Episode 183: The Benefits of Adult Expansion & Myo with Kelley Quolas, BSRDH, QOM

Hi and welcome to episode 183 of the Untethered Podcast. Today we have Kelly Qualis joining us. Kelly's the founder and owner of My.

Myo My Health, which offers myofunctional therapy, speech therapy and breath work in two locations, Phoenix and Mesa, Arizona and globally via telehealth. Her practice includes registered dental hygienists and speech language pathologists working alongside each other for the greater good of getting to the root cause and empowering and advocating for their clients. She's a licensed dental hygienist with over 20 years of specific pediatric and special needs experience and and has had extensive training in the world of orofacial myofunctional therapy and the practice of Buteyko Breathing, in which she's a certified Buteyko breathing practitioner. She received her specialized training initially through the International association of Orofacial Myology and has achieved her qualification in orofacial myology.

Through NEO Health Services.

She prides herself on keeping up to.

Date in current research and therapy modalities.

To benefit her clients. Her favorite thing about being an orofacial myologist is the connection and relationships she.

Develops with each client.

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 health care 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. Welcome, Kelly, to the podcast.

Hello. Thanks for having me. I'm so excited to be here.

I know we were just like talking before the recording, but we've been like Instagram friends forever. So I was like, I feel like I know you so well and I'm so excited that you're here.

Same, same. And I know I. I think we kind of started our MYO journey because I remember seeing you posting when you were pregnant in my own Masters and like, oh my gosh, this lady's like pregnant and going through the comics and she crazy or what?

Yep. Hi, that's me. Yeah, crazy Totally, totally defines it. And yes, point, like we've both Been on our own, like, airway, you know, expansion, myo tots type of journeys. So I'm excited to. I've been following yours online and I know that we talked about having you come on here and share a bit about your journey. So I would love for you to share with us. I know you're using a vivos appliance. I used one as well. Just kind of share with us, like, what. What got you started on your journey.

Yes. So I think we're all in this space because we have a personal connection to airway health and sleep and breathing. So I was in pediatric dentistry for over 20 years. And so you see these kids come in and out of your chair and you start to notice things. And I would say over the past 10 years, I started to notice more of these concerns and checks on health history with sleep and breathing and tonsils, and it was getting harder to manage them in the chair. And then looking back into my history, I had my kids really young. And so at 20, I was a new mom. I was in the army. I was trying to breastfeed, and there was absolutely no support at all. And my son had a tongue tie. Fast forward, you know, 15 years later, when I'm sitting in my first IOM course with Sandra Holtzman, and I'm like, this, this was me, this was my son, this was my daughter, like. And so my why is I don't want any mom to feel like how I felt with no resources. No. And then also I don't want anybody to experience motherhood like I did and have those sleepless nights and think that it was just okay and go on for years and years thinking it's because I'm a mom and I had kids and, you know, it's not my job to get a well rested night of sleep. And that's not the truth. And so that's why I'm here.

Love that. And I think you're absolutely right. So many of us start on this journey because we. We take our first course and we go, hold on. Okay, wait a second. Like, I came back and I remember flipping Lily over, like, in like, our nursing chair. I mean, she wasn't nursing anymore, but I just, you know, got home from. From Sandra's course. I sat down in that chair, I had her on my lap. I kind of flipped her head, you know, upside down, and I looked and I was like, her tongue, like, went up and I was like, oh, yeah, okay, let me look at her lip. Like, there it is. And I was like, so she's 24 months old now. And now I know why the feeding experience was so painful and so challenging. And this child never could get over the first percentile for weight in her first year. And, you know, I took her to IBCLC and was turned away. And it just. It started exactly like as you said. I don't want another mother to go through what I went through. And if I can educate and prevent that from happening even on a small scale. Right. That's. However many other moms don't have to experience what I did or. Right. If they're going through that they have the resources or the know with all to know who to seek out, what questions to ask, what symptoms may be connected to what. Right. And so, yeah, I mean, I've seen so many of us mamas, like, on this journey because of personal experiences, and then we all kind of look at ourselves and go, like, okay, I guess it's time to focus on us.

