Episode 182: Tongue Tie, Development & Pelvic Floor Health with Kelsey Daniels DPT

Hi and welcome to episode 182 of the Untethered Podcast. Today we have Kelsey Daniels joining us. Kelsey's a doctor of physical therapy who works with mamas and their babies in their homes. She uses a coaching style to empower mama to support her baby's motor development without stress or guilt and focuses on mama's recovery to help her return to activities she enjoys with less pain, more enjoyment and yes, less leakage during the day. Kelsey's a working mama of two under five, so she understands the transition back to the office and the exhaustion of pumping, feeding and the desire to still nurture your dreams and ambitions. Check out her Malison's in action birth to 36 months for transformative play ideas and ways to reduce anxiety about development. She looks forward to helping you and your little one explore and stay mobile during whatever adventures you seek. 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. Kelsey, thank you so much for joining me on the podcast today. I am excited to have you join us.

Thanks for having me. It's new to talk to a speech therapist so it's really exciting to collaborate.

Yeah, I mean we haven't had too many physical therapists on the podcast. I think I can, I can think of like a small handful and I think that most of them were like PRI trained and type of like manual therapy and just like really amazing individuals because I actually as an adult like went to one and so anyways, I've been very fascinated by that PT aspect and you know, I know we all are part of the team, but we're going to dive into a bit of tongue tie, tethered oral tissues in general, you know, its impact on all things, right, like posture and feeding, head, neck, all that fun stuff. So before we dive in, would you share with us sort of your origin story or how you got into this specialty space as a pt?

Yeah. So if you would have asked me when I was in school and graduate school, hey, are you going to have your own practice and be working specifically with moms and babies? Nope. I would have been like, yeah, I'll probably do ortho sports, you know, like every other therapist that was like, maybe I'll do neuro. But, you know, those are the things I was thinking. And then I went into peds and then I had my first son. And it was overall a really good experience, honestly. But I did think to myself, if I'm having this challenge or if I'm struggling with this in this way postpartum with my medical training and knowledge, what, how, what are other people doing? Like, they are going to be so lost and it's going to be so much harder. So that, that was kind of one level that I decided to work with peds and adults or moms and babies. And then I had my second about three years later. And that's when the tethered oral tissues layer just like put right on top of that. And I was like, wow, okay. So this is not something that I have a lot of knowledge in. I have the torticollis or the head and neck tie into my what I practice, but it wasn't like on my radar for tethered oral tissues and airway at all. And then going through that journey with him and having his release and just while we're still, it's a long term game, as you know. But I was really dove into like, oh my gosh, there's so much connection between the oral health and the ties all the way down to the pelvic floor. And so that's where I was like, oh my gosh, these babies that I'm seeing and these moms that I'm seeing, you know, this developmental thing just doesn't really ever go away because you still have pelvic floor tightness and asymmetries and all those things that we're working on. So it really became this, this niche or this group that is already underserved, which I learned in my first pregnancy and postpartum and then with my second, it's that other layer that we have capability to help as a physical therapist. But a lot of physical therapists minds kind of don't mesh well with that. And so with my pelvic health already, like thinking holistically and thinking about that, like you mentioned PRI and those crossovers, I was like, oh my gosh, this is absolutely needed. And so that's how I got into really going away from just like peds in their own silo and the insurance model, adults in their other silo and the insurance model. And I just kind of broke free. I don't feel super free as a business owner, but I. I like to say I broke free.

Oh, yes. No. A lot of people go into business thinking, like, I'm gonna work these hours and I'm gonna do this. And then you're like, nope. Now I work 24 7, but, hey, myself.

Right.

Yeah. I love how you just kind of went right into the first of all the pelvic floor. Like, we need to talk about that, but how we can't assess and treat in silos. And that is traditional medicine. Like, that is what we see. And it's tricky because, yes, I get that, like, we, you know, doctors even have become more and more specialized. PTs have. And, you know, certain ways SLPs have. There's so many different specialties, like within or subspecialties even, like, within all of these different medical professions. And it's. It's interesting because we often miss so much when we just go, oh, you know what? Yeah, that checks all the boxes for this diagnosis. So here you go. And I'm going to treat that versus looking at, like, okay, well, how is it impacting this patient, whether it's an infant or an adult? You know, holistically, like, let's look at the whole body. What is the full body impact? Because we, you and I, know everything is connected from the. I always say from the tip of our tongue to the tip of our toes, our fascia and our, you know, than just fascia. But it's so fascinating to me to speak to other providers who get that and to learn from you. I mean, I'm an slp, so, like, the pelvic area, that region, not my thing. Like, we didn't learn about that. We didn't learn about the limbs. We. We learned about what we needed to know from, you know, head, neck, and basically up to the point of the stomach for disorders, but not much beyond that. So it's really fascinating. And I.

Which you're getting really close. When you get to the stomach, you're getting really close.

Right?

So it's. Well, right.

We need. Well, and this is the interesting thing, too. Now I'm in this world where I'm, like, hearing about, okay, well, tongue ties and posture. And we know we need a posture. We posture all of our kids and the appropriate 90, 90, 90, you know, set up for feeding. But here we are as adults, totally ignoring ourselves. And, hi, I have, like, an anterior pelvic tilt, and my patient has a posterior tilt. And, you know, and it was funny. I was actually coaching a business client yesterday, and they told me that they told they they were carrying a lot of tension and pain in their lower back. And they were working, doing some body work and some energy. More like energetic healing, too, on top of the body work. And, you know, I go a little blue. So this person told me that they woke up and the energy had, like, basically the pain, everything had moved up to basically head out of the body. It was now up in the shoulder area. And then something like, snapped. And, like, not in a bad way, but all of a sudden.

What did they say?

They said, oh, they were like, my posture is perfect. It's like that pain that I've been holding on to for so long. And. And they said, I don't know if it's physical and, like, emotional.

I.

