Episode 168: An Update on Hallie’s Airway Journey

Hi and welcome to episode 168 of the Untethered Podcast. It's me, your host, Hallie, and I am catching you up on my own journey today. I recently, about 10 weeks ago, if you're listening to this, in June, middle of June 2022, had a septoplasty, a nasal turbinate reduction and a nasal swell body reduction. And we're going to talk all about that as well as my expansion and airway journey. Let's go. 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 substitute 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 and 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. Hello friends, it's your host Holly here and I wanted to just do a quick episode today. This will be a fast one discussing my journey. As many of you know, on April 5, 2022, I went in for a nose procedure or several. So let's review what I had done. I had a septoplasty, I had a nasal swell body reduction, I had a turbinate reduction and I also had a rhinoplasty. So let's talk about what each of these things are, because some people, I think, have heard of septoplasties. I know many people in the myo world have heard of turbinates. I know that friends of mine who have had rhinoplasties have heard of rhinoplasties or nose job as the common term. But most people are like, what the heck are nasal small bodies? So we're going to talk about that. I actually have a picture that I took when I was in my ENT's office when I went for the consult. And if you've been following me for any period of time before we get into this a bit deeper, what I want to talk about is, number one, I'm not an ENT and I'm not a plastic surgeon. So I'm talking about this purely from a patient experience with the background of also being a certified myofunctional therapist and A speech language pathologist and a pediatric feeding therapist. Right. So I have a certain level of knowledge to understand what's going on with myself. And obviously, I've learned more as I've dug deeper and as I've gone through my own journey and as my kids have gone through their journeys. But I want you to understand that while I have all that knowledge, and, yes, that will help this conversation today, I'm coming to you as a patient, and I want to share my experience and what I've learned as far as treatment planning goes, especially as an adult in their mid-30s. So let's talk again in case nobody's listened to any of my podcasts ever before. You're brand new. You don't know about my history. We're going to talk about that. Then we're going to talk about how I got to the point of where I am. Then we'll talk about the. The nasal procedure the surgery just had and next steps for me. So. And you might hear a little bit of congestion because this is how I wake up in the mornings. Not congested, but I do the two things going on. One, I do my nasal clean, you know, cleansing every morning with the Neil medication bottle. But I also am packing to move. And you can't see it if you're watching this on YouTube, but I am surrounded by boxes in my room at the moment. And why is that important? Because there's a lot of dust right now, and we. The house has not been clean this week. I have a dust allergy. We had molds in our other house that we're moving into. It's a new home, but there was water damage caused. That's now been renovated. But this kicked up a reaction to mold about a month ago after I spent a couple hours in that house documenting the damage. And so I've been having. It's been taking me time for my nose to clear in the mornings. And so even though I can breathe out of my nose and I'm sleeping with my mouth closed at night, I am noticing that there is a bit of clearing that still needs to happen. So if you hear that in my voice or you hear, you know, a sniffle or a throat clearing, that is because everything's kind of like taking its time to kick itself out. And this is all part of the process, which is why I'm sharing this with you. So, going back, let's first talk about my experience as a teenager who went through all the typical types of expansion and braces and all that fun stuff. So. So I Had a pallow expander, you know, where you have the key that you crank. And then I had braces as a kid. Then they gave me a retainer. And I remember that I had some orthodontic relapse right where my teeth started to move back into their initial position. After the braces came off, was I wearing my retainer? No. So we fixed that, and then they put in a permanent lingual bar, upper and lower. And that lingual bar was cemented to the back of my teeth. I believe it spanned like eight teeth on top and eight on the bottom. And then slowly over the years, like, the ends would come away from a tooth, and so they would like just kind of snip it off. But I was told this would fall out by the time I was 20. And I believe it was put in when I was like, maybe 14 or 15. Well, needless to say, it did not fall off by the time I was 20. And so my dentist removed it because it was really hard to clean behind my lower central incisors. And because of the salivary glands down there, I actually noticed that there was a lot of, like, plaque buildup. And so no matter what I did, it was always inflamed. It was hard to clean. I tried to clean it the best I could with