Well, I also, like, it's. All of my nieces and nephews need help. And so I feel like, you know, I'm on this planet for one purpose. But I had my oldest nephew sleeping over. And, you know, I was working in the office, and I started hearing that. That sound, and I thought he was kidding. And I looked over at him, and his lips were turning blue, and his mouth was wide open. And, you know, that really started getting me. That was the pivotal moment in which I started Ask. So I went back to the dentist I was working for at the time, and I'm like, you know, hey, I saw my nephew do this mouth open, snoring. His lips were turning blue. And so we kind of put our heads together and started looking at what did that look like as a pediatric dentist and pediatric dental hygienist. So then I came across the orofacial myofunctional therapy course, and I was coming to Phoenix. And so, you know, that's kind of, you know, all of those breadcrumbs led me to where I'm at now. And sitting in that course, I'm sure, you know, your experience, too, is just lightning bolts, fireworks, and, oh, my lanta. I'm seeing this in every kid in my chair. And, you know, I need to put my armor on and start knocking down doors and get throwing kids over my shoulder.

So, no, I came back and I was like, hi, can I assess your child for free this week? I was like, you're already on my caseload. I won't charge you extra. I'm seeing you for a session, but can I just do you mind if I did this? My assessment. And then it really changed the trajectory of how I looked at the children in front of me and how I approached them in therapy as well. And not, you know, not all of them, they weren't all there for the same reason. But for the kiddos who had speech sound disorders, who were on my feeding caseload, kids who were drooling, open mouth, posture, you know, all the things we learned about in that intro course, and we're kind of going, huh, okay, there's more going on here. And then I started to look at the kids who had like certain behaviors, like the off the wall kiddos who can never really calm down and who are super sensory seeking. And I started going, I wonder about their airway in their sleep. I mean, it was just like this, like the rabbit hole had been opened and I was deep down that rabbit hole. Like it was.

Yes, I think we all were after that course. And so, you know, I'm so grateful because I've been able to, you know, we're going to talk about our vivo's journey, but I've been able to help myself become a better mother, a better partner, a better sister. And so like, that's transformative. And you know, I had one patient and when I was still practicing clinical that said, you know, I went and I went to the ENT and I got her tonsils and adenoids out and she is a different kid. And I just want to say thank you. And you know, to me, that really hit home. I'm like, okay, I have to, I have to pivot myself. So like you, I was going to people's homes for free. I was doing free mayo for quite a while just to get some hands on experience. And you know, these families were willing and they were at the point where they were inviting me into their homes and wanting help. And so the need is there and it's just such a rewarding career. It's just such a. I love what I do.

So, yeah, I mean, you're changing the trajectory of someone's health and I think, you know, I look at it as giving them a lease on life. Like we are literally taking these children who are headed to, toward maybe ADHD medications, depression, increasing anxiety, struggles in school. I mean, the list goes on. You know, feeding challenges, nutritional deficiencies, like all kinds of issues that, you know, not that every child has every single one of these issues, but we see this across the gamut. And if we, you know, I tell everyone if we can intervene during childhood, whether that is like the little, little ones, or we're talking about, you know, anywhere up through, like, teens, before young adulthood into, you know, before the college years. Like, I. We work with all ages, we work with college adults, etc. There is no limit who we will work with. Like, you know, on my own, I know your practice, you know, sees the whole lifespan, too. I know you've got. Even got some SLPs I think, that work with you as well, which is awesome. So, you know, all this to say, like, if we can change a trajectory, we can change the anatomy, if we can change the soft tissue, if we can change the way we're breathing and speaking, sleeping and chewing and all swallowing, all that fun stuff, it's literally changing health trajectories and I think arguably causing less stress to the system. And we know stress causes most of the ailments in life, so, you know, we could go talk about that all day long. But it's really amazing. It's amazing work. And, you know, I've had those situations, too, where, like, a child gets tonsils or adenoids out and, oh, my gosh, all of a sudden, they're a different kid. Like, I don't recognize my child for. But this is, like, for the better. They've. They're totally different. And all these symptoms we were seeing before that we didn't really realize was a major, major issue. Like, now we see it was a major, major issue, but we were the first ones to really bring it to their attention and help them advocate for what was needed for that child. And so, you know, I think we all have these types of stories that just absolutely makes the work that we do, like, 100% worth it.

