benefit from meds now. I mean, I don't want them, but I'm not, you know, that's not the route that I'm choosing because I know I still need to deal with my airway. And that's the route that I learned right through going through all of this that we need to be looking at first. And that, unfortunately, is not the route that's often discussed. I know in our offices, that is. But most others, they immediately go, hey, here's medication, right? And it's like, I don't want these kids on. I know what it feels like on it. I was irritable. I was mean. I was like, I couldn't eat. I also couldn't be around anybody. Like, I needed to be, like, locked in my dorm room by myself with complete silence. I was, like, copying all my notes to note cards, chugging down to learn how to study. It was. I mean, I had to teach myself, like, how to exist in this, like, you know, new state of affairs on these meds. And I did. It was short acting, so it was about four hours in and then four hours. It was awful. I mean, when I look back, I'm like, yeah, I got good grades, and that was my goal at the time, but it was awful. And I go back, and I think about these kids being on meds and how they must feel, and we're putting them in a room with other people, and then they're sleep deprived. They're now on stimulants. They don't feel good, they don't want to eat a lot of them. So, like, they're not getting proper nutrition throughout the day because meds are preventing having an appetite. You know, I'm like, there's this, like, we need to restructure how we're doing things here in the US you know, and I obviously can go on this rant, but it's just, that's. Why are we not looking at everything?

We must definitely be soul sisters because I was diagnosed at 23, so I was out of college. Yeah, I was out of college in grad school and my poor husband this day still has to deal with me in my, I feel bad for him. I feel fine. He has to deal with me. But yeah, I mean, it's crazy, right? In your adult life trying to like, oh wow, putting those correlations together, putting those things together and it's huge. And like you said, you know, how do these kids feel? Like they're moving through life. But are they experiencing like, do they really feel and are there things like you said that we can look at and say this needs to be done? Those things take a lot more time, right? They take a lot more time. A lot more looking into in terms of measuring progress and status. But when it, when you finally get it, you've seen your kids just totally turn around. And when I explained to a parent that, yeah, we're used to, you know, making jokes about picky eating toddlers, but are those picky eating toddlers trying to protect their airway because they're scared that if they eat something else, they don't know what's going to happen? Got to think about it, right? And there's so many things that we think about that may be tied to the things that now we look at or we used to look at in our mommy groups as oh my gosh, my child. And you know, oh, yes, no, that's not normal. That's not normal.

I mean, you mentioned a great point with picky eaters. You know, we always say if it happens for like a few weeks, maybe even a few months, right? And then they phase out of it, okay, that can be typical because they're exploring foods and kids get a little pickier in toddlerhood. If it goes on more than two months, we have a problem. They're no longer picky. They're selective eaters. And those selective eaters have, we've got to look at why they're being so selective because like you mentioned, it could be they're protecting their airway. Maybe they can't efficiently chew their food properly. And so that's why cut their foods down to the foods that they know are one, easy to like dissolve in their mouth or break down but and, or swallow if they're not properly prepared. Because it won't hurt to swallow it or they'll have better control of it going down their esophagus versus it potentially falling down their trachea. Right. I mean, it is the body. Just the body's gonna protect all day long. Whatever is safe is going to trump everything else. And then I look at these kids with enlarged tonsils and adenoids. It doesn't feel good to swallow food in general if you have enlarged tonsils, very small space through which to swallow it. So if your food is not prepped properly, in addition to having enlarged tissues in the back of your nasal pharynx, like, yeah, not. It's not feeling. So they're going to stick with. I always tell parents, like, and I says, well, okay. I mean, I see how they eat like cheese and crackers and yogurt and these softer foods. I'm like, yeah. That are all colorless for the most part. Yeah. Okay. They're all like brown. Like, they're kind of like, like one category, right?

Because those are the blah. I call them the blah.

Like they're not eating their greens. They're not eating, you know, and sometimes they'll say, well, but they eat carrots. And I'm like, yeah, I don't. I haven't figured that one out. A lot of my kids who are really picky will eat like carrots. And I'm like, I can't tell you why. Or kids who are like really tongue tied and they won't eat anything else, but they'll eat steak. It takes them a long time to eat it, but it's like they love it so much. They're willing to in the work. Right. And even then it's not properly prepped. But they make exceptions, right? There's always an exception to the rule. But it's so fascinating to look at these kiddos because they, they're doing, it's. It's survival. They're doing what they know they need to do in order to be safe. And I'll get parents who say, well, what if they eat chicken nuggets? And I'm like, this is gross. But chicken nuggets are like pre chew. Like, it's like somebody chewed it, formed it back together and it's pushed it.