a water pick and with, you know, those flossers that they use when they give you and you have like, braces to go between the teeth, which always was super uncomfortable. And it just like nothing would get right. So they took it out. And immediately within a week, I noticed my lower central incisors starting to shift. Now my uppers were not, but my lowers were. And I thought that was interesting because I was like, this has been in my mouth for years. I mean, I think I was 30 when I had them take it out. It was, you know what? I got them put in. I think at 13. I believe I had them in my mouth for 17 years. I believe it was 13, 17 years. I had an upper and lower lingual bar, and my teeth immediately started to shift as soon as they were taken out. Bizarre. Okay, so that was interesting. Now I get into this myo space because my own children, right? Tongue tied babies, I'm a feeding therapist, all that. And I start to look at myself and go, huh? I also have a tongue tie and orthodontic relapse. Okay? So I ended up going into a vivos DNA appliance. I was in it for two years. It did give me growth. I can fit my tongue up in my palate. The majority of it fits. It's not 100 perfect. I think I could get a little bit more expansion. But what we were noticing was on the cbcts that there was skeletal expansion. But I think my teeth were starting to tip a little bit. And we didn't want to tip the teeth. So we basically pulled back the springs on the DNA Beavis appliance. They actually even broke off in a couple of places. Because keep in mind, I had this in my. I had this appliance for like a couple years, which was fine because we weren't using the springs because at that point they were tipping my teeth forward and we didn't want tipping. So we pulled them back so the teeth would basically come back. And what we, what I noticed was so one, it created an open bite, but I was still in crossbite. And if you're watching this on the sides, right, it looks like my teeth match up well on the left and right side. But we learned, and this, actually I learned this from working with a PRI trained physical therapist that my maxilla on the left side is turned inward toward the right side. It's kind of like torqued a little bit. And so we did try to work on unlocking it in a sense and we did actually get some movement, but it wasn't holding. And I think that the reason why that happened was because of what was going on in my nose. So the left side was a little bit torped my septum. And this is where the ENT conversation starts to come in. Was deviated. Now, it was straight in the front, but it was deviated back toward the left side. We're starting to notice a pattern here with my left side. I've had injuries, so I've broken my ankle on the left side. I've sprained my ankle, that ankle. I've had 13 stitches in my knee. Seven on the outside. No, sorry. It was more than that. I think it was seven on the outside and like 13 on the inside. So there was like 20 stitches or something in my knee. That was back when I was 13, 14. I've had a lot of things happen. I have an issue with my wrist on the left side. I keep like a splint around so that if it starts to, if I like pick something up the wrong way or so, it starts to like kick up. I can just kind of throw the splint on to give it some support and definite like asymmetrical weakness on my left side. I'm also a low tone human being. I hit a lot of my Motor milestones toward either, like, a little late or towards, like, the end of that typical range. Like, my mom would literally take me to take me to the orthopedist. And I, like, rolled over that day right in the office for the first time. You know, like, things like stories like that would happen where I was. I was always on, like, the. The slower end of development in terms of, like, gross motor skills. Language was. Was on time, feeding. I was awful as a baby. We've talked about that in the past. But anyways, this is all just so interesting because it all has to do with, like, my tongue tie and the fact that I didn't shape my palate correctly and my tongue never lived in the top of my mouth, and I became a mouth breather while sleeping and all of these things that kind of snowballed into adulthood. I've been diagnosed with upper airway resistance syndrome. U, A R S. I did have a sleep study done, a home sleep test years ago. They were like, oh, it's mild. You're fine. And then I just did the test with Ken Hooks with True Sleep Diagnostics, and that showed uars, because he actually reviews the raw data very differently than a lot of individuals who do sleep studies and review sleep studies do. And so he was able to pinpoint what was going on. And basically every single time I went into REM sleep, my body was like, nope. And like, kicked me awake into a state of arousal where I was like, not. I was no longer getting. Or I wasn't getting any of that deep, restful sleep. So that's a problem. Right. Because how does your body restore itself if you never go into or stay in REM sleep? So we're going to redo that test after I've healed. And there's more inflammation that's disappeared because currently I have a lot of inflammation still, you know, in the nose. That's expected for a year after the procedure. But all that to say that