So. Worth it. So worth it. Yeah. And I was the kid that had the tonsils and adenoids and the tubes and frequent ear infections. I have a strong memory of being out on the playground and not hearing the whistle and crying because I couldn't find my classmates and my teacher. And so. And then nightmares, you know, my whole life, nightmares. You know, being in the military, I had some ptsd. So I'm sure, like, all of that kind of connected to where my airway journey led me. And now, you know, going through my. On myself, retraining my body on how to breathe better, you know, I have to be that example that I'm showing to my clients. But also it's helpful because I feel like a different person. And so using the Vivos appliance has. Has definitely transformed my sleep. And just really, like, at this stage of my life, I'm 43. My hormones are changing, and, you know, I want to be the best. The best person I can be. And so I feel grateful knowing all the things that I know and how to, you know, connect with the right practitioners. So, yeah, I just. I feel that there's value in information too, and we're here to deliver that now.

I think it's amazing that you practice what you preach. Like, I think it's. It's hard because it is a journey. It is not a quick fix. It is definitely a journey and a big commitment. I think that going through some of this myself really helped me connect on a much deeper level with my patients and with parents of my patients. Just as the mom who's been in through it with her kids, as me, myself as the patient, you know, you just have this different level of, like, appreciation. And I think these, you know, the parents especially, and sometimes even the kids are like, oh, wow, you do that too. You have the same thing. I. Or you did this already. Or, you know, it just, it. It normalizes it in a sense, and it makes it a little bit less scary because it is a journey, it is a commitment, and there's a lot of pieces to this puzzle. But I'm curious to know, like, how did. How did you come to pick your specific appliance? And is it the DNA vivos that you're using, or can you tell us about what you picked and why?

It's the vivos DNA. And so I worked with a few clients that had the vivos appliance, and I also worked with a client that worked with Dr. Ted Belfor, who had a bioblock system. And so, you know, kind of just seeing that experience from being on the other side of the table with them or the computer, and, gosh, they're. Their sleep is getting better. You know, I'm like, talking to myself. Oh, wow, this is really cool. And so, you know, this. This career, too, is you're constantly learning, you're constantly researching. And so I did a lot of that deep digging. And then it was serendipitous, where I had a practitioner, a dentist reach out to me and cold call me and say, hey, I came across your website, and I see that, you know, you guys have myofunctional therapy and you can teach people how to breathe from their nose. Well, I just bought into the vivo system and was like, oh, Like, I had just literally, like, looked at the map of practitioners, and I was planning on. On hitting the pavement. And, like, that's how things work. I don't know if it works like that for you, but that's how it works. How. How it's worked for me so far. And so we connected and then, you know, talked about our patients that we were seeing collaboratively. And I felt like this was the best appliance for me, seeing the results, reading the research. Then I had also heard Dr. Dave Singh, who is no longer affiliated with Vivos, and Dr. Liao, who's no longer affiliate. But I heard them speak when they came out here two or three times, and I was just blown away with how much they've poured into researching the science behind it, all of those things. I was like, okay, let's. Let's do this. And, you know, we. We went and did our records and things like that. And of course, I think, too, it's probably similar. When we started. I started this in 2017, it was like, tongue tied, tongue tied, tongue tie. And I really wanted to get my tongue tie released because I knew I had one, but I didn't have enough oral volume. I didn't have enough tongue space. And so I, you know, was, what are my options here? And then this. Vivos also, I knew, could help me with that. And so it's been really practical because I can take it out when I'm working with my clients and put it in. But that's also the downside, too.

Everyone's like, why were you in it for two years? And I was like, well, there's a number of reasons. One of which, I only wore it eight hours a day because I talk for a living. I was like, oh, and I needed my mouth for what I do. I was like. And to, like. I think just from cranial strain patterns and things like that. Like, I sometimes had to go see my pt, who was pri. Trained to, like, unlock me before I could actually crank it and, like, put it back in, because it just, like, halfway through the treatment, it got to that point where I was like, I need to see Manny before I can, like, crank this again. And, yeah, so I moved. I moved slow, but I did what worked for me.