Combination of both. Right. And so they were working at it from both modalities because it was sort of, we don't care what works as long as something helps us move this pain out.

Yeah.

And sudden they were like, my posture is perfect. Like, I'm sitting on this call with you, and I'm looking at them on zoom. And I was like, wow, your posture is perfect. Like, this is insane. And basically the person was like, I can breathe better. Like, feel like my shoulders are sitting nice and tall, like, but it wasn't possible when carrying so much pain in the upper and. Or lower back. And so I was just sitting there thinking about some of my, like, adult patients that I worked with, too, and.

I was like, huh?

I mean, I'm not a pt, so I'm not trained to ask. I mean, I do ask about past injuries and for babies and young children, birth, like, birth history. What is birth trauma? Which is a whole other topic, you know, and go into these things. And it. So it's just. It's also fascinating to me because I feel like I'm not hearing enough about the pelvis, and we need to be talking more about it.

Right. And I think that a lot of the challenge, I think, like, you kind of touched on with what we're expected and what we are. I mean, first of all, you know, this probably being coming out of school. And then you're like, I didn't know anything. They didn't teach me anything. I learned everything up until this point. Point. But so much of what we're kind of trained to understand is the process of the doctor sends you a prescription, and it only says this thing, you are only allowed to touch their back. You can't talk about their shoulder, you can't talk about their rib cage. Like, I mean, that's a very old school. That's not how I, that's not at all how I treat. But that kind of really lends itself to like, you only do this and if you need to see someone else, you do send them somewhere else. And so it becomes complicated because as we know, like you said, there's a lot of overlap and being able to adjust. Even as a pelvic health therapist, I don't only. And I've tried to kind of change this. Like I'm a physical therapist first with pelvic health training or with developmental training because I have to look at everything. And so that's, you know, I want people to understand that even though I might look at your shoulder and treat your rib, even if you come to me with a concern of a pelvic health or like for babies, just because you have neck tightness for Torticollis, I'm probably going to be working on your trunk and your hips as well to open that up and not necessarily only sticking here. So that's kind of a really challenging mindset shift. But I think when you're a business owner, you've already gone through so much of those hoops anyways. It doesn't, it's not that weird by the time you get there.

Yeah, no, it's, it is definitely interesting. And I know in the very insurance driven model, it's also like you only have so many minutes to see a patient. So it's like, what is a cheap complaint? Let's address that. We don't all have time to sit for 30 minutes and ask a whole bunch of open ended follow up questions, you know, and it's, it's kind of that catch 22 where you basically have to do what you're able to do within the environment in which you work in order to, in some cases for people to keep their job. Like, that's, you know, and then there's people like me who are like, no, I won't do this, so I'm gonna quit. I'm gonna go do my own thing.

Yeah.

Which, hi. That's basically my M.O.

But yeah. And then you are able to transition out of, you know, that kind of penned in model and you have this opportunity to say, okay, if this is what works for you right now, I will see you one time a month for the next few months while you get things, while whatever is happening in your Life is kind of settled. Not settled, but you're at a better place. And we understand that, even though clinically we need to see you once a week. But I want to meet you where you're at. So we're going to take two hours to do your eval instead of one hour if you're very complex. Or I'm going to see your baby for 30 minutes, they're going to take a nap for an hour and they'll see you and then I'll see your baby when they wake up again for their last 30 minutes or. And I can adjust that versus like in a different model, you know, you're really stuck. So that's been just a big change with the population in general. I mean even seeing, like you said, I think of myself as seeing populations. So pregnant postpartum to five years, baby to kindergarten. So anything that's happening for you and your baby in those five years of life and that pregnancy part for you, that's where I come in. It could be your shoulder, it could be your foot, it could be your leaking pelvic floor, it could be your baby's tongue tie revision and release. It could be their crawling, it could be them riding a bike towards that five year mark. So that's how I think of it as kind of like population based because then you really know them and you know their other social, emotional things that are going on. You know their physical characteristics, you know what their goals are, because you just know them better.

Yeah, no, I love that. And I think that it's a more holistic way to approach it. So I love how you phrase that because, you know, when I started my practice I was like, I'm birth to five. Like basically we were birth to five. We do speech, we do language, we have an ot. Yeah, feeding, here's all that we do. And then over time I had therapists who worked more with certain populations within that population. And so then it was like, okay, well a lot of the feeding kids went to this therapist. But I think what's so interesting too, like even no matter how niche you even get within certain populations or certain areas, right? Like, yeah, you almost can't because there you still need to be knowledgeable about everything else. And maybe you're not like, you know, maybe the person who is working on feeding in my practice is not really working on language, like language only kids. But if they get a kid who needs language support and they're on their feeding caseload, they're doing both, right. So it's kind of also to what you're saying. Like we are trained in and work with the children and. Or in our case, we also do my. With adults. Right?

Yeah.

And I work with these, you know, pregnant mamas and postpartum. There's a, we need a lot more support for the population in general. And it's. I, I was so excited because. And I've talked about this before in the podcast, like I like stumbled upon called the Midwife. The show, like, oh yeah, it's on Netflix and somebody had, I don't know, one of my friends mentioned it to me like months back and it may have been like when my family had Covid or I don't know, but I was like in Bedford. It may have been after my nose surgery. I was like watching it and watching it and there's 10 seasons and I went through all of them and people were like, oh, the show is slow. And I was like, you know what, for me it was so fascinating to watch because I was just so fascinated with the care that was given to mothers like during pregnancy surrounding like they went to their house and you know, this is a low income area and they had amazing support and it didn't matter what it was. You call your midwife and they showed up, you or the baby, and they're checking both and they're, they're teaching you different, you know, what you need to know basically to be a first time mom and to see like the relationship they developed and how they even approached these mamas, like for baby 1 versus 2 versus 5, you know, it was just, I was like, wow, when they say it takes a village, right? Like this is what they're talking about. And I was like, we've gotten so far away from that in the way that traditional medicine works. And I'm like, I just hope that we can get back to that to some level. Because that's, that's what it should look like, that's what it should be, you know, and not to say that, you know, hospital births definitely have a place and we need to have both options.