we noticed that there's this left side with me. And I even had been told in the past that my hips were not aligned. And I went to a chiropractor and they said, you know, oh, no, it's not that you're so may back up orthopedists because of my ankle injuries. Right. I believe they happened because of the asymmetry. Now, am I truly asymmetrical? No, but my hips were sitting asymmetrically. Right. My pelvis was not. It was not symmetrical. I definitely had a pelvic tilt going on because of my low tone in my Core and just throughout my body. And what we noticed was that when my hips were adjusted, my legs were the correct length. Now, when I had these ankle injuries and when I had a hairline fracture and a sprain at the same time, it was a gymnastics injury. And then I re. Sprained it. And at some point, they wanted to put. They wanted to do surgery on my ankle and put in screws. And we ended up deciding not to do that because I was still growing and we didn't want to stun any growth. But they also basically told me, the orthopedist told me that my legs were different lengths. They were not. My hips were misaligned at the time. And ever since figuring that out and having my hips aligned, I have had fewer issues with my ankles, my legs, right. If I stay aligned, all is good. But it's just fascinating because all of this has been on the left side. Like, the left side was shorter, you know, which is not really right. It was just the misalignment. The ankle, the knee. I also have a. My left eye is a droopy eyelid, and it had. There's a ptosis. And the. The left levator muscle that's supposed to help keep your eyelid, like, raise your eyelid up and keep it open is. I've had surgery on that three times. I had it when I was five because it was blocking my vision a little bit. I had it when I was 13 because I said it was kind of due for it again, because it looked like my. My eyelid was blocking my vision a little bit. And at the end, I had it again before my wedding, and it only held her about six months that time. So we're not really. I'm not really sure I would want to go into some other specialist to see, like, what's going on and see if they can figure out, like, why that only held for so long. But I have tried Botox, and I'm going to do it again because I do notice it lifts my eyes up, which actually helps to. To naturally lift up the eyelid a little bit. And so if the surgeries are not going to work and hold. Right, that's another option. Now, why am I sharing all of this? Because look at all of the different things that have happened on the left side of my body. Right? It's literally from head to toe. Again, my eye, my maxilla, my deviated septum was towards the left. My left wrist, my left ankle, my left knee, I mean, my left hip. Are we seeing a trend here? I mean, I can't tell you. I've had conversations with people and they've said, yes, there's a side of my body that's weaker and that I've had a number of injuries to and that gives me lots of trouble. Yeah, we have to look at, like, what is the root cause of this? Where is it coming from? Right. And I know that once we figured out, like, my hips were misaligned, then we kind of went, okay, like, I should do some Pilates. I should strengthen my core. I, you know, should. To keep those hips aligned because that kind of keeps the ankles and the knee and everything in check. Um, I also most likely have eds. I always say, wrong Elos Danlor syndrome. I'll have to look that up. Or is it Ehler Danlos? Anyways, EDS and I haven't had an official diagnosis. I did have a PT who kind of diagnosed me, but whenever I've checked the checklist, I don't really meet all of the criteria to have like an official diagnosis. So it's, it's kind of still in the air as to whether or not I have that. But I do have hypermobility in some of my joints. My knees, my thumbs, you know, my, my wrists even, supposedly so. But it's not, it's not excessive. So I don't know. That's still, that one's still up for debate. But it's a connective tissue thing, right? Connective tissue fascia. We talk a lot about this on the podcast. So just another very interesting symptom or, you know, topic to consider with everything going on. So where am I today? Right. So I was basically in MYO as a myofunctional therapist, every single day, did my own myo. My tongue rested in the palate. I'm very cognizant of where it is at all times. I do know that before the surgery I was sleeping with my mouth open. I was also snoring a little bit congested at night because of these reasons. One, I mentioned the deviated septum where it was straight in the front but then went back towards the back. My sinuses were completely clear. And this was shown on the CBCT that was done by the ent. My nasal cavity, like, no infection, no fluid filled areas. That should be clear. Everything was clear. But I had enlarged turbinates and I had enlarged nasal swell bodies. And so everyone's like, well, what the heck are nasal swell bodies? Basically, from the image that they showed me, what I could see was that the turbinates filled the nose one direction and the nasal spa bodies filled the nose the other direction. Right. It's a nasal swell body is a fusiform structure. It's basically this kind of like spindly, kind of a spinny