Back in a little more.

Yeah, yeah. I'm like, follow it. Like, not super prepared. It's a softer consistency. So it's not like a grill, a grilled chicken or grilled, you know, like grilled meat. Yeah. It's not the same. So it's. That's always A tipping point for me. If a parent tells me their child is picky, I start to go, oh, but you ever looked in your child's mouth? Or they can't see certain sounds, you know, then we go, oh, how, how's the food going? Do they, Are they adventurous eaters? Are they? You know, it always begs the question one way or the other. And then that also allows us to kind of get into the whole myo tots airway conversation.

It's all interconnected.

And you know, it's interesting to have that conversation because then, and I know you do too, you watch the parent make their own connections for themselves. And then I'm like, and here's the adult referral. Here you go, yeah, because, you know, I've looked at you and your posture and you're here it is. How's your back feel? How are you feeling?

It's amazing. I love it when you see, like, you can see the wheels turning and then they look at you and they go, can you look at my mouth and see if I have a tongue tie about. And. And I'm like, I'm like, have you ever had migraines? Do you have any upper neck, shoulder, back? For years, like I take migraine medication or I just have consistent headaches. I just thought it was like weather related or allergy related. And I'm like, and it could be, but let's see. I don't know. There's also something it off when weather comes in. Why is that? Most people don't react, but some people do. I don't know, it's, you know, it's a very interesting conversation. It's always the parent is like, huh? Or I get the parents. I have to say, a lot of times it's the dads who are like, I have that same problem, but. Or that same tongue, but it's never given me a problem. And I'm like, okay, well, can I ask you a few questions? Or like, sure. Like that. That could be because of my tongue tie. I'm like, yeah, like. So let's go back to, you know, not causing any problems for you. What we look at is function. If you think you're functioning fine, by all means, continue on, but you're compensating.

Go on.

Yeah, it's like if you've got issues with this or this or this or this or this, like, you know, maybe set up an evaluation because.

Yeah, and that's, that's a good point. I mean, everybody doesn't have to be treated, but everybody deserves to be Evaluated. Right. Because you want to know. You want to, you should know, especially with what's going, you know, what continues to, as we move along, just looking at the whole, the whole child and the whole family.

Yeah.

So I'm curious to know, like, inside your center, do you, with thrive, do you have, like, a certain way that you help parents go out and advocate? Because I know obviously in your office, you can do a lot of things. You can do the myo, you can, you know, the pediatric airway to an extent. But say a child really needs. And I'm thinking, because high dmv, it's been really hard to find ents who get it. How are you navigate that pediatric airway space in terms of getting sleep studies or getting the tonsils actually looked at beyond just a quick little glance down the throat?

So, thankfully, there are a few things I can skip over because I'm an attending at Children's national, so I can order a sleep study.

Yay.