Yeah. And so you wore yours for two years. Okay, I worked.

I wore for two years. And then I admittedly was like, oh, I don't love all these spaces. I'm a little vain. I don't love all these spaces in between my teeth, especially on the sides. I felt they were really, really visible. So I went into Invisalign.

Okay.

Which I then learned from presenting with some dentists in the airway space. They were like, yeah, don't do the last couple sets of trays because it actually retracts you. And I was like, you couldn't have told me that four weeks ago, because I just finished them. And I was like, and I see what you're saying. So now it's like, I need to go back into another appliance. I don't know.

Yeah. Because I heard you mention that on one of your previous podcasts, and that's kind of like me, you know, I'm a dental hygienist, and so teeth are everything. And so, you know. But you know what? I thought I would have more value in the aesthetics. I don't, because I. My reward is I feel better, I'm sleeping better, my head's clearer, I'm not as foggy. And so, like, it's really what's more valuable to me. And to me, it's the health benefit as opposed to aesthetics. Now, don't get me wrong, honey, I love the way that my face is looking. I love. You know, I love all of that, too.

Cheekbones.

Exactly. Exactly. So, you know, I have seen some. I had some slides of the pre and my checkup, and I'm in it for a year now. And so he. Basically, his name is Dr. Batais at Scottsdale Family Smiles. But he said I could probably wear it another six months to a year if I desire to do so, which I think I'm going to. I think I'm going to see how long I can go and how much growth I can get out of it. And growth. I mean, my airway. And then go from there. And, you know, I had my tie released in February. Yeah, February. End of February. So six months now. And just the amount of tongue space I have is crazy. Like, crazy, crazy swallowing. I know we work with people on swallowing and tongue thrusts, but I understand from a patient perspective of how the limitation in your oral space can definitely inhibit a functional swallow. It's just so much easier now. That's part of the pathway, is we want to make things easy and attainable for our patients, clients, and make sure we're looking at those barriers of why we're seeing the dysfunction in the first place. This is a tool in our toolbox.

Yeah. Yeah. No, and I. I honestly, I loved it. It was bulky, and I noticed that my tongue would sit in between it. I did have my tongue tie released before the appliance, but not. It was sort of done, like, in chunks, not as a cohesive plan. I would do things differently now. It was like, I have enough space to get away with A tongue tie release. But I also have low tone, like lower tone. And I have. My body just heals very quickly, very differently. I don't really feel a ton of pain. I think a very high pain tolerance. So like no pain, just like a teeny bit of discomfort. A little hard to eat like the night that I had my tongue released. But also it healed. It started to heal on itself to more of like a triangle versus a diamond, like immediately. And I've now learned that I possibly have like eds. I possibly have, you know, just my body heals differently, so probably should have had it sutured. It's not perfect, but it semi fit. So I think between, you know, my body like locking up, my maxilla still turned in on one side. I definitely am not done in my journey. But I kind of was like pump the brakes on the dental stuff at the moment. Because I got benefit out of using the DNA. I definitely could breathe easier at night. I think my sleep did improve to a certain extent. However, aside from the fact that I retracted myself a little bit with Visal and afterwards, unintentionally, I had a deviated septum. And when you looked at me, you couldn't necessarily tell really, really well because it was deviated in like the posterior third. So it was kind of hidden back here. But I really couldn't breathe very well at all throughout the left side of my nose. And so I think that that plus enlarged turbinates, plus enlarged nasal swell bodies, like all of that was, I think, impacting me in a way that I wasn't feeling the full benefit from the appliance work. And you know, the growth that I had, I was feeling some, but I'm like, why does everyone else have such a. They have much better, you know, relief. And I didn't have migraines.

I didn't.