shape. And the widest part is the middle of it. And the narrowest ends are at like the top and bottom or, you know, head and tail, if you will. It's in the wider area of your nasal septum. And it's located right above the inferior turbinates, which, keep in mind, my turbinates were also swollen kind of like. And toward like the front of the middle turbinates. Right. Also swollen. So here I've got these nasal swell bodies that are inflamed, that they're enlarged. Okay. And it basically impacted my airflow because I also had enlarged turbinates that needed to be reduced. And so when you have narrowing of the nasal passages, it's because of inflamed tissues or cartilage or, you know, things like the, the turbinates or the nasal swab being enlarged. Right. They block the airway. So here I already have it blocked on one side because my, you know, the left side is basically very narrow already due to the, the septum, right. That was deviated towards the left, towards the back of the septum. And then we had the swell bodies that were enlarged and the turbinates that were enlarged. And so this was an in office procedure. They have a surgical center in their office. And I can tell you that I can breathe equally out of both sides of my nose right now. And I could feel that almost like immediately after. And then it kind of swells, it got swollen. Swollen. It swelled up for about a week. I had. They don't hack at my ent, but they use these forms up your nose to kind of hold the shape. And they were actually two up each nostril. I didn't know that they were sutured in and they came out about a week after the surgery. And then all of my sutures, because I was so swollen, all my sutures, they thought maybe they'd come out at like a week or like 10 days. And I think they ended up being in for two to be. Ended up being in for about two weeks or so before they took the suit, all of the sutures out. Now I also had a rhinoplasty because I had heard that fixing a septum and, you know, turbinates and it can change the shape of your nose. So I figured, you know what, I'm going to be under already. Let's just do the Whole shebang. So I had the rhinoplasty to reshape the nose, and it's still swollen. The tip remains swollen for six months to a year. And I, at the time of recording this, I had the procedure on April 5th. So I believe it's been about eight weeks now. Let's see. 1, 2, 3, 4, 5, 6, 7, 8, 9, up. Wait, it's been 10 weeks. Okay, I've lost track of time. It's been 10 weeks. It's. I'm recording this on June 15th, and we'll put this one out next week. So it's very close to this upcoming Monday. I mean, in like five days. So it's very close to when I recorded it. But what's very interesting is I had never heard of nasal swell bodies before and a lot of my MYO friends had never heard of them either. So it became very interesting to learn about what, you know, what they are, where they are, and the fact that they were blocking my nasal cavity. They were contributing to the narrowing of my nasal cavity. Um, now when you have hypertrophied turbinates, right, enlarged turbinates, it's basically where there's just, there's too much growth, right? Or there's enlarged growth of the bony structures that are located inside your nose. And you have these inferior medial and superior turbinates. There's three sections of them. They're also kind of this little, like, spindly looking shape. And so if you, you can actually Google it and look it up to see, like, where they exist. But basically if you have like my septum, where it was deviated was, I believe, closer to the superior turbinates and beyond that section. So I don't believe that it. Well, it may have been around like the medial to superior turbinate area, but it was not, it was not deviated in the front. So just very interesting. They are important though, because turbinates help to like, filter and warm and humidify the air. And that's one of the really important parts of nasal breathing, is being able to prep that air for your airway as you take it in. That doesn't happen when we mouth breathe. If you've listened to the podcast, you've heard us talk about mouth breathing, you lose all of those benefits. You don't have anything filtering the air of, like, foreign particles and keeping it out of your airway. You don't have anything warming or humidifying it. So when you have this, like the, this air come through your mouth, that's cold and that's harsh and that's full of like all different types of contaminants, toxins, things that are not filtered out by the turbinates in your nose because you're mouth breathing. That's where we tend to see a lot of kids get sick more frequently. Colds happen. It's very interesting. So do like, can they go away on their own? Well, not typically. Like, and when I say go away, I mean like, reduce in size. They might. But at the same time, if you've had it happen where you've, you've had them for a while, like I did, or if you're someone who's had like chronic sinus issues, which I did in the past, and the, you know, the enlarged turbinate size most likely is not going to. And this is what was shared with me by some other entities. I didn't talk about this with the ENT who did my procedure. This was from another ent. They basically said like