So, you know, I'm just like, don't worry, you know, and in that, in that time, even spending time in the operating room with some of my ents, I'm literally like, can I have your ear for just a moment? I, like, I need your help. And so, you know, you find your people. You find your people, and I hope that circle grows. Because I don't want to have to say, you know, maybe you should. Yeah, I know you talk to your pediatrician. Maybe you should talk to this one. I don't want to have to say it. I want to say, yep, everyone gets it. We all get it. We all looking around the same, you know, looking for the same things and understanding the same thing. But, you know, really just show. Sometimes you have to show it. The proof is in the pudding. For some of the, some of my team that may say, yeah, no, we don't need to do this. And then maybe we go ahead and resolve the issue or we've gone ahead and gotten this child help. I will go back and say, hey, I just want to reconnect with you. You know, I saw this. We went ahead and did the study. These are, you know, these are the results. And, you know, this issue, Would you like to help resolve this issue or should, should I, you know, refer them to someone else? And those are times because I want to keep relationships right. I, I, I'm the pediatric dentist. I can't do the surgery or I, I can't do the, to, you know, TNA surgery. There's some things that, you know, again, we keep in house, but we need our peeps. And so continuing to have those conversations. And I'll always send a letter back to their original pediatrician and whomever they bring in. You know, sometimes they bring in a list of people they've been to. I just send back that courtesy letter. And sometimes I'll get a curiosity call that says, you know, you know, do you really think they need, you know, this? And I'm like, yeah, I kind of do. You know, I do. And, you know, if you just, just, just, just go down this path with me for a moment. And so, as you found, it's about people trusting you. It's about your, you know, your team just trusting. And, you know, I've even had PD just to say, I really don't have the time to. To follow, to follow up for all of this. And I'm like, that's cool. We got it. We got it. Maybe there'll be a day we, you know, I don't know. But the way we're, the system we've set up, we're able to do that and make sure that it happens. So I think people. People are just like you. They know the name, and they're like, oh, goodness, here she comes. What does she want? What did I do now? But I appreciate that because I don't want anyone to feel like we're saying, oh, no, they don't understand or they don't get it. Like, my whole goal is to educate because we can't do this alone. We need everybody to be on the same page. And now, you know, we have parent advocates who are, you know, would you mind talking to the other parent about your, you know, about your experience? And, you know, if. Because there are some things we're introducing for the first time, they've never heard these things. And so, you know, omc. What is that? Like, what is. This is something. What kind of, you know, I had a grandparent say, this is some old, new stuff. Not really, but, you know, I get it. You're not coming to your pediatric dentist to talk about sleep and, you know, tongue ties, but now you are. And so we want parents to expect that. We want parents to expect a full evaluation, to expect questions about their child. For a teenager to walk into our office and still get questioned about breastfeeding, because we want to know your history, and we want everyone to thrive, which is the whole reason for why we named the center that Love that.

I love that.

It's one of the things I've talked about so much that it's not enough that we are Just functioning. Like we need to be functional, thriving, right? We need to have optimal function. And so I love that, that the whole mission behind this, because it really just drives it home. And I think when you can even have that conversation with a parent that, look, it's called thrive. Because every child deserves to thrive. And if we are not looking at holistically, they're not going to thrive. We need to be looking at this and figuring out what is the root cause. Get down to the root cause. Stop slapping band aids on these kids. Stop just medicating them. Stop just waiting. Like, no. If people, I think, truly understood how fast the human brain develops and how critical these time periods are during the first seven years, the fact that our jaws are shrinking, our skulls are shrinking, you know, epigenetics, like we're already up against, you know, the odds are against us. And so if the odds are against us, we then have further malocclusion. You know, from what I'm seeing and all these dentists and ENTs and everybody that I've been talking to, it's been so eye opening to learn that odds are against us. So we gotta work, you know, work on really putting these things in place to help these children because they're the future. And I know it sounds so cliche, but really, what's going to happen if nobody intervenes? And so, you know, I'm always so grateful and thankful for like comprehensive teams and practices who get it. And, you know, I think that interdisciplinary care is amazing. And I'm going to be, you know, reaching out to you after this. Be like, who at CNMC can we refer our patients?

I got you. I gotcha. I've got you.

Standpoint, it's, it's been tricky. And I've had families go, like, I had one family recently who went to a couple different ents in the area in Maryland. And mom came back and she's like, well, you know, she's like, hand throws the hands up in the air. Like, I just, I don't know what to do anymore because you're saying this and you know, and I'm not even the one treating the child. I'm just on the calls with the team with the treat therapist, is a myofunctional therapist and feeding specialist. And, you know, because I want mom to hear from more than one of us. So it's not just the training therapist, but it's me. You know, I also worked with one of her other kids at one point. So we have that relationship, you know, so it's, it's nice when you can also speak to somebody you trust in the area, which I know not everybody gets to do. And you know, and it was very, it was just further eye opening for me, right, because somebody who trusts me, who knows we have the best interest at heart for her child, is over here, like frustrated beyond all means because she's like, I will do what you tell me to do, but I do it. And then I just. And we finally sent her to a pediatric dentist in the area who gets it. And you know, and I sent him an email and I was like, heads up, she's coming with a list of questions. Here they are. I'm like, but here's why I'm sending her with a list of questions. You're going to say all these things to her already. And I know you're going to go over this with her, but I want her to feel really empowered to be able to advocate for herself and her child walking in. Because I know that she's already gone to two providers who have really just kind of set things backwards, you know, in motion. And so he was like, no problem, it's all good. But she walked in with like, I'm like, here's the 10 symptoms we're concerned with. And my therapist was like, she's like, so can I use this as a template to send to other providers? I was like, please. I was like, no, no. I was like, not normally. Like, let's send a note that says here are concerns and here are the symptoms. Like, please look at man. If we start sending this to providers, they're gonna be like, what is going on?