I wasn't a very unhealthy individual to begin with, in my opinion. But it was more like my body's always inflamed, I'm always tired. Like it was like, you know, fatigue, you know, having a lot of fatigue and an inflammation. More so than, you know, I've had patients who really just. It's completely debilitating, like they can't get out of bed in the morning. And that wasn't me. So I was like, oh, maybe my symptoms were more mild, so my results are more mild. I don't know. I do think that going back after my nose is healed, like I don't want to mess with anything because I also had a rhinoplasty so I'm like, I'm giving it a full year and we're about five months into that. I want to see what we can do. Now that my nasal airway is patent and like, once all the inflammation is like fully down at the 12 month mark, I'd be curious to see like, do we think another appliance, like, even in vivos DNA may be a good route for me? Because I think now my facial anatomy would support the growth and would sustain it. And now, I mean, I'd be curious to see. We could like unlock and kind of like shift my maxilla because we did get some movement, it just wasn't holding and so we couldn't really get it to go any further. And that was a combination of using the appliance and having my, my pri trained who did what he called modern counterstring technique. So, you know, it was. I definitely feel like I was doing all the things, but sometimes like we hit a wall and it's kind of like, okay, what, what now? And finally, what now is nasal surgery. So here we are five months later and I am very happy that I did it. I definitely can breathe better. I did a sleep study, like right before the home sleep test with Ken Hooks, and I'm going to do another one. I want to do it once I know a majority of the swelling is down because I don't, I don't know that it'll be super beneficial to do it yet. But he and I go over it on one of my podcast episodes and one of the things that we noticed was as soon as my body went into that deeper sleep or into REM sleep, it was like, nope, pop you right out. So I was never actually getting REM sleep during the majority of the night. And I'm like, well, no wonder I feel like I don't sleep. And I rather stay up late and just get things done because I'm not getting restful, restorative sleep anyways, even if I do go late in bed and, you know, think I'm sleeping.

So anyhow, yeah, that's like where, where I'm at too. I had a sleep study before and so that's pretty much standard, right? And so I didn't really have anything that, you know, nobody in the space would look at and say, oh, you know, you got this or you got that. But I had my AHI was 3, but my RDI was a little concerning. And you know, I just, prior to my journey with myo release breath work, I was waking up multiple times a night I was sweating through my sheets and I thought that was just my old lady hormones. But, you know, I was like in my late 30s, so, you know, those were, those were something for me that was life altering. I was getting migraines, cyclic migraines. Every Wednesday. I remember calling a client, laying on the floor of my office. I cannot go the rest of my day. And that's debilitating, especially when you're a business owner and then you're a healthcare practitioner. So for me, I have maybe had four migraines in a year where I was having them weekly. My neck is definitely in a better place occupationally, being in dental, you know, that long. My neck was just jacked. And so now I have better extension, range of motion and which even improved after my tie release, which was really interesting. And just overall, I'm definitely feeling more rested when I wake up. I'm not like, oh, laying in bed and hasty and turbinate reduction. And, you know, there's been some health issues. He's got some cardiovascular issues, hypertension, afib. And so I know talking, even talking to his ENT and his cardiologists, they say sleep is everything. And I told them, I'm like, I'm so happy you're saying that. And to make that connection of how restorative sleep needs to be when you have these inflammatory concerns, we have to be looking at the quality, not the hours, the quality of these people's sleep.

Yeah, that's amazing. So you talked a lot about your symptom improvements. Do you see? And I know that this is primarily the appliance that you've used, but you've seen some patients and others are there like pros or cons to the vivos appliance that you notice? I mean, I know we kind of talked about a few being that obviously it's removable and so that can be a con. Sometimes it's pro and a con in of itself. But any other like pros or cons that you've noticed as a user?

Yeah, so as the user, it's, you know, for one, it's keeping up with the time that you're supposed to wear it, of course. And then it's hard to communicate. So it's, it's kind of. You get frustrated when you're, when you're trying to communicate and it's hard because there's this block between your palette and your, your appliance and your speak very.

Well and it's hard to close your lips. So. Yep.