that enlarged turbinate is not going to just go away, it's going to be pretty permanent. And so you'd have to have surgery to correct it. So we don't want to necessarily remove the turbinates because they serve a very important function, but we can reduce them so that they're not filling the airway and blocking your ability to breathe if they become enlarged. Because that's what exactly what happens is, you know, you've got the terminates coming off. Like I say, I tell people, like the term, it's like coming off like the outside of your nose and you got the swell bodies coming off the, the nasal septum on the inside of your nose growing outward. And so I just had a lot of blockage in addition to, like I said that deviated septum. But I'm healing beautifully. Everything's going as planned. Surprisingly. I told my kids I would look like a raccoon afterwards and surprise because of the rhinoplasty. And I had no bruising. Zero because I was using homeopathy, like arnica 3x3 times a day. I was also using some other recovery stuff to help with the process. And so, you know, there was obviously some swelling but no bruising, which I was absolutely floored by. So where are we now? Well, you've heard about my history. You've heard about, you know, I also should add that I was prone to strep growing up, constantly getting strep. I. That turned into. And pink eye that turned. And I had ear infections as a younger child, but never had tubes placed. So I had all the things. And then in My, like, late teens into college years or so, I was constantly getting sinus infections. I would get one every spring and every fall. They would constantly put me on a Z pack, which I became immune to. And then I remember being like, hey, you guys usually put me on like three rounds of Z pack before, like, you realize I need something different. They did that one time and then followed that with Augmentin and that kicked it out. So the next time I got one, they gave me Augmentin right away. And I've never had a sinus infection since, so I don't know why, but that seemed to do the trick. And that was probably about 10 years ago, or maybe it was probably mid-20s or so. Yeah. So a little over 10 years ago. But why do I share all this? It's all connected. All of this is connected. So I did have my tongue tie released after I had Mia, so I believe that was in 2018 that I had it done. And both of my kids had both had their tongue ties released. So I went and had mine done. I might need to touch it up a little bit because I do feel like it might be restricting me a little from fully getting my tongue into the palate. I can feel a pull, but the verdict's out on that. Still. I do need additional expansion because after I did vivos DNA, I went into Invisalign and it actually ended up closing up the spaces that were created. But it kind of did some retraction and I've. So I've stopped wearing them because I spoke with some colleagues who said I don't wear the last two trays that really fully pull everything back. But I had already done that when they told me this. So I was basically kind of just like in a retainer form of Invisalign at the time. And I've noticed that because I stopped wearing them, my teeth have started shifting again, which tells me that my tongue is not resting on a palate. I still have the turned in maxilla on the left side, and I appear to have some crowding with some teeth that are turning on the mandible as well as some turning that I never had had before on the maxilla. So my journey's not done. I'm just trying to figure out who I can go to in South Florida for myself. But I've been treating my children and they are, you know, spoiler alert, both going into Mia's using a myo brace right now, just temporarily, until we can build up her bite a little bit because she's such a Deep bite. And she's grinding her teeth down. So we're kind of hoping she'll sleep with that in. That sort of the goal right now with that is getting her used to it. So she sleeps with it in until we build up her bite a bit. And then she and Lily, actually, Lily already got measured for hers. They're both going into a hyrax expander. Except this is a hyrax that. That grows on multiple planes, right? So a lot of traditional expanders, even hyrax expanders, tend to only grow the palate laterally. Transverse, right? And we want sagittal growth, transverse growth. We need to have growth on multiple planes. We want the palate to come down a little bit. But basically the. For those who are not familiar, the sagittal plane is a longitudinal plane or the basically anatomical plane that divides the body into left and right parts and kind of splits the body down the center. We also have the transverse plane. And so why am I sharing this with you? Well, like I said, most only expand one direction, right? Typically we see, like the transverse plane is that line that kind of divides the body into a top and bottom, like superior and inferior parts. Right? We have multiple planes, sagittal, coronal, transverse, and just different ways of looking at expansion. And that's why it's so hard to find these airway centered orthodontists and dentists. You get it? But we don't want to just grow on a single plane, right? We don't want just that lateral. I'm going to