Right.

And they even have that in the show. Right. But it's fresh on my mind because I didn't know there were 11 seasons. I only knew there were 10.

So you were invested.

I opened up Netflix last night cause I was like, I just need to watch something. I always watch something like while I'm making my kids lunch for like 30 minutes. Like never take anybody that long to make a kid's lunch. But hi, adhd. I put my phone down, I'm like, Watching it, like when making their lunches for school, and I was like, oh, my gosh, there's a season 11. And so I started watching and I.

Was like, oh, I love this show.

But again, it just seeing the different medical providers work together. And you know, that. That whole approach, I'm like, it existed once upon a time and we are all. I know so many of us are fighting to bring it back because again, treating silos is just not. It's not productive and it doesn't make for a healthy society.

Right. And I think there's. There was a few things kind of that you said that were really. That resonated with me as far as just within the last week. It's funny that you bring that up because I just feel like in the last week it really has. I've been able to articulate that better, but absolutely. Being able to visit someone in their home when they're at their most vulnerable is very different than having them come in, drag their baby in, find childcare for the other kids, whatever, take time off work. Like, that is a very different. And a better access to care. So I do that. Like, I'm mobile only.

Yeah.

I only go to people's homes. Everyone. You know, every therapist is different. I'm sure you've met some therapists where they're like, there's no way. And I like it, but I'm kind of a weirdo in that sense.

I love it. My team loves it. The families love it.

Yeah. So you found the right. You found the right people for sure. But one of the things I was thinking about even yesterday was that just. I think that this is like anthropology. Anthropology, I guess, based, but just the change in what we as a culture, society are expected. We move so much more and we don't move together. Like, people don't move in, like, nomadic groups together. They move like in this family. So they're going to a new place where they may not have the same support system as they would if they were in their, like, place of origin for very various reasons and all probably appropriate reasons. But that creates a challenge if you're not like a member of a church or if you're not a member of a community that you can kind of insert yourself into there. And then that community is really challenging. I was just thinking about that this last week, and then even on top of that, I learned a fact. And I'm probably going to butcher this statistic, but I think that it was like 40% of women postpartum do not get access to to or they do not attend their six week visit postpartum visit, which I'm like, oh my gosh, that's almost 50%. That's, that's. Half of the women don't even get there.

Probably because of like beyond that.

Exactly. Like we can't even get to the minimum here. And that's not at the fault of the birthing person or the postpartum person. I just think it's the system. It makes it really hard because they have to get there, like I said, for those reasons. But another piece of information I learned was that OBEs are not reimbursed for follow up care like past that six week visit because of, I think the system, like you said, is there used to be that support, you know, financially motivation to go probably to complete these visits, and now there's not. And so it's like, well, okay, you can go to your family practice physician, but you still have to go to them. A and B, you, it makes sense in your mind as a birthing person to think, okay, I'm going to go see the person who is literally in the room or has the training and knows about what happens during birth and like gives birth to babies all the time. It makes sense you would go to see that person. Like you go to see your surgeon who does your knee surgery for a million follow ups, right? Why would you not go see the person who did your C section or your vaginal delivery for a million visits too? So that was eye opening in combination with the kind of the village theory of like, wow, we really, we're getting back there. Like you said, we're fighting. I think, I think moms of this, I guess of the more recent generations are realizing that we can just as the system has changed to this point, we can change it to a different point. It doesn't have to be backwards, but it can change to a better version of that because we come this far. So that was really interesting. And even just advocating for things like tethered oral tissue release and all of that, I mean that's also kind of changed quite a bit. And you probably have more knowledge in that area, but that's changed a lot as well.

Yeah, we're definitely moving in the right direction. From all of my like dental colleagues that I talked to, they all kind of suggested suggest that, you know, 10, I think was one of them said to me, and this may have been on a podcast even somebody said about 10 years ago or so, like the whole topic of oral health was like taboo and like just not Discussed a lot. And so there's been a lot of advocacy around that. And now oral health is like commonly discussed in dental practices. And maybe I'm forgetting, maybe it was not exactly oral health, maybe it was something else, but I think it was. No, you know, it was the oral microbiome. So it is oral health, but specifically.

Yes, it's. Yes.

And so now that's become, that's become a much more, not just discussed topic, but readily accepted discussion and it's not so taboo. And that took about 10 years. And so they felt the same person basically felt like it. It may be like another 10 years or so or we're kind of like in that 10 year cycle right now where talking about tongue ties and talking about our tether girl tissues in general be more common, you know, more mainstream, if you will. Ten years down the road, you know, and I think it's going to take a little bit longer than that. I think that it's become more readily discussed. But I think that the people who are having the conversations are not well educated. And I say that with the utmost respect. But you know, like we get an ENT at Children's Hospital who disagrees with three pediatric dentists and says, oh, they can stick their tongue out because, you know, they're not tongue tied. And we're like, my therapist is like, the child's tongue is always sitting out beyond the lower lip. That's why, like, I mean, there's a lot of other functional deficits as a result. But like, that's one of them. Like this isn't.

Yeah. If you, if you start out, if you start with your tongue out, you're, you already have what, a centimeter out. So you already started ahead of the race. You're starting past the starting line. Of course you can do this.

