Episode 174:Tongue Tie Release & Airway Health in Birth to Three Population with Amy Luedemann-Lazar

Hi and welcome to episode 174 of the Untethered podcast. Today we have Dr. Amy Ludovan joining us. Amy is a board certified, biohacking, laser, airway focused, innovative pediatric dentist. She loves children finding minimally invasive solutions to root cause problems and she believes each and every individual has everything they need inside of themselves already to be their very best selves. So her role as a healthcare provider is to remove obstacles and enrich the environment to allow all of our patients to take off and thrive. 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 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, Amy, I was actually sitting in my bed last night, like thinking about our conversation we were going to have today. I was like so excited after that initial phone conversation we had and I know all the listeners are going to just eat this episode up. So welcome to the podcast and thank you for joining me.

Thank you so much for inviting me. I'm really excited. And my associate, I was talking to you yesterday and she's like, you're going on that podcast. I totally listen to that podcast every week. That's so exciting. And so just thank you so much for inviting me. I'm excited too. This is going to be fun.

It is. We're going to have fun. And we have very similar interests and like the early intervention birth to three, you know, age group. And so I'd love for you to share how you got into working with that birth to three age group and just, you know, what is it you're doing in, you know, in your space with that, that age group as well?

Yeah, yeah. Well, so of course I'm a pediatric dentist, so that kind of lends itself to the kiddos. But even as a pediatric dentist, we don't, you know, we're not even trained to start at birth for sure and residency, so that's a lot of afterwards. But gosh, I think the way I kind of Got into the world of really treating babies was through Mark Mohler and his group and going to Joy's class and then laser courses and so forth. But Jessica Altamira helped me to set up, I think, the third interdisciplinary clinic in the United States. We have an osteopath or I have also a chiropractor who does cranial osteopathy as well as three IBCLCs. And so we brought that group together. It was originally Rosalva and myself and our osteopath, Elena Williams, was just wonderful. That's kind of where we started with having this approach. We asked the patients to get ready outside the practice, but I wanted someone there to verify because I'm not a body worker and not all are equal. So sometimes there were red flags. We found broken clavicles and one kid we actually sent away to get work on and they had a cancer diagnosis. We're very observant and looking at the whole baby and that's been such a huge learning experience. And then I would say, probably some years into doing that, I started noticing I like to see the kids every three months for the first three years of life, if they live close enough. What I was doing during that time was seeing did we heal nicely, do we have. Are we meeting our milestones and also looking at the jaws. And I noticed that for most babies that were born with tongue tie and who had a high palate at 1 and 2 and 3, they were still.

Having a high palate.

This stressed me out because what I had learned in all my CE is like, fix the tongue breastfeed, try some baby LED weaning, and it's going to be all great. And it's really not all great. For a lot of kids, they still don't have the structural changes for lots of reasons. So that kind of just got under my skin. Like, what can I do different? What can I do different? Then I learned from Derek Nordstrom because I'm an ALF provider, so I learned about a neonatal alf. And so I tried that a little bit, but I just. I think the pandemic kind of happened sometime shortly after starting that. So I stopped doing that a bit. Well, then fast forward maybe a year ago, and we had a little kid come to our practice that was almost two and was being referred for tongue tie. And we sent them for the team approach to a really awesome SLP at low tone, all these other issues. Dad found him in his crib two weeks later and it was just heartbreaking. And I thought, I cannot sit around and just watch These kids until they're at an age where I have appliances that I know work. So that got me started with my people, my clan. And we have been innovating and so now we're working on and because it is a little bit of a labor of love and kind of a lot of work, but we're seeing tremendous results. And I'm doing now 0 to 3 year old trying to widen their palate with an osteopathic complementary appliance through a team approach. And that's been super exciting. And also doing the laughter Laser assisted Functional Therapeutic release. And Baby Lase is also what it's called. It's the same procedure. So that's been another game changer, helping us to see sometimes differentially what's a tie or not a tie. So that's kind of where my heart is right now in developing better things because there's not a lot of options for them if they have airway issues or sleep issues at this time.

Oh, my gosh. We said so many things and I was just like sitting here like, yes, yes, yes. Oh, my gosh. We've had a provider on the podcast in the past who's use Baby Lace and talked a little bit about it, like very briefly. It wasn't really the focus of the episode.

So.

So there's that and then sids and like, just some different things that came up. And I'm like, oh, goodness, these are such great topics. So with Baby Lace, right, You mentioned you're. You're able to use it to determine if there's a true, you know, restricted tissue versus what tension may be surrounding the area. Is that what you're finding? And you can release that tension and.

I'll share a screen. This is an adult, but just for fun, to show you a example of doing this laser procedure on an older patient. Can you see that? Yeah, this is obviously an older patient, but you know that we want to get a patient from here to here to have a really nice release. This patient's not ready. This patient is. Takes a lot of bodywork and myofunctional therapy. And the surgery is so much nicer and easier on this one. But it only took us five minutes to get the patient from here to here.

Oh, wow.