What is happening here?

That's, that's where we're at sometimes. You know, it's like one of those situations where these parents just feel so helpless and they just want to help their child. But they're also like two working adults. Their child's in school for a full time. Like where do they have the time to continuously go to another appointment and another appointment turned away, you know, and that's, that's where the, you know, I know, like thrive is just gonna create such a phenomenal space to send parents where they're gonna get like the whole kit and caboodle, you know, and, and then your ents that you can reach out to. I love the other thing you said too, where you said, you know, well, I send them your way or should I refer them elsewhere? Because that really back to you. But if you don't, if you don't want me to, like, I'm glad To forward, you know, send them on. That's such a great way to navigate that conversation because we do want to respect our colleagues regardless of whether or not they're in the airway space. And I know that's a really hard space for a lot of providers to navigate.

Yeah, it is, it is. We get it. But like you said, it's all about keeping the relationships. And so hopefully, you know, from maybe that experienced child, they will learn something. Be like, you know what? I might need to dig a bit deeper into this myself.

I love it. I love it. So what other, if you don't mind sharing, are you using certain, like, growth appliances in your practice? Are you headed that direction? Tell me a little bit more about that.

Yeah, so we have the. The luxury of also having orthodontist in house. So depending on. I see my little littles, I see my. I see the toddlers, even if they have to have early expansion things of that sort. We host a variety of appliances from Healthy Star to Vivos, et cetera. But, you know, as you know, it's not all about the appliance because we have to use it correctly. Right. To get what we need done. So those kind of the diagnosis and need for whatever is basically just individualized for whatever that we're trying to resolve, if we think we can resolve it through that manner. And so in my work with the Breathe Institute and those kinds of groups, Vivos, the Sleep Airway center, we just kind of look at what does kid need and what's the best modality to go to. And I like having that flexibility too, because I don't want to be. I don't like to be locked into a system because I feel like then I'm just treating by a system rather than what do I have? Okay, I have all these things now. How's that going to help that child? And so that becomes really a good way for me to approach it too. And then having my orthodontist by my side too, for my older kids, it's been super true because it's allowing her to learn a bit more. We chat about it all the time. The things we didn't learn learn in, like, dental school, things we didn't learn even in residency. Then we're like, oh, my gosh, okay, step back. We're doing something really awesome here.

I love that I've had my eyes open to how orthodontics can be airway centric as well, and how we can even use, like, it's not always about the tool, right? I mean, yes, we want to grow the pallet forward and we have expanders that do that. But old arch braces, I know, are still a great thing. It's just managing to grow the palate enough before we put them on to straighten the teeth. That is often. That's missing in some, in some practices. And so I love that you've got dentistry and ortho and early appliance options. Early expansion, earlier the better, in my opinion. I was expand Lily, my, my now 6 year old. So she had her. Taught her. She had her tongue tie released at 24 months right after I came back from that course. Okay, we're doing it. Let's go. Then I was like, okay, I think we need to do some early expansion too. And so she went into an ALF appliance at four years and then pandemic happened. She ended up staying in it a little bit longer than planned, but her tonsils decreased in size. They went from like a three plus two to like one. Like where we really couldn't see them very much anymore.

They're like, love it.

And they wax and wane, but they've never gotten back up to concerning levels at this point because I'm constantly looking in her throat. I'm like, what's going on back there? What's. You know? And I, we were turned away from. And so I'm like, I've had that experience as a mom where you go in and they both know what I do and they both are supposed to be in like the tots airway space. And I was like, okay. That was really disheartening as a mom, like, to walk. I was almost in tears. A mom and provider. And so anyways, I was very excited because that was not something I was anticipating.

That's amazing.

During cold and flu season, her tonsils just disappeared. She was in preschool. I was like, what just happened? Like three months into a growth appliance?

Yes. That was my. Always a sick kid. Always a sick kid even.