Yeah. It's frustrating, right, because looking at the current medical system, like who, like what is covered? Well, you usually an ENT procedure will be covered to do a tethered oral tissue release, but that often requires anesthesia, that often require, you know, general anesthesia, that often requires scissor and suture, which, okay, fine, you know, there. But there's other options available versus paying out of pocket for an oral surgeon or a dentist. You know, sometimes you can get the oral surgeon covered, but most of the time, time oral surgeon, dental, you know, releases, or whether they're using scissors, suture, laser and suture or just laser, you know, you're often paying out of pocket and oftentimes they charge you per location. So if you're Having to release the tongue and the upper lip. That's times two, right? Or they have a fee for each one. And so, you know, that said, I know a lot of dentists who do this in their practices, and these are not their money makers. If anything, they lose money working with these patients because they're also trying to establish a standard of care, like we're talking about, where they have the mom and the baby come in and they do the consult, and they spend 30 minutes with you having a conversation to understand the functional impact. And, you know, are we on track for a release? Do we think that's actually necessary? Okay, who are you working with? What kind of support are you getting? Let's make sure you've got your support team and that you're prepped for this release. And then there's the communication outside of meeting with the patient and, you know, and parent or guardian and, you know, where they're consulting with the other, like us, right? They're consulting with the other practitioners who are working on the case to figure out, okay, what are we seeing? What do we think is the best plan of action? Is the child ready for step A, B or C? Like, where are we in the process?

Is the parent ready?

Right. Is the parent. And that's a big part of it. Is the parent, you know, are they ready? Do they need some form of support? I mean, sometimes that comes in the way of mental health. That might come in the way of ibclc. That might come in the way of just, you know, a session with the therapist to make sure they feel really good about active wound care. You know, there's so many factors that play in that often get missed. Not necessarily by you and I or, you know, people we work with, but by others. And then we get these parents who are like, oh, it didn't work and they just wanted my money. Well, no, actually, they. They could have just gone on to drill somebody's tooth and made a heck of a lot more money in a much longer period of time. Instead, you know, here they are really passionately pouring everything they believe into your child's case. And look, at the end of the day, it's the parent, right, who gets to decide which route they take. And no team either way, in deciding whatever is best for you and your child. Like, that is no shame in the game, but I always like to preach that, like, collaboration comes at a cost. And oftentimes we are not getting reimbursed for the amount of time and energy that we are spending as practitioners to deliver the Best of care. And that's a big difference between, not that we should work for free, but we have to reflect that in our fees when we take on these cases as well to some extent. And just, and then the aftercare, right. Like then you have follow up sessions and you have to continue the therapy afterwards to make sure that the site, the wound site is healing properly and the function is being gained. We need that, you know, neuromuscular re education and all the fun stuff.

Yes, absolutely.

It's a much larger process I think, than most people realize, whether they're the parent of the child, the patient themselves and or other private practice or, you know, I say private practice owners, but really practitioners, especially those working under an insurance based model, whether it's practice or a hospital base, because we don't, we don't have the constraints of insurance basically saying, nope, sorry, you can't do this the way you want to do it versus others, basically being like, I've got five minutes with you, let's, let's do this. You know, and so it's, it's definitely an interesting topic and one that it's like, I wish I could educate more parents on because I know we all want to use our, our insurance that we pay a lot of money for, but at the same time it sometimes comes down to like, well, you can use that or you can have a collaborative approach to, you know, to care. Not in every situation.

Not in every, like you said, not in every situation. But I think even being able to say, okay, I'm gonna go with you either virtually or in real life if that for some reason works out virtually to this appointment. Like I have, I'm in my, in my approach to care. I have a flexible mindset that if a mom is like, I really don't know what I'm asking. I'm really overwhelmed. I'm not really sure what to say. Can you either write it on a piece of paper for me or can you like come with me? I, you know, I still consider that treatment. Like, I would still consider if we, if you virtually had, you know, FaceTime me when I was there and just kind of set me on, on the desk and you had, you'd ask your questions, you go through your appointment and I'm just there to do some follow up and make sure that you're understanding and they're the, you know, the dentist is understanding, kind of like communicate that, then that to me is still a visit. Like, I would still consider that. Okay, we are working on. And honestly, that's A more valuable visit than maybe you poor parent, mom or dad trying to remember what happened in the session when your baby was crying because they're hungry or they just had the tongue tie released or like they're going in for a follow up care and they just did the wound, active wound care and had to reopen the tie or had to reopen the wound. It's like that is valuable to me. And so I think even collaborating in that sense or you know, I've had overlap obsession with speech therapist or overlap sessions a lot or co treated with ot's quite a bit because those every once in a while that's really helpful for that plan of care to make sure I'm not saying something different than what the OT is saying or vice versa or like we're giving this poor parent 20 million exercises and they can't, they just can't do, they just can't do it. And that's not, that's not a bad thing. That's real life. So how to figure out what is the really like effective thing that we're going to give you to get you to move the needle to the next step? Even if it's a little bit like feeling confident as a parent and then also getting that feedback from that baby. So I think that I'm hoping, like you said, it's changing, but I think it does require therapists to go down the route of owning or kind of getting out of the reimbursement model because that's the only way I can do those things. I can't do those things if I'm someone else.

It's not going to be reimbursed. Right, Exactly.

Not going to happen.

So they're billing for, it's for this during that hour or they can bill insurance for this during that hour. And oftentimes like you can't bill for you know, like, like feeding for example, 92526. Like my OT use it, my SLPs use it but only one of them can bill it for that date. You know. And so look at it, it's not even so much the domain, it's the CPT codes. And then also, then you get those parent education codes. Like nothing gets reimbursed under those codes. Like it's not available for practice. So you're absolutely right. And that's, you know, that's also the beauty of being in private practice. Being a private pay private practice where like we do supply super bills to our patients. In my practice, however, I do as well. Yeah, they pay us directly and there's no guarantee on anything. And we do try to help families figure out how to get pre approval, you know, pre authorization. And we have like a little guide how to submit their claims and everything. And they do like 99 of it themselves. Unless like the insurance is like no, this has to come from your provider. And so.

Right.

Like the little amount of time that we do have to spend like helping with insurance stuff, it's, it's a major time suck. I mean it is a full time job. Even like to think about who you have to pay to have somebody even manage this in your practice. It's just whole model is broken but we don't have to go into that.