Yes. That's the power of the laser procedure. I got to co teach the first Baby lace course with Angie 10 holder, and it was obvious that was going to work out for me to go and teach with her often. I asked Derek. I also teach osteopaths and chiropractors. A lot more. I asked him if I could trademark it under a different name because there was an issue with the original name and so forth. So that's why it has two different names, teach it differently. But it is a psychosensory therapy and it also has a lot of direct effects. The direct effects. If you look at some of the work on fascia, we know that normal fascia can change shapes. If you're going to hit me in the arm and I know it's coming, I'm going to armor my fascia and that's going to be one type of response versus if I didn't know and I don't armor. It's to give you a mental picture of how fascia can change shapes with any age patient. I have like in the presentation, which maybe we'll bring up, maybe not, but basically there are a lot of different things that can make someone's frenum get short and tight. So secondary airway issue. Because the genioglossus muscles are airway dilator muscles, they can in effect, basically short and tighten and pull the tongue forward using part of the frenum. And so when you look at that patient, you'll think, oh, that's a tongue tie for sure. Just look at it. But when you apply, the laser liquefies the hyaluronic acid. So hyaluronic acid is our lubricant and it should be loosey goosey everywhere. And when you're like this from, you know, typing all day, you think your muscles hurt, but you really have fascial strain patterns and gummy fascia. So the laser at the specific wavelength, the 1064, liquefies the hyaluronic acid on contact. So what will usually happen from that is you'll see that change, like, of that tongue that I showed. I call it cobra tongue. But you'll see this change. And sometimes in children, we'll see the front end double or triple in length. So you have a posterior tie. It's like, oh, well, it's pretty far back there. But wow, it's so short. A lot of those aren't as short as you think. Low tone, core instability. These are other things that can cause the person to use that deep fascia line to kind of keep it all together. So the laser gives us that little window to say, oh, okay, this isn't a structural problem, this is a functional problem. And then the psychosensory part of it is really powerful and that I teach that. So I could go into a lot of that. But it Helps to integrate primitive reflexes. It helps with preverbal trauma and just trauma in general in older patients through that limbic system and the window that it opens. And yeah, it does really powerful things. And even though we're staying in our scope of practice as a dentist, you know, the brain is just right under these big muscles right here and things like that. So I think some of it is also the transcranial laser aspect of it, which is pretty powerful. So did I answer?

Yeah, no. It's so fascinating. It's one of those things where, first of all, I just want to mention real quick, any slides that are shared you can view on YouTube. We always post our episodes on YouTube, so we'll make sure that you guys have the link to that. But basically it was initially a picture of a tongue that looked a bit more heart shaped actually when it was ready for release than it did initially in the initial photo. And it's so interesting because I know sometimes we get kids with these truly heart shaped tongues and look, yes, there are real tongue ties. Nobody's questioning that. But it's one of the reasons that we always recommend, regardless of presentation, we recommend, you know, our intervention as well. Before you just send a child or adult into a release, one, we have to prep, right? But two, there's usually always some degree, at least we find of tension surrounding a tethered tissue because of compensation. Like there's just no way around that. The body has to compensate. It's naturally going to do that. You're going to then carry tension. Where you carry the tension may vary. The degree in which you carry it may vary. But if, especially in families who are hesitant and younger children, if we can avoid these procedures, then by all means, let's see what we can do behaviorally or with things like myo feeding laser like we're talking about here, what can be done to see if we can bring the child back to function and out of dysfunction. And so I love that these kinds of conversations are happening because I think that publicly it's usually tongue tied versus not tongue tied and release it or don't release it. Everybody tries to make it so black and white. And we're like, when you actually work with these patients, there's so many more variables. And like you said, there are other things that can make the tongue appear to be restricted. It could even be a small palate where the tongue just doesn't fit and it's just behaviorally learned to rest on the floor of the mouth and they have challenging time lifting the tongue up, you know, it's, they're, they've never had to before, so why would they start now? You know, one of my therapists sent me, showed me a video of a patient she actually interviewed, interviewed, assessed yesterday, and she said she was like, you know, this five year old. They couldn't elevate his tongue at all. And you see these children, you know, raise their head and neck up and try to then take their fingers to.

Lift their tongue up.

And that doesn't mean, I mean, he appears tongue tied right now, but he's new. We'll see what happens. It's one of those things where we don't know how far we're going to get. Usually in our sessions within like three sessions or so. And that's like initial eval and two to three sessions afterwards. We typically are able to get, you know, and obviously referral, you know, referring out, working with others, bodywork, everything is important component here. But we can usually determine, okay, this needs to, this child needs to go for a release consult or this child really doesn't. Let's continue to work together here because our goal is never to keep a child in therapy and our goal is never to really to send a child for release consult who may not need, you know, and so I just, I love your team approach. I love the model. I love that you have all these providers, you know, at, at the disposal of. Your patients are able to, you know, they trust who they're working with. Everybody's kind of on the same page. You can have that interdisciplinary, you know, case review and conversations. It's just, it's so powerful. And I, you know, I always talk about, I remember this one case where it was my entire team and then some other providers as well, and multiple disciplines sitting around my kitchen table and, and we literally passed a computer around, a laptop around the table with the case. We'd all seen this patient, with the exception, I think, of one of the PT osteopaths, and the way that we presented the case and what we were concerned about was different from every single provider that saw this case. And as we all started to discuss it, it just became, and this was years ago, but it just became so apparent how critical these conversations are and really how much of a disadvantage patients are at when they don't have the ability to have this team approach. So anyways, I'll shut up, but you know, I just love your model.