So that's frustrating. So I Usually have to take it out. And I'm, you know, like, didn't you understand me? Especially after wearing it for a year, honey. So that's another con. And then I guess the teeth, the aesthetic part about it is my teeth look different and they're shifted and there's spaces. And I have a diastema now where I didn't before and taking it out to eat and keeping it clean. So, I mean, I guess it's like, on the low end of inconveniences, for what it's worth. But then in regards to being on the other side of that, being the therapist, I see that there is definitely a patient selection concern. And when I met with the Vivos reps, when they came out here a few years ago, they were really interested in talking to Audrey and I. Audrey works alongside of me about myofunctional therapy, and I feel like there needs to be a little more connection to that, to these Vivos providers, for sure. Because I also am on a Vivos support group on Facebook, and you know how you kind of, like, are a silent reader and I don't. I hear lots of questions coming from these patients who don't have a lot of background on, like, where their tongue's supposed to be, how they're supposed to breathe. They have ties, but what are the steps on releasing if so, and things like that. So I feel like it's so valuable to be working prior to the appliance and kind of going through a screening process in regards to barriers. So, like, in your case, the nasal breathing and things like that, because, you know, it can be costly. And I think I mentioned that when, you know, I sent over my little bullet points. But access to care and cost is definitely another con. I do have a client I'm working with who's a dentist who we've discussed, like, she's able to get it covered through her medical because it does qualify as a sleep apnea treatment. And so. But it's not well known how to write that out and how to code it and how to bill it. So that's another thing I feel like we can get really good at as another tool for these people that need it.

Yeah, I mean, that's one. You nailed it. I have so many patients who come back to me, and it's not just this appliance. It's a lot of these growth appliances. And I think, especially if you work with, you know, young children or people who have already paid for braces and expansion in the past, just you're not Expecting to do this all over again or to spend this much at such a young age, you know, for your child and I, we get this all the time where it's like, oh, wow, like I didn't realize it was going to be that much of a financial investment. Like that's, that's a little bit prohibitory for many people, not a little bit very prohibitory. And so, you know, I think it comes down to in such a finance, in such an insurance driven world, you know, like you said, figuring out, okay, how can we run this through insurance so that at least, if not all, at least a portion of it is paid for to make this more accessible. Because I know that like the devo, I think it's the vivos mRNA has become more widely acceptable as like a sleep apnea coverage type of appliance. But arguably the vivos DNA should be too. And I think that, you know, I guess the other flip side to that is people like me who don't present as having sleep apnea. Well, what about. I still had a sleep study. Ken reviewed it. We found that I never go into REM sleep. Like arguably, from a health standpoint, I'm at the same risks as people who do fall on the sleep apnea scale per, you know, insurance, you know, how they're going to code something or whatever. And lots of people haven't heard of you a RS People don't know what upper airway resistance syndrome is, right? And it's like there is actually a code for it, but people haven't heard about it. And so I think just the advocacy like surrounding getting these things covered and then also like you said, like helping patients to even be aware that like, hey, this may be something that you can get covered, but you're going to have to put a lot of legwork into the process because it's, it's such a shame to me that that's what stands between like, you know, everything we've talked about, right, like just putting a child on the path to better health and giving them the best lease on life, putting an adult on a better health path so that they are not on a dozen medications and you know, struggling in their mid-30s or their 50s or their 70s or, you know, it's what can we be doing to ultimately lower healthcare costs? And I don't really want to go into that conversation, but it's, you know, I think that being proactive and using things like this, paying for things like this, getting things like this covered is really, personally, I think it's the best Answer, but I might be a little biased, but, you know, yeah, like you.

Said, not specifically vivos, but it's like I have a hard time, you know, in this field, like with the access to care, I have to keep my doors open and things like that. And so it would be lovely if there was a way that we can get this, not only the appliance, but also therapy and education and things that we can do. Like I remember you talking about on one of your previous podcasts about going into preschools and just bringing up that awareness and that knowledge so parents have more power to help their child with their health journey. And so, you know, it kind of got off on a tangent there, but with things that help us be better in general and health and wellness, you know, we have to look at it that way too, so we can deliver it to other populations as well, because that's what we're here for.