So I know it stresses me out just thinking about like, like you said, having another person. I'm like, oh, like I can't do that. Uh huh.

No, you mentioned too like when you're able to co treat. Right. You're able to see from different lens and what you've been trained in and what someone else has been trained. And when you're looking at that same child and you're seeing, you're technically quote unquote seeing the same child, the same five minute span or a 30 minute or 50 minute span or whatever. But how you interpret or make sense of the data you're collecting or that child who's sitting in front of you and their behaviors or their movements or I don't know. You get what I'm saying?

Yeah, yeah.

It's very different depending on the provider that is with that child in that moment. And you know, we've done this with study clubs sitting around my kitchen table and I've had, you know, one of my, I have this like favorite case that we all were sitting around my kitchen table. This is like pre Covid. And there was a vision therapist. There were three myofunctional therapists, two of which were SLPs. One was an RDH. We had an osteopathic couple, one who's actually got a PT, who's also a PT. And we had two dentists who are in the airway health space and who do like growth appliances and I'm sure I'm forgetting. Oh, and an oral surgeon. There was like a number of different professions sitting around this table, like really good representation. I think the only thing we were missing that night was an OT and so. But it was really cool to pass the laptop around and all look at the same pictures and have this discussion about what we were seeing and have the osteopath say, well here's what I'm seeing in these, like, cranial strains and these patterns. And then we're like, oh. And then, you know, the dentist is saying, well, I told her she would go to sleep, close her. Her mouth, put her teeth, you know, close her lips that like, I, like, buy her a toy. And I was like, you just asked someone who's physically incapable of closing their lips over their current dental anatomy to like, yeah, so horrible afterwards. Because she was like, oh, my gosh. And the dentist, like, I should have realized that. I'm like, but you know what? We're also trained closed mouth breathe, you know, breathing your nose. Mouth. Yeah. Okay. This child has a bilateral posterior open bite in the front, you know, incisors, central incisors, upper and lower. Literally the only things that come together on this poor child right now in their current dentition and can't. I mean, it was just the top. Poor child's mouth was a mess. But it was very fascinating to, like, have the same case. You know, the child wasn't physically in front of us, but we had images and some videos, all of that together. And that was the most eye opening experience for me was that study club. Because I was like, oh, my gosh, like, why don't we do this in medicine more often? Like, right. As a student, I went in and we had, you know, rounds, and we then all came together and we sat around a table and all the different professionals basically said what they were seeing on the case. But it was a very different experience. It was more like, okay, the box. I know what I was supposed to. With the patient. Yep, the patient's fine with me. Okay, great. Well, maybe we need to send them for a swallow study. Okay, great. You know, moving on. Next patient. Like, it was like 22nd, boom, boom, boom, next patient. And this was like, we got to sit at a table for like 30 minutes on one case, an hour case, and just all discuss what we were seeing in the next best step, you know, in the approach. And. And like, that's what medicine needs to come back to.

Yeah, and I think we did. We did that. It's funny you mentioned that, because we did that in early intervention, which was my first Pete's job. And we did that in early intervention for, like, the. Once a week. We did it. It was an hour once a week. And we went through plan of cares partially because of deadlines, like, of where they were at making sure and making sure kids got picked up and that kind of thing. But it was. It was wonderful. We had the family resource coordinator we had the speech therapist, we had ot and we had pt so we had everybody in the same room, and it was. I mean, we could talk about. Obviously, some kids were still chugging along, so they took less time. And then some kids or something changed and we took more time, and it was. It was really wonderful. But I think that's probably where as a physical therapist, I was, you know, formed a very formative time. And early on, understanding in my mind, thinking that way and not being afraid to reach out to those people on the team. And very much a team mindset of the kid has all three services or the kid has. So it's just natural to me to think that way. But it's hard because a lot of, you know, a lot of moms and babies just don't get access to that. And then on top of that, with the pelvic health piece of airway health, like you said, I sometimes I refer to it as, like, airway to anus. So it's really just this whole connection of. There's literally the tie from your tongue all the way down to your perineum. So, you know, it's not something that's talked about a lot. And so even, like, even us being able to talk about, okay, this is what's happening in this area to someone who's trusted and that they aren't feeling judged is a big step for a lot of people. And even. Even people saying, like, oh, my baby looks. There's something kind of like, they're not quite developing the way I thought they would, or they're not quite.

Something seems off, right? Like something's off.

I don't know what it is, but something seems off. Even that is hard. So I often have. Because you don't want to. Like, I think a lot of people are like, I don't want to judge my baby. It's not fair. It's not their fault. Which is true. It's not their fault. But it doesn't mean that they should have limited access to care. So it's both of these topics. I'm very used to being like, okay, let's just talk about it. I'm not judging you. I just. You're in a safe place to be able to share what you need to share. And both of those populations have a hard time actually going into that discussion.

Well, and I think a lot of that, too, is, like, we're trained not to. I mean, we don't have that time with providers usually. And. And it's amazing because when you do have a provider who spends like more than 10 minutes with you?

You're like, like an hour or two.

I, when I went to the new, the ENT down here, because I was like, okay, I know I need to, I need a septoplasty and I need my turbinates and I don't know what else I need, but like, like, let's go talk to someone. I was so impressed. Like, I went into the office, the nurse practitioner sat with me for like 15 minutes, did a thorough history, sent me down the hall for cbct. I came back, the ENT came into the room. She had already reviewed the notes and the cbct. And she basically said to me, tell me why you're here today. Like, no preconceived notions? No, like, here's my plan for you. And I went into it and I told her and I said, and look, this is kind of what I do. Like, I feel like I've been putting this off for a while. I've. I have plenty of colleagues who have opinions of what I should do. I said, but I don't. I want your opinion. Like, I want your professional opinion on what you are seeing and what you think. And so she spent like a good 30 minutes running through like, and showing me like on the cbt, like, here's what I'm seeing here, and this is that, and this is that. And then she pulled out posters with pictures and she's like, and here it is on this. So you can kind of. I was like, like, I had never heard of nasal swell bodies before, but here I am teaching like a bio course, you know, and I'm like, nasal swell bodies, what are those? Like, those had to be reduced too, which apparently is less common in most other people. They have the turbinates that need to be reduced.