defer to terms that I think that most of you are more familiar with, like lateral growth. We don't want just that left and right growth. We want the palate to come. We want to grow the palate forward. And a lot of our patients, the maxilla and the mandible often need to come forward. Sometimes the maxilla is okay. We just need to bring the mandible forward. In my children's case, like, Lily has already had forward growth in her maxilla and some in her mandible, but she needs a little bit more mandible. Mia is just starting the process. She hasn't had any growth yet. We need her to grow in multiple directions. We. We need to build up her bite because we need to create more space, you know, what's the word I'm looking for? Vertically, right? They're vertical on the vertical plane. We also need to grow her laterally, and we need to grow her forward. We need to bring the jaw, her lower jaw forward. So she's got A lot of work to do. But the hyrax that our dentist uses allows for growth in both the vertical plane, right in the lateral, and in that forward growth plane. And I'm again, I'm using these terms so that I don't confuse you all because I've had people message me in the past and be like, can you explain the difference between sagittal and transverse and vertical and all that Fun. I mean, yeah, yeah. Okay, so it's in the course, it's in the myo course. But what you basically need to know is that traditional orthodontists and dentists only grow the palate laterally with a rapid palatal expander. And then they slap braces on and oftentimes the jaws are still too far back and there's not enough room for the tongue. And then we see orthodontic relapse, especially if there's a tongue thrusting forward because it doesn't have enough space in the palate or it's tight or any number of reasons. So that's ultimately what happened to me. And that's why I'm trying to prevent this with my kids. So for me, I don't know what my next step is yet, but I know that I'm not done. And I do feel like I hit a wall. And I can only get so much growth in my palate with the vivos DNA because of my nose. Right. The roof of your mouth is the floor of your nose. And I could not get it to cooperate. And whatever we did get with my PR ipt, I couldn't get it to hold because it wasn't. What's the word I'm looking for? It wasn't the best scenario. I didn't. My nose was deviated. I was not nasal breathing. I was mouth breathing because of the enlarged turbinates and nasal swell bodies. All these different things were going on and they were kind of working against what I was trying to do. So do I go back into a vivos appliance? I don't know. Is there another option that we do next? I don't know. We'll see. I'm going to consult with some different providers and see what treatment plans they recommend for me and which. Which route we think is the best for what I'm trying to achieve. And that really is a straight bite. Because I used to think that my nose was really crooked in the front, but it wasn't. My nose was straight. It was at my max list, turned in on the left side. And it kind of makes things look a little bit more crooked, but you can see that it doesn't line up with. With my nose, with the top of my lip and with my maximum. My maxill is straight. Sorry, my mandible straight. My maxilla is not. So that's that. That's where we are currently and just wanted to catch everybody up. I am having, I am experiencing great healing, so I'm really excited about that. Since my nose procedure that's apparently been. It's been 10 weeks now. Holy cow. Can't imagine like it'll. It just keeps improving, it keeps changing. My nose keeps changing because like I said, the, the tip of the nose remains swollen for anywhere from like six months to a year. And they said around three months. Like a lot of it will go down and then around six months you'll notice that like a ton more has gone down and it'll look really great, but it really takes a full year for it to heal. So I'll keep Everybody posted on April 5, 2023 and let you know how it's going. But that's, that's the update I wanted to just hop on, give everybody an update of where I'm at. If you're on this journey, you're feel free to email me DM me Hallie Balkan on Instagram. I'm always happy to, you know, hear your thoughts and what you've experienced. I have a lot of people who DM me and say, oh my gosh, I listened to this episode and I have like all the same symptoms or I've had very similar like history of X, Y and Z. We're not, you're not in this alone. Even though it can be hard to find providers, we are all in this together. So reach out. I'm always happy to try and connect you with a myofunctional therapist who, who's in the MYO membership in our group or who's taken the MYO method. And if we can, we will connect you and they can always help you find providers in your area if you're seeking something for yourself or your children in this space and having a hard time finding those airway centric providers. So I hope this was a fun episode to listen to and I will talk to y' all next week on the podcast. Thanks for listening to this podcast. If you want to hear more of these Myotots, 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. 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