Absolutely. And being a private pay practice owner, it's at the end of the day, like I have to pay my people who are providing this highly skilled service that they spend thousands and thousands of dollars per year to not just learn about this skill set and, you know, but hone their skill set and continue to keep up with the latest research and the latest, you know, patient care and discussions and, you know, collaborative attempt to deliver the best therapy, you know, to our patients, which I'm sure you get. And you know, it's, it's nice because as an slp, I can provide a super bill. It doesn't mean it's always going to be covered. We do try to help patients get it covered. And you know, one of the things that I encourage patients to look at is like, what are your out of network benefits, number one? Number two, if someone doesn't have the skill set that's in network, then arguably insurance should have to cover it. So, like, let's figure that out. Like talk to a rep at your insurance company. And then lastly, you know, kind of figuring out, well, what else is going to happen, right? Like, where can we start to reprioritize things if we don't address this now? Not to, like, not in a fearful way, but like, if we're not addressing this now, we're going to wait a year or two. Like at what, at what expense? Based on the case that we're seeing in front of us right now and just having a good understanding so that an educated decision can be made by the parent and whatever they choose, the parent or patient, Right, whatever they choose. Great. That's, that's Their choice. But at least I know I've done my job in educating them and, you know, helping them kind of lay all. All the pieces of the puzzle out and really get a good full picture on. Like, here's what we're recommending. This would be the best case scenario approach, but we're willing to work with you and figure out what. What should be step one, if we're only going to do, like, one piece of the puzzle at a time. So I know we get very crafty in our. Our approach to work with patients. And it can be very hard to, I think, access not just like you said, not just the appliances, but the cost of therapy. So it's. It's definitely. I feel like we have more people who are getting trained. There are more options to receive therapy, you know, in the myofunctional space now, which is great. And I'm like, I just hope that it continues to expand and it becomes a more normalized type of conversation and therapy and process that people go through to. It's like, oh, I got mayo today. Like, no big thing.

Yeah. Like, I went to speech and she gave me candies.

I went to speech at school. I went to mayo at school. Yeah.

But that's a perfect world. But with, you know, getting back to the vivos appliance. Like I said, it's a tool in our toolbox. We know it can help with airway and sleep and just in general quality of life. And so the. It does cross the gap between adults and children. I have a handful of clients that are in a. That are. That are children that are in vivos, but they fit a specific scenario. So they're very compliant. The parents are super on board. But I have to say, there's been, amongst everyone, there's been an instance where they've lost it. And like, you know, so that is a definite consideration. I actually, actually threw mine in the dumpster on accident diving. So I just have to say that's a big con.

But I found it. It's here.

Yeah.

That's why we ended up putting, like, the permanent retainers that I would like an orthodontic relapse case. So when I was a teen, they put permanent retainers in my mouth because I never wore them and. Or lost that. You know, it's like, that's. That's what happens with these removal removable appliances.

Yeah.

So it's a little tricky in that regard. Yeah.

But you have to know that based on who you're seeing, that could be an option. But then on the other hand, if compliance behavior, parent involvement, I know that I have resources to help them and referrals to do so. But I think across the board we really need to be looking at these barriers. Nasal patency, breathing, re education, having some awareness of where the tongue needs to go and helping work through that process prior to any intervention with appliances. I see that across the board in our clients and also in my personal journey. There is no way I would have been as comfortable as I have been with this appliance if I didn't have a really strong awareness of nasal breathing and oral rest posture. So I feel like that needs to go hand in hand before. Like I look at it as just a band aid if you're not really getting to the behavioral component. So I have to just throw that out there. And you know, providers that are offering vivos making sure that they're working with the orofacial myologist prior is where I see that that's where there's more success.

I love that and I, you know, we talk a lot about that as far as like tongue tie release goes, as goes with needing that pre op and needing that post op and seeing a big difference in the, in patients who receive pre and post versus those who receive only one or neither. So it's, it's a fascinating conversation to have too regarding appliances. Right. And knowing like what we need to. I think that one of the things that I think about a lot too, and I think this comes from like my feeding background is a patient needs to understand like their oral orofacial complex. They need to be able to feel and know what we're talking about and understand, see the changes. Right. And how do we see the changes in our mouth? Well, we feel them with our tongue. Right. We feel them the difference in the food that we can chew or move around our mouth. And I've had anywhere from kids to adults say to me like, oh wow, my tongue fits better or oh my gosh, that was a lot