I mean, she was sick sometimes, but she wasn't chronically sick, which is why they were like, oh, her tonsils are fine. Her mouth is usually closed and sick. I'm like, but they look really veiny and not super healthy. And her airways like this big. So I don't know. I'm not saying I want you to remove them. I'm just saying, like, what's next? Like, what do we do?

Right, right, right.

Not even. Not even. Let's monitor. Not. Let's try a nasal spray. Not like, nothing. And I was like, okay, guess I'M on my own here. And that was that. I just, I was, that's what really, I think lit the fire under my butt because I was like, well, I'm not an ent. I can't go like, you know, diagnosing these things or telling people what procedures they do or don't need. But I can find providers in the area who can help me help the children who are in the same situation as my child. And that's where a lot of that passion comes from, which, you know, I feel like every single person I talk to has either had the experience themselves or their child. And it's like it really took that flipping me like flipping this all on its head to be like, whoa, what are we looking at here?

Yeah, I love it. Wow. Wow.

Yeah. Yeah. So do you guys have. I know I saw you have a book that you're co launching coming. Tell us a little bit about that.

Well, this has been, my God, this year has been quite a year in terms of just some really awesomeness happening. So with about six other women, we launched a book called Innovative Women in Healthcare, Exceptional Leadership. And then I via Instagram met a budding authority who we are co launching what Should Mommy do for Their Child's Oral Health? It's the first in the series, so he's also working with another pediatrician in the area regarding topics about that too. And so it's just been really exciting to now just kind of share, continue to share knowledge. Right. And you know, I see by your coursework and the offerings that you have, you kind of see the important of just making sure to push and get it out there and just continue to inform everyone, whoever wants to listen about how they can, you know, how they can also help their, help their child. And so it's just been very exciting in terms of making this happen. And the book coming out this year came out a few months ago and then the new book coming out in the spring of next year.

Well, congratulations. That's awesome.

Thank you.

Well, I know, and the last thing I wanted to bring up too is we had mentioned the research earlier on about like adhd. And you know, I know that you link with like the ADHD and sleep conundrum, the review. So we'll link that for everybody in the show notes so they can easily access that, that review if they are interested in, you know, reading anything further. But is there anything else that you want to share with us about, you know, thrive or anything before we start to wrap up today?

You know, we talked about a lot today So I would say, if, you know, in terms of my providers who are listening, trust your instinct. In terms of my parents that are listening, trust your instinct. There is a lot more that we still have to learn. But I feel like we have taken some leaps and bounds in our field to really address the whole child. I say beyond the baby tooth, which is what we're known for, right? Which is what pediatric dentists are known for. But now we've taken that a bit further and really excited for what we have in our community. And that's growing. And the colleagues that are really saying, oh, I see it, I see it, I see it. And once you see it, you can't unsee it. It's impossible. My hygienist, I'm like, guys, this is a hygiene visit. Y' all are all on lesbian. They're like, we got just want to talk about it. I'm like, okay, go ahead, go ahead.

I mean, that's what I preach. I'm like, I created that fast myo screener because I was like, it doesn't matter if you're an SLP or an OT or a hygienist or a dentist or so on or so, you know, I'm like, if you're looking in somebody's mouth or you're looking at their face and you start to see some of these things right away, you know, we might want to recommend an eval. I mean, and it doesn't have to be a minute, 15 minute, 10 minute screening. It can literally be walking them from the front of the office back to the hygiene chair or while you're looking in their mouth and then you make them note in their chart so discussion can be had. Right? And I love that you're instincts. I've always said your gut never lies. Like, especially that mommy gut, you know, something is off. Do not let anybody gaslight you into telling you that you're just a new mom and you're sleep deprived and you're, you know, all the things that I've heard from these parents, you know, oh, you're just worrier. Oh, you're overthinking things. Oh, they're fine. Like, most kids like this are fine. Like, no, if you think something is up with your child, keep pushing. Like, this is your permission to keep pushing until you get the answers that you need, you deserve. And your child deserves an answer. So I love this. Thank you. Thank you so much.

From the mouths of two. From the mouths of two moms and two practitioners, we trust it.

That's great. Well, thank you so much. Janelle. It's been a pleasure having you on the podcast today.

I appreciate you and all that you do, so thank you for all the great work that you do for our families.

The feeling is mutual. Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page at halliebulcan biz, on Instagram @hallebulcken. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes, where you can also subscribe to be kept up to date on the latest podcast episodes.