So you're so lucky.

But anyways, at the end of the day, I was, I left that office and I was like, I almost don't care what this costs because I am so, like, I just trust this provider. I feel like passionate about what she does. She has a great reputation, like, clinically and skill wise. So like, it's a no brainer. And I feel like it just, you know, I'm used to leaving a doctor's office and being like, well, I could go somewhere else. It doesn't really matter because they spend like 20 seconds with me. So it's, you know, it's a interesting conundrum that I think that we're kind of in right now, but we're not used to that. And I mean, I'M telling you, I've had grown men cry in front of me because they were like, I've been sent to a dozen different specialists, and nobody, like, to the point where they're like, they think I have PTSD or they think I have a psychological issue because they think that I. Or Munchausens or something. You know, just something. As if they're making this up. And I'm going like, well, anybody sent you for a sleep study? Has anybody ever asked you about your sleep? Has anybody done this or that and the other. And at the end, like, having that time, I mean. And this is all built into our evaluation. Right? Like.

Right. That's the whole point. That's why we have the model we have. Yeah.

I'm like. And I'm educating them, and they're putting all the pieces of the puzzle together in their mind and kind of going, like, why? Why didn't anybody else tell me this before? And so you're saying, like, I'm not crazy, and, like, you can actually help me. And, like, you just see them, like, tear up. And I mean, I've had this with parents of babies who've gone through this with other children. Like, it's not their first child, and they're like, why did I have to struggle so much with my other kids? And I'm like, hi, it was me. That's why you're on this mission, because.

Absolutely.

I'm the mom. I have the kids. You know, and it really, I think that passion, thankfully for so many of us that I've, like, encountered in this space, unfortunately, we had to go through that. But also, I think it is causing a greater change and greater good. So I want to talk about, like, tethered oral tissues from, like, your PT perspective. Because, yes, this kind of goes into, like, my kiddos. Right. Like, I had two very different kids, and I always find this topic very interesting. So my first one was Tongue Tied. Didn't know until she was, like, 24 months old. And I came back for my. My course because she went to an IBCLC and everybody said she was fine. It was like taking your. I would say it's like taking your car in for service. And you get there and they drive, everything's fine. They don't hear the noise, everything work. You're doing something wrong or bring it back if it starts again. And then you go home and you're like, yeah, this is. Here we are like, I don't know why you can't just come see this.

Because we're back. Yeah.

She was like, both my kids could hold her neck up at birth for tongue and liptide. And everyone's like, wow, their necks are so strong they can hold their head up. And then with my first kiddo. Oh, that's so cool. My second kid, I was like, no, this is horrible.

It's happening again. You were having, like, the walls close in. Like, ah, yeah.

No, no, no. But with the first one, it was interesting because, like, her gross motor skills, her fine motor skills. Because I did have her evaluated by one of my ots, like, at least from the. Not really formally for the fine motor. But they were like, wow, her fine motor skills are like, really on par. And like, even early. And I'm thinking, like, I think maybe this was tension. Not actually early fine motor skills per se. But she was the kid who crawled it. She crawled. Or like she crawled up the stairs at six months. She crawled down the stairs at seven months independently.

Ally.

To show her once, like, I showed her how to get like. We were on the deck and I showed her how to get on like a really low sitting couch and then how to like, get back off. That's all she needed. And she had that motor pattern. And I was like, oh, man. And then she was the kid who, like, at little gym would climb, like up the little rock wall thingy and then turn her little booty around and slide down the other side. And it was like, how old is she? And I'm like 10 months. And they're like, wow. And I'm like, she's a freak of nature. I don't know, like, she could hang for like a minute and a half.

At, like, months of age.

She would just hang on the high bar. And I'm standing there, like, waiting for her to drop. And I'm like, okay. Something in the back of my mind was like, okay, this doesn't seem normal, but, like, I'm not going to overthink it because nothing wrong with her. And then all. You know, but she was like her struggle was feeding. And now I know airway. And then there is the opposite. My. My second one was born and she had more normal tone, if you were. And still a hat still could hold her head up nice and nice and strong. She was a kiddo who dragged her. Her knee behind her and scooted.

Yeah.

We were in PT for like 8 months and not much was changed. And then I was like, mind you. And I was like, they're like, she doesn't have torticollis, but here's a torticollis handout And I was like, okay, now both my kids had great head shapes. I got very lucky there. But I ended up taking her for, like, CSD and osteopath and to the osteopath too. And like, boom. Child gets up, walks, like, starts calling normally the next week. I think it was, you know, certain system integrations at that point that needed to kind of just be finalized.

Yeah.

Or whatever. You will have everything flow together. So all of that, like, not to say, like, diagnose my kids or, you know, whatever. But I just see so commonly these types of links and they present differently. Right? Like, absolutely. Issue kids, obviously, we. I feel like the feeding stuff is very easy to see, but then some of the motor stuff, parents don't notice until a little bit later. Like when the kids crawling yet or walking late or. And whatnot. So, like, what do you see? Like what I mean, I'll just turn it over to you.

So as far as what you talked about, with two very different levels of tone, but still things that were concerning. One of the things that I see a lot is, you know, early isn't always necessarily better. Like you said, okay, you're coming out of the womb and you can hold your head up. But like you said, is that tension or is that true, Truly strength. The other thing being. The other aspect being so much. We skip rolling so much. Like, yes, I'm happy that people are. We're talking about crawling a lot, which is great. Still a milestone. Sorry the whole AAP thing, but don't get me started. Yeah. But the rolling all. A lot of times gets skipped too, because I think we feel like, okay, we want to let the baby develop. And it's so early on. They shouldn't really. They shouldn't be doing anything because. Because they're so tiny. And there really is a lot of prep with rolling that goes into crawling, that goes into walking. It really is such a blend. And I think what I see a lot of times, and this happened with both of my boys, was they. I think honestly, they have lower tone. It's not low enough tone that they're not doing things. But I'm also their mother as a physical therapist. So if they were born to a different mother, it could have been entirely different as far as what their expectations were. And if they were working on things I was working on, I work on things with them every day. So that tone or low tone can be hard because a lot of times people are like, well, the baby's just big. And I have had two large babies and they're just big boys. But that doesn't mean that their expectations of their milestones should be different. There's a window of time that we're looking at, so we want to hit the sweet spot of that window. Not too early, not too late. But that tone factor. And I saw an email from you the other day and I was like, oh, my gosh, she's talking about tone. Great. Because that really does come into play. And what's interesting about the tone that I've seen, at least with them, is that my older son, he doesn't have. We're not going to do a release for him. We're going to do omt and we're just. That's where we're at with that. But he had drooling early on. He was an orthodontic pacifier baby. Again, I didn't, I did not know what. I know. Now he has a retracted jaw. He doesn't. He still kind of feeds with his mouth open. Like, like eats with his mouth open half the time. We're working on all the nasal things and the oral things, but. So that was him. And he was very much. Even my husband, my sweet husband, who I usually give a hard time, but he was like, he drools a lot. Is that normal? And I, like an idiot, was like, oh, it's probably fine. He's still like eating and talking and like all this stuff. And now I'm like, oh, my God, that was a sign.

But you know, you know what? You know, right? You know what you've been educated on and it's not your fault if you don't have that information.

I was just so proud. He crawled on like, in the window. I was like, woo, you're crawling in the window. You're walking in the window. We did the things you were rolling, but we had to try. I worked with him so much along that, along his continuum. I still work with him now. But then my second baby, we had him released at two months and he still does have that lower tone. It was tough with his wound, active wound care, because his. This low tone of his tongue. And I was like, oh, my gosh, why? This is so hard, so frustrating. But with him again, I seen him reach his milestones and he had a myofascial release. He had myofascial release before he had the procedure and then after, once he had the procedure and those two journeys, they both have this, like, lower tone. But my second baby has been not early, but has been ahead of his brother. And it's hard to say if it's like, because he sees his brother doing things or if it's truly because he had his tension, he's had his tension patterns managed more effectively or more holistically than his brother. Because like I said, I worked with his brother, his older brother, but I didn't do all the things that I did with the second one. So a lot of times what I see, like you said, is really this concept of just because they don't have torticollis and they're, like, kind of strongish or they love to stand. That's like my fear. Oh, gosh, that gives me anxiety. When a parent is like, they love to stand and they're five months old. I'm like, okay, let's work together then. Because that tone tension is a whole body. And what their muscular tone, it is telling us something. It's not necessarily saying they have to do it in this way, but it's telling us something. And I think that's a flag that sometimes as PTs, we can be like, oh, well, they're a baby and they're lazy because they're not rolling. If you're like a new repeat, if you're a newer peds PT and you're not kind of stepping back and looking at, like, the whole system and asking if they've been. If their oral function has been evaluated at all by the speech therapist or the ibclc. So those are the big overlaps I see. Of like, we need to ask those questions as physical therapists because we know our stuff, but we don't. We miss a lot of the picture if we're not asking.

So here's. Here's like, a touchy subject. What are your thoughts on guiding parents who are like, okay, well, I'm working with someone because, like, this was me, and I valued the person that I was working with, second child, the pt. But I also came to realize, well, this person's not really trained in tettural tissues and airway and holistically connecting all these dots. Like, I felt like we were forcing the knee down, and that wasn't working right. It wasn't staying down.

It was like, only to that specific spot, like, you were addressing the problem.

Right where it was the knee down. We pulled the leg in a certain position and forced her to crawl this way or force her to stand against the wall this way. Or forced her hips into a certain position while she reaches up on the wall and does. You know, it's like, okay. You look at it and you go like, well, it looks like, we're working on full body stuff. But then I talked to, like, a pri trained pt, and they're like, well, you never want to go against the strain. You want to go away from it. You want to kind of release it so that, you know, the bot. And when they started explaining things with just, you know, from a fascial standpoint, I was like, okay, well, I mean, I'm an slp, but, like, that makes sense. Like, I was like, okay. And. But they're like, but that's the opposite of what's often taught in the school. And so it's like, if something's not working, what else can we try? Why do we. You know, it's this whole, like, we get stuck in a rut of, like, doing the same things over and over. And, I mean, I tell my team all the time, I'm like, if we're not making progress, we need to stop and figure out why. And if we can't figure out why, we need to see what else we can try. We need to have open discussions with the family. Like, they are paying a lot of money for this private service, and I take it very personally if we, you know, like, I don't want to just say, oh, the family's not doing their exercises at home. Oh, the child. Low tone. Oh, this. Oh, that. Like, no.

Yeah, that's what I was gonna say. Is that little. That little piece of. Again, what we. What we were trained in school. I've been there. Not recently, but years and years and years ago. I have been there where you feel like, okay, that their parent isn't doing what I had asked them to do, which is a very. It's a very small. Honestly, it's a really small piece of the puzzle when you look at it. When you look at it overall. And I think probably in that situation, it would be a question of. And I think this is okay. I think this is okay to say to a therapist. I think we need to take a break right now for this reason. I feel like we're just stuck. I appreciate what you've done, but I think that we're going to take a break for now, and we will come back if we find something different or if we want to collaborate more. And I think the two that can go kind of a couple ways is the therapist maybe is younger, and they're like, oh, no, they got not younger, but, like, younger in the profession. Profession. And they're, like, personally offended. Like, oh, my gosh, what did I do wrong? What am I doing? Like, that's why don't they like me? Why don't they like me? It's just because they don't. It's just because they. The parent doesn't know what they're talking about. It's one way more traditional way. I'll just figure it out, fill them, you know, fill my schedule. But on the other end of that is I feel like a little bit more of an enlightened therapist. Of what do you feel, especially with you as a parent with medical knowledge, even if you weren't an slp, even if you were an ot, even if you were a physician, like, what are our dentists? What are you seeing? Help me understand what you're maybe seeing and what you've talked to another colleague about that I'm missing because I value that I can probably learn something from you. And I have had that happen to me where it's like, okay, I just don't think we're the right fit. And that's okay. I just ask for feedback. I just say, okay, what is it that we. What is it that you would want me to know for the next family? Is it something that you want me to know for our plan of care and our relationship that we have? And you would maybe want to rethink your. Your initial thought, because it's a very different place. Because that person can learn a lot as a therapist and then figure out, oh, wow, like, I learned that through my kids, but I could have easily learned it through a patient. I learned things from my patients all the time of, like, wow, okay, that didn't work. Cool.

But that also requires putting, like, you have to put your ego aside and you have to get vulnerable, and it is hard. Like, you have to. I think that's the biggest thing is I see a lot of egos get in the way of therapists, like, being the most incredible therapist they can be. Not to say that this happens often, but I've seen some situations where it becomes more all about the therapist. They're like, oh, that family was awful. Like, they just canceled their sessions and this, that, and the other. And I'm like, well, maybe they felt that they were making a big investment and it wasn't the right fit for them. Or maybe they found someone who they felt was more aligned with the path that they wanted to go down. Or maybe it just wasn't a good time in their life. Or maybe there's something financial going on at home and they want to share that with you. You know, it's like, we could make up 75 different maybe stories. Right. But I think that at the end of the day, because I like, I coach on this too. I'm like, we have to understand that like in the world of business this happens all the time. Oh, absolutely.

Things are shifting all the time. It's so dynamic. Your schedule is not ever really going to look the same all the time. It's just not.

And like we're, we're in a helping profession. So I think a lot of us take things very personally. If someone's like, hey, you're not the right fit for me or hey, we're going to go this other route or hey, we want to use our insurance, so we're going to go over here and you know, and I learned a long time ago not to take it personally. And it's also interesting because sometimes, especially if it is monetarily driven to some extent, which I totally get, like sometimes those families find a way to come back to you if you were the right. So often when they leave us to go in network to use their insurance and then they're like three months later, they're like, hey, can you work us back into the schedule? And we're like, okay, no problem, we'll figure it out. But I think that you mentioned something that was really great. We'll start to wrap up in a minute. But one of the things you said was like asking a provider like what the plan is, why, like why we're doing this. They should be able to explain to you 100 why they're doing it and provide education. Now look, there may not be level one, level two, level three studies, like evidence based practice type studies to support everything doing right research 17 years behind. Right. That, that's not what I'm talking about. But if they say to you, I'm referring you to this, this person, or I think that we should do this in therapy or you know, there should be a reason. It shouldn't just be oh, because someone told me I should or oh, because, you know, they catch them off guard and they can't tell you why they're.

Doing what they're doing.

Then that, that begs the question of like, well, what are we even doing here? We should be working towards some overarching.

Because you're asking them to be, especially in the populations that I see, you're asking them to be, to be very, very vulnerable. You're asking them to be very vulnerable about their life, their literally their pelvis and what is all contained in that. Or their baby, their new baby that they created and they just want to be seen as a competent mother. So you're asking them to be vulnerable. So you should be able to be vulnerable, too, in what you're saying. Not that you have to say, like, I have no idea. But you're saying this is my. This is my intent and what I'm trying to do. I see that you're not seeing that it's working. This is a progress that I'm seeing that maybe you're not seeing, but this is what I'm seeing. And I'm happy to ask this other colleague that I have that has dealt more with this specific thing than I have. And I'll get back to you. I've also done that a lot of. Like, I know a colleague who works with this with tongue ties a lot and with feeding a lot. And I have a lot of experience, but maybe I hit a bump and I'm like, I don't really know what to do right this second. This is what I want to do. Let me get back to you. And that's more appreciated than, like, yeah, I'm just gonna hope you don't know it all.

Right. Like, nobody.

Yeah, like you know it all. Yeah, Yeah.

I actually. I say that too. I tell people I'm like, you'll be more appreciated for not pretending like you know it all and saying, hey, you know what? Let me do some research or let me speak to a colleague in this space and get back to you. Like, they're gonna appreciate that you are taking your time and energy to answer their question versus just giving them some. Some random answer and blowing them off. Because that's what they're used to. They're used to someone just saying, oh, you know what? I know, or, oh, everything's fine, or, oh, you know, most people don't take time out of their day to research something further so that. That's.

Or ignoring them. Ignoring and hoping, like, oh, time's up. I have another person. See you later.

Yeah, let's talk about that next week. Oh, goodness. Well, this has been amazing. So tell us where we can find you.

Yeah, so I am. I have a website. I'm over on Instagram at the mobility project, and I think that there's a link probably in your show notes that you'll have there for. For that. But My website is www.bmobile live L I V E. So that is easily, like I said, or on Facebook. I have a Facebook business page as well. And actually a group that is specific, has specific experts. So if we have an IBS dlc, a dietitian a pt. We have a sleep consultant and I believe we have another expert on there as well. But it's kind of like a mom group that you don't have to worry about random information, but you get actual concentrated information and that's on Facebook as well. So easiest to just follow me on Instagram and all that stuff is linked. Awesome.

Well, thank you so much Kelsey for joining me today. This has been so much fun.

Thank you for having me.

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 for 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 @alliebulcan 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.