No, I'm glad you mentioned that because it's probably been maybe seven years ago that I started an interdisciplinary study club I think that's the first one like it, at least in our area. And so our first scope. So it's IDCLCs, SLPs, sometimes midwives, doulas, osteopaths, chiropractors, myofunctional therapists, pediatrician, functional pediatrician, now pediatric neurology. So I totally hear what you're saying, because what was so wonderful about that group is I remember going like, what's the difference between an osteopath and a chiropractor? I really don't know. And how do you.

And so then CST and, you know, you start to. You need to know what these different domains specialize. Like, what do you do exactly.

And like, another thing, I was just on a call last week kind of doing a little teaching thing, and one of the people in the Q and A time was saying, oh, yeah, do you think that laughter is great as a psychosensory therapy, like emdr? Because EMDR doesn't cover certain things. And Karen D. Was on there with me. And so anyway, long story short, I'm telling him what I think about blah, blah, blah and Kearney's. And I noticed he had a torch in, like, because I just look at people and I'm like, left side bend, you know, kind of that sort of thing. And so I was like, you know, it looks like you have a torsion. And then Carrenty chimes in and she's like, yeah, so if your sphenoid is actually, you know, lopsided, so to speak, from the torsion, then the eye EMDR therapy is not going to be as powerful for that person. And that's probably something that the EMDR person doesn't even really think about. So I absolutely feel like collaboration. I have learned so much, and my first experience was at the craniofacial team at Seattle Children's Hospital when I was an attending there and on that team. And that's when you'd sit there on Monday morning and recover a few cases and you have the whole team there. So you see what your role really is for that patient. And sometimes your role is little to none or like a way backseat because there's all these other things going on. And also, like you said, if they're getting a tongue tie release and they have one of these other issues, those are those babies and kids that are healing tight because the body will use that opportunity to scar it up and make that tension really secure. So, yeah, team approach. There's just no other way to do it anymore.

Yeah, yeah, I know. It reminded Me of one of those conversations. We had a vision therapist who also had ot. It was a very interesting couple where they were both vision therapists, but the wife was also an ot. And so it just. The brilliant, brilliant practice. But hearing from them how, like, the impact on vision therapy and the, you know, then the impact of vision therapy on my own. And. And I'm sitting here going like, well, yeah, because, you know, you're talking about eyes and occipital load and the spinoid.

One, and I'm just like, oh, my gosh.

Okay, hold on. And now makes sense. And I'm like, and these. Okay. And you start, like, putting all the pieces together. But it's just so fascinating. We always say, like, we're connected from the tip of our tongue to the tip of our toes. Like, everything is interconnected with fascia, but also we have bones.

No, I actually changed my vision in my late 40s. I started doing ALF, and I got 11 millimeters more arch length in my late 40s by doing the ALF appliance. And I had two different prescriptions in my eyes because I'm missing a lateral on this side. And I finally made room, and now I'm consolidating. But there were two different prescriptions. And in the process, when my palate went from super asymmetrical. Asymmetrical. To more broad. And even now, my vision's the same in both eyes because the roof of the mouth is the core of the eyes. I know. We just don't think about that stuff.

Yeah. I mean, I did the DNA vivos, and my. I remember, like, my dental colleague and I, like, we were sitting. She's like, you're developing cheekbones. Do you realize, like, you have cheekbones that, like, were hidden before? She's like, you've always been there, but you couldn't see them. Yeah, it was just. It was so interesting to see, like, the changes, but also, you know, symmetry and, you know, to the extent that I can as an adult, it was very fascinating. And I look at my face, like, then versus now. And I had ortho. I had all. You know, I also have relapse and all the things, but. Yeah, and just nasal surgery three months ago that I'm still healing from. But, you know, it's. It's an ongoing process. And every step of the way. Well, I tell everyone it's a journey. It's an investment in time, energy, money. Like, it's totally worth it. Like, I can breathe through my nose equally on both sides now. It's pretty cool. Who knew that would be such a cool thing, right? Speaking of which, so going back to our like birth to three, you know, population, when do you. Since I know you get them in there earlier on than maybe even some other dentists. When are you seeing those initial signs of airway issues or sleep issues and whatnot?

Let me go ahead if it's okay and I'll share again and I'll show you. I put together some signs of airway issues in the 0 to 3 year olds. So first Hallie, I wanted to say that, well, let me screen share this here but that it's not a very well defined problem. So if you google right now and ask what are signs of sleep issues or airway issues in infants to toddlers, other than SIDS information, there's really not a lot out there. There's some new research out there which is kind of concerning, but there's very little amount of information and it's a growing problem. And I could talk a lot about why I think that's happening, but it's happening a lot more in infants and young children having sleep disordered breathing. And so the current situation is if you have someone really young, it's a sleep study and a cpap. If it's severe, if it's not severe enough for that, then it's like let's watch it. But at certain point they're too young for adenoids or tonsils to come out. I'm a root cause girl anyway, so I don't lose very many tonsils or adenoids in my practice. But here are some signs and symptoms that we have collected in my study club. We just right now. So we did zero to six month old for six years. I mean literally six years. We talked about zero to six month old pre crawling infants and now we've expanded to zero to three years old. And next month, pediatric neurologists who treat sleep and the youngest of kids who I collaborate with a lot, she's going to be speaking to us. So these are some things you might notice. Open mouth posture, rest, a low tongue posture, audible breathing retractions, snoring is never okay. The high narrow or misshapen palate. So here's some you might not know though when you lay a little baby down. One of my friends, I didn't have time to see if I could borrow his video and show but he's in Singapore and he has this great little video where there's this one baby and it's so cute but you know, it's kind of fussy and moving and Making little noises. And you lay that baby down on its back and it's very uncomfortable. You can see that. And it immediately turns to the side. And I see so many babies, like once it's in my head of like, oh my gosh, this baby's struggling now. I can't not see it. But I think of how many parents and just people in the world are just, oh, it's a fussy baby, he just likes to be held, or he's got this or that. But it's when you lay a tiny baby down and they're turning, that's a red flag. And sometimes you'll have parents saying, oh, my baby's so strong. He's got such a strong neck. No, it's not a strong neck. He's trying to breathe. And then the babies that aren't born with torticollis, although having torticollis makes them, you know, set up for some other things. But when they develop torticollis in the first few months, again, it's that really strong preference because turning the head to the side helps them to breathe. Arching, even though we think of arching a lot with digestion and reflux, but it also can be a sign of, of airway issues. A baby that thrusts their tongue forward. So also we see episodic masseter activation. That's basically those babies that are moving their jaws a lot. That's precursor to grinding. And grinding, we know, opens the airway and so reflux. So that's Bernoulli's principle. If you have a restricted upper airway, that can create a negative pressure gradient, which causes reflux to happen. And then that creates other issues, but of course, dark circles. And then as you enter the toddlerhood, it makes me so sad sometimes for preschoolers and toddlers because I feel like this whole terrible two, like my daughter wasn't a terrible two. And I don't think terrible twos or some people, oh, he didn't do terrible twos, he's doing terrible threes. I think some of this meltdown, low frustration tolerance and just really challenging babies and toddlers, we might be missing an airway issue. That's my perspective. I'm really looking a lot closer at that now than I ever have before. And like I said, really just trying to collaborate and figure out ways to help these young ones sooner because it's completely life changing to be able to sleep versus not sleep in those really formative years. You can go to an ENT if they're too little. I have a patient right now that is 20 pounds going to be three in October. Adenoids, 100% blockage. Tonsils, kissing. Has had multiple fall head injury things and she has severe sleep apnea and she doesn't have all of her teeth in. So that's the big challenge when they're growing teeth. It's changing so rapidly. How can you get something to be retentive but not lock up the cranium and things like that. So that's. But anyway, so neonatal alpha. I've had that for a while. 06 month. But now we're. I haven't named the new appliance yet but I'm working on it. And yeah. And then. LAUGHTER and that's another. Using the laser non surgically can sometimes get kids pretty far along. Like pretty big changes and then that may bias time if they're not urgent to put in an early appliance. But yeah, so that's what else I have. Oh. So like why. The reason I. Some of the reasons I think it's happening more common. We know from like Kevin Boyd and others work that mom who have hypoxia and sleep issues during birth. Those kids are born more retrognathic. They are born just already predisposed to be mouth breathers and have hypoxia. Mouth breathing leads to enlarged tonsils and adenoids and inflammation of the airway and so forth. We also used to breastfeed until the fourth year of life, which is crazy to think about it, right? But four in Mongolia they still go to seven or eight. But breastfeeding, a lot of people don't realize that it really is the first thing that we do that decompresses the cranium because it's 23 bones floating in fascia meant to get really squished on the way out. And horses walk within a few minutes of birth. But humans take a year. So we're really neurologically immature which gives us so much room for sophistication. But it also leaves room for a lot of error and challenges and gaps. So breastfeeding helps to do that decompression initially. And the way the jaws move as you know, is much different on a bottle versus breastfeeding and then solid foods. We used to give babies a little slab of beef jerky with no nitrates and sugar at six months and be.

Like work on that.

So we don't do those things anymore. And I think those are the biggest factors related to changes. But I'm talking too much.

So. No, this is great. This is great. It excites me to hear these Types of symptoms, because I feel like I for my own children. And then from my private practice and experience in the courses that I've created, I've pulled these symptoms into my courses, and I've said, like, this is what we're seeing in infants. We're seeing. Like you talked about masseter activation. I think that's probably the only thing that I haven't really highlighted. Everything else on your list is in my course. And, like, I've, you know, even educated on social media about these things. These babies with the strong, tight neck, at first, those are both of my kids. And everyone's like, wow, your children have such strong necks. Look at them hold their head up literally at two days of life. And I was with my first, I was like, wow, I have a picture in the hospital on day two with my first daughter. She's on my chest, but her, like, you know, her shoulders, her neck, her head completely just straight up, holding her own head up. My second daughter, I then knew that was not normal. And so we did start intervention much sooner. They were like, well, she doesn't have torticollis, but here's a paper with exercises do at home that says torticollis. I don't care what you call it. Like, let's just figure out how to help her develop properly early. So living it as a mom, I think, also just gave me that passion to be like, what are these other symptoms that people are not connecting the dots on? You did such a beautiful job of pulling in such a nice list of common symptoms that we see in these kids. And another one that I talk about, too, is tripod sleeping. My kids always, especially my first daughter, would float herself onto her stomach, which was scary because she was like a couple months old and only wanted to be a belly sleeper ever. And she sometimes would have her little booty up in the air, you know, with her head on her hands, as an infant, as a young infant in the first six months of life. And it continued beyond that, too. And I'm just glad that I lived in bliss seven years ago and had no idea that was an airway issue, because now I don't think I would ever sleep. You know, I'd be constantly trying to reposition her, figure out, like, what the heck do we do so she doesn't put herself into a state where she may become a child, you know, who dies in their sleep. And it's just, you know, it's. It's like a sad truth that I now know my second daughter was a back sleeper, mostly but we also. We intervened much earlier on, like, day five with the tongue tie release. I was kind of prepping her body. We were doing all kinds of things. You know, I was. We took her to CST and Osteo. Not until later on, I did just, you know, pt and, you know, for her, it was like, okay, we're doing pt and it's, like, keeping her hitting her milestones, but, like, we're not really closing any gaps. Like, she's still kind of on the far end. And I feel like I'm not convinced that this is, like, doing anything. I think it's just making me feel better. And so that's where I finally was like, okay, I need somebody else. And that's kind of what threw me into being like, all right, I need to understand what these osteopaths do and these Cairos do with these babies and these, you know. You know. Anyway, so I took her to both CST and Osteopath, and it was like a whole world opened up for her with just a couple of sessions total. She went from not walking to standing up, like, walking. And then she was also a kid who, like, dragged her one of her knees behind her and did that little scoot on the knee across the room. And so instead of working, you know, against the grain, we kind of went with it. And all of a sudden, everything released, and she was crawling on both knees after she knew how to walk. And, you know, and that's where I was just like, okay, there is something more to this, like, reflex integration, our nervous system, perhaps. Like, why is nobody talking about it? Yes.

I was trying to stop the share here, but I lost the ability to do that. Oh, sorry.

No, you're fine. Let's see if it'll let me.

Yeah, I have a lot of pictures, too, but again, I know as a podcast, but I'll show you, for example, just randomly. But this. This is one of my favorites to show, because in this picture, you know, we talked about the connection from head to toe. And little girl, you know, of course, had crowding, and. But her posture, her whole anterior chain has her forward. And this is about eight months of just doing a little bit of. Oh, hold on a second. Of doing a little bit of all the stuff that we're talking about. And it's just such a beautiful change. The. I think I had a picture of her teeth somewhere, too, because, you know, Dennis, we. Yeah, so you can see, like, that's. I feel like that's our door in. Right? My door in is the mouth, but I get to make changes of the whole body, and that's super duper exciting. The reason I was showing this is just because this is a more dated back skull. And look at the. Look at the cranium and look at the jaw where it is. And this is just a few hundred years ago. I mean, that's just so, so sad how much change we've had.

It is incredible how we are moving out of or not moving out of, but we're. Our jaws just continue to shrink. And I know there's that conversation that's happening about how, you know, from one generation to the next, like, we are, like, when does it stop?

How do we stop it?

How do we stop this progression and maybe even attempt to reverse it? You know, it's. It's.

There's a whole Pottinger's cat book and all that, which I'm sure you've read. Yeah, there's just. But there's so much more available, too. I mean, I don't know how plugged in you are or your listeners to biohacking, but that's another really huge area where I'm definitely a biohacker. I've always been sort of early adopter and that sort of thing. But yeah, we're even working. So this is another kind of, like, tidbit. And I feel like I can just retire a happy woman if I'm able to accomplish this goal. But you know how so many kids. Thanks for doing that. Have persistent adenoid enlargement. So typically when I place the biomimetic tongue appliance, the adenoids and tonsils just drain and everything drains. And we don't lose them, they shrink. Mine shrank for the first time ever. I went from, like, usually I'm a three or four, almost had them removed a few times to a one.

And that was my daughter with the elf.

Yeah, it's so cool.

I have the CT that shows like the before and after her sinuses, her adenoids, and, you know, people think I'm nuts. And I'm like, this happened in three months time. Having that appliance in. We got it in an end of August. Her adenoids shrunk in her tonsils during cold and flu season in Maryland in the cold weather.

Yes.

Tell me this was not the appliance. And we did absolutely nothing else.

It is biomimetic tongue. So it's basically doing the job for the tongue until the tongue can. But there are cases, and these are. I always get the hard ones because I do love the puzzle. And so Those kiddos that have persistent enlargement of adenoids typically are mold toxic. So we're having marcons or mold issues. But I'm working with a biohacker who's created a ton of different stuff to come up with not a spray, because most little kids hate them and not surgery, but to shrink the tonsils and adenoids with potentially a supplement or a laser application. So that's really exciting, too. I think that's gonna be a huge game changer for a lot of kids because, you know, nobody wants to put their kids under general anesthesia and cut body parts out and adenoids regrow, and you've got to add, ask why they're that way and correct them.

Right. And then there's that whole debate, like, I know these are part of our immune system. Should we be reducing them or removing them? You know, and it's. You know, and I was like, I don't know where I stand on this topic yet. But I really, like, as a mother, yeah, I want to avoid procedures for my child that are invasive. She's a sensitive kid. Like, she's sensory. She's picky eater. You know, she's like, had all the things, like, horrible breastfeeder. Like, she is literally the one who threw me down this entire specialty, you know, pathway. And that whole rabbit hole was just like, oh, okay, well, here we go. So, you know, now I recognize that in everybody else in my family and my patients and, you know, but it's. It was so fascinating, too, because there was so much. Even within the mild community, there was so much pushback that an appliance could possibly do that. And this was coming more from myofunctional. This was coming more from myofunctional therapist, like I was told. So I put a picture up of her tonsils, and I was like, Look.

3.

I was like, has anybody seen this happen? Because my dentist was like, look. And she was going through the training, she was like, I'm told this can happen. But my daughter was the youngest case she had treated yet at age 4. And she was newer to ALF, and she said, I don't want to make patients any promises. Yes, I'm being taught X, Y, and Z. She's like, but she's like, I want to see this stuff happen in my office, and then I can speak to what I'm seeing, what I've learned, and so on and so forth. And so, yeah, I posted it in a large group on Facebook, and I was messaged immediately by the moderator of the group. And Told to remove that post. I was absolutely out of my scope to suggest such a thing could even be possible. And this was like another speech pathologist and myotherapist. I was just like. I was like, you know what? This is my child. Like, I'm saying this is what actually happened. Like, I know firsthand. I'm not claiming that this appliance does that for all patients. I'm asking if anybody else has seen it so we can have a conversation. And I was like, but you know what? Like, I'll just remove it. Like, it's not worth it.

Another one with you that is exactly the same.

Now I know they're seeing. With. With expansion. They're also seeing a decrease in tonsil size. And, you know, there's actually published research that's coming out on this, which is great to see.

Yeah, there is. This is. Okay, so just keep this picture in mind because I don't want to. I'm going to stop. Share for a second to go on the second one. So you don't see the patient's name, but this is also an SLPs kiddo. So she took these pictures and this is, I believe, three months later. So.

Yeah.

Yeah, it happens a lot. And the reason is it's not really hard to understand, but if the tongue. So there's a picture I would love to share also with you. Let me go back to that one.

On my.

On my.

Yeah, it reminded me of Lily because I have this, like, really great photo. I've shared it on social media of her tonsils. Tonsils, they're almost touching. They're inflamed. They look veiny. They don't look healthy to me. And she had a piece of, like, broccoli stuff in her teeth, so that was cute too. But I took her to the ENT with tonsils that looked like that and was basically told that the ENT was like, I'm unimpressed by these tonsils. That was the ENT's word. Knowing that I'm an SLP, knowing what I do, working with other myotherapists. And she was maybe three and a half ish, right? It was, you know, before we went into the appliance at the time. And I'm like, look, I don't want surgery for her, but I need her to breathe. Like, what are our options? Like, what can we do?

And there.

Nothing. Not a nasal spray, not a. And no medication, no. Let's monitor for three months.

Nothing. Just turn me away.

And this is supposed to be the specialist in this space. And I was like, oh, yeah, no.

This is what I tell parents. This is a conversation to have at least once a day in my practice. And I just say, listen, if you go to the ENT with a young child and you're suspecting a sleep issue, I want you to know before you go. They have four choices and only four choices. Choice number one is they're going to look and say, I'm not that worried. Let's just keep an eye on it. Which basically means you don't qualify for the other choices in their mind. Choice two is a spray, which is a steroid. What they're trying to do is shrink them to see if that helps sleep and airway get better. But nobody wants to keep their kid on steroid spray for any long period of time. And so if it works, or if it doesn't work, and they move to option three, which is cutting them out. What they don't tell you is generally six out of 10 times the kids will get better right away. Four out of 10 times they don't. And then there's a huge, almost 100% relapse at two years out for sleep. Because the problem was not the size of those tissues, it was the size of the airway. And their fourth option is a cpap. And that is all an ENT has to give you. And none of those options are root cause options. Let me show you another couple just because I think you'll appreciate these. But I love this. Okay, so this is Kathy Holloway. She's actually a PT and craniosacral therapist. She helped. She helped. What's his name? Craniosacral therapist. Upledger. She helped up Ledger get his stuff going. I love this drawing of hers. Right, so she goes through embryology. And what you see here is the top is all neural tissue, the bottom is all gut, and the red is what's going to be your heart and cardiovascular system. And she just says when she's teaching this. And this little silver nut right here is basically the primordial mouth. That's how early 10 days old that that's starting to happen. And I love how she says the heart literally grows out of the mouth. And so we used to know like, and focus so much on cardiovascular health. And then we learned like, oh, neuroplasticity. And we focused a lot on that. And now we're understanding the gut, but little do we know that it's the peristalsis of the tongue from very early in the embryonic development that actually helps the embryo to fold in and unfold and develop. And another little known fact, but about five to six weeks, the roof of the mouth. What will be the roof of the mouth? A little bit of tissue, invaginates, migrates upward and there you have your pituitary gland. And the pituitary gland is a master gland. It's really, really important. And so not only is it so intimately connected, the nervous system, the gut, the heart itself and entrained, but also, you know, function like the pituitary gland. And so this is without the pituitary is something that I always am teaching in my little infant clinic. And so I tell parents like, you know, the bottom red line is your tongue, the top red line is the roof of your mouth. They should fit hand in glove. And when they don't, you know, the yellow line represents the alterations that can happen. But the tongue exerts this strong force as compared to what it takes with braces. So 500 to 1200 grams of force on swallow. It only takes less than 2 grams to move a force with braces. What is all that force supposed to be doing when we're swallowing thousands of times a day? And one of the things it's doing is just draining all those sinuses. So there's a muscle that goes from your soft palate directly to your Eustachian tube and it's the back part of the swallow that, that, that sling muscle tugs and clears the Eustachian tube. And then so when you see little babies that are like Darth Vader babies, like they're not pumping, their tongue isn't pumping. And so, but the other thing directly above the nose and the palate is a perpendicular bone that goes right up to your ox or to your spinoid and it pumps the pituitary and releases feel good hormones and all these other things. And then, not to mention all that force is also meant to help us drive our growth of our face and jaws forward and wider. Because your airway is literally just the space in front of your spine behind your jaws. And so if your tongue is doing its job, you're going to get that great forward growth. But also I think I have one. Yeah, this is a really cool one. This is an amplified mri. And so what I love about it, the left is non amplified, the right is. You know, osteopaths have known for a long time that we have glymphatics or that there is movement of the cranium. But so I love that video because you can imagine where the tongue, when it's resting low or low tone, you're gonna have less movement of the entire cranium and nervous system. And when you got a really strong swallow that hits right back here, not only do you get all the drainage and all that other stuff we talked about, but you get really great motion of the cranium, which lends to great motion of, you know, brain function and all that.

But anyway, yeah, no, I love that. That was a really cool video. And I experienced that firsthand as a patient. With my expansion, I would hit a wall and I could not, like, open the DNA appliance anymore. Like, I couldn't turn it. It was just like. It wasn't that it hurt. It was like, my body's no longer responding, like. And I would go see the pt, who's pri trained and uses what he calls modern counter strain technique. And I mean, 45 minutes with him and all of a sudden I can move my appliance again. Because now everything is motion, you know, all the motion is regained. Everything's flowing properly. It's like, I think it's very similar to, like, what I saw the osteopath do with my child. And it was just fascinating to me. I'm like, the body is literally locked up and his whole thing is like, unlocking your body and. And you have to be able, you know, it's just all interconnected. So everyone's like, well, how does that work? What do they do? And I'm like, they can explain that better than I can. I just can't tell you it works. I don't know what he did or how I did it. And, you know, over the years, I've come to understand it better, but I'm like, it works. That's all you need to know.

If I could go to back to school again, which my husband says I can't, I would be an osteopath.

I love that. Well, I know we're wrapping up on time soon, but I want to talk. I know we talked a little bit earlier about, like, non surgical, you know, intervention for potential ties or faux ties, as well as just, you know, some of these cases where a tongue time might reattach. Especially infants and children who just heal really quickly and, you know, maybe, maybe they are getting proper care, maybe not, who knows? But what, like, what do you do when these patients, I feel like this is happening more and more, come into your office, they've already had a release, maybe they've had two or three releases and they're not even a year old. Obviously there's going to be some, some scar tissue. I mean, what are. Like, what do you. And I know this is kind of a broad question, but like, no, I love this. How do you approach these patients?

So let's see, I'll just answer it verbally, but I have some pictures.

But.

So first of all, I hate the term reattachment. I guess I'm the only person that hates that term because in my mind there's two types of frenum. There's a normal one, which is just fascia, which can change shapes and properties. And there's embryonic fibers that have not undergone complete apoptosis, which those fibers don't stretch or change. And so we know both of those things from research. So when you release a tongue tie, assuming you did it properly, those fibers can't reattach. What happens next is the body decides what to replace it with. Because we are all going to have a frenum. The frenum attaches the tongue to the mandible and it's really important. So we're going to form a new one. And I personally believe that any person of any age that's had one surgery and they're looking like the way they did before, that's a huge red flag to stop, pull back and problem solve. Because almost every single time they go in to get a second or third one, God forbid, any more than that, you end up with not only scar tissue, but the potential for oral aversion and just, you know, medical procedure, trauma. So for us, we work really hard to green light first. That's not a fail safe, but it works really well in our practice. And then secondly, we like to see them about one week and that's usually where my assistant's looking because she probably should be a doctor at this point, but so she's just looking for healing alterations in the first days to weeks post surgery. Low level laser therapy is a great tool to use. In fact, some of our families will buy a laser that we sell for $100 because it has two and a half inch penetration and it's a great wavelength for healing. You can also use it for like carpal tunnel and other stuff. But so we'll have them do every 48 hours low level laser therapy. So that's in the days to weeks afterwards because we know that low level laser therapy encourages more idealized healing. I do not subscribe to the fact that poor healing equates to parents not doing a good job. Personally, I think if we look back hundreds and thousands of years ago, like Hundreds of years ago, and also up to thousands of years ago, it was a midwife with a sharp nail that just clipped the front tissue and that allowed them to thrive. I maybe think that there's so much more going on and so many more changes than we really have wrapped our brains around that we're focused on these frenums. But. But yeah, sometimes there's a lot more going on. And so low level laser therapy is great. In the initial time afterwards, my osteopath at the time, we didn't have those lasers and I just loaned her one of our $7,000 lasers to take home. Just because her child was at high risk. Anterior tie. And she's an osteopath. She was working on him all the time, but she was like, wow, that was a total game changer. Her feeling his whole body and how that helped him. Once you get past weeks or months, that's when you use. I developed something, I didn't mention it, but I call it laser neural therapy. Because neural therapy was developed in the 1920s by German surgeons who noticed that after a surgical procedure, sometimes the patient would have an upstream or downstream problem with another part of their body where there was literally nothing wrong with that part of their body. But they were acting like there was and it was from scar tissue. And sometimes their autonomic nervous system would also be off. So they would inject large needles into scars with prolocane and into autonomic ganglia to get the results, which is very painful. I've had it. So that's what led me to go, wait, I have a laser that penetrates just as deep, blah, blah, blah. So I worked with my osteopath and we call it laser neural therapy. But it's where we target at certain wavelengths to break up scar tissue. So that's always my go to. I try to get the frenum without any scar tissue, very supple and bouncy. Then my eyes can see if the first release was complete or if we're dealing with an incomplete release and a still tied baby. On that note, I know you had Rachel Garrett recently, who she and I were. She is my first associate. For six years she and I went to Dr. Giovanni Olivi, who is now a mentor of mine and I co teach a laser course with him. And we learned at that time in the U.S. everybody's taught to just use this horizontal. And they're often CO2 or diodes, which are hot. Both of them are hot. I don't care what anyone says, but we Learned actually that the proper technique is to start at the insertion and go down to just above the caruncles and vertically release. Using an erbium laser with water is a dissection. It's different than melting the layers together. With carbon CO2 laser or diode, we do that true dissection and we go back vertically and you don't need to go so wide. I'll show you one more picture just because I think it is. It's one of my favorite pictures. So this is an example of someone who was not prepared and who had a diode release. And you can see all the melting together. And this is someone who was prepared, who. Now this is even more aggressive. But why I like to show this when I'm teaching surgeons. The procedure is, this is normal fascia. Why do we need to open way up there? The frenum is simply right here. We don't even need to take the septum out. And in this case, we were a little aggressive. We took some of the epimycin layer. And in general surgery literature, if you take the epimycin layer at all and disturb it over those striated muscles, you always get scar tissue. So I think what we're seeing, Hallie, is that a lot of times people are not realizing that the way they're doing the surgery with this quick horizontal look, mom, no blood. And melting all the tissue layers together, you're going to get scar tissue. You can't even see your field and your anatomy. So. Well, yeah, we've seen that.

I've definitely seen that. There is a. There's a dentist who's kind of notorious for going really wide. And one of the oral surgeons said to me, well, when you go that wide, you lose the ability to go deep enough sometimes, or you. You don't get the entire. Yeah, when you go.

As soon as you go horizontal, you.

Lose your bearings and you're like, so it's. It's a waste. Basically, the procedure is kind of like, what, what for?

There's no contraction. Like, when you're that wide, skin has so much more.

So you have so much more contraction. And functionally, we see these kids come back and they can't move their tongue any better than pre release. And we're going like. We were racking our brains, like, what gives? Why is this happening? And that's why it came up at our study club. And, you know, a provider said to me, well, this is why. Look at, look at the type of release. And they were doing exactly what you explained. You know, Releasing, you know, vertically more so following that tethered tissue versus just going, you know, straight horizontal line across. And so, you know, we see the differences in children who are prepped the same way, who have similar profiles. Obviously there's always different variables, but the type of procedure. And I'm not an expert on lasers. We do have, I know, CO2 lasers in our area. We also have water laser. But we've seen really good releases from providers who are doing it the way that you're explaining. And then I know we don't have all day to talk about this, but it's this whole idea of reconstructing the underside of the tongue and like functional, you know, frenuloplasties, especially in young children, just seems so abnormally invasive for many of these kids, that and adults too. I mean, I. My provider, I think has, in the hundreds of patients that we've shared over years, you know, I think ever did like three of them. And that was because there was so much skin under the tongue. It just structurally, there were other things going on. It wasn't just because of, you know, the tongue tie or the frenum. So very interesting, like eye opening experience. And I'm all about, like, how do we upset the body and dysreal homeostasis, like the least to get the child back to function. And I'm also a biohacker like you, so I think I look at things very differently than many others may even in this space. But I really appreciate, you know, everything you've shared with us and your knowledge. You're just your brilliance. And so I'd love to hear more of, you know, more of your stuff, courses, whatever you have out there, is there. How can people find you if they would like to?

Well, I'm the owner of Kidstown Dental and so it's myself and Karen Long who's amazing. Let me say that she's got a great hand for surgery. And I teach a course twice a year with Dr. Giovanni Olivi. And so the next one's in October and we're teaching laser pediatric dentistry with an emphasis on getting the patient ready. A team approach, how to properly do the surgery with any tool. So how to modify, if you're using hot lasers to do it. Well, and I do cover a little bit of laughter, but I don't do the whole course in that setting. So that's really fun and that's been a great way to meet a lot of people, but thanks for asking.

Yeah, of course. So we'll have kidstowndentist.com in the Show Notes and everything they can find you there. And just thank you again so much for your time, your expertise and this amazing conversation.

Yeah, this has been a pleasure. Thank you so much again Hallie for inviting me. I've had a lot of fun and I really enjoyed visiting with you today.

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 Halibalkin Biz, on Instagram at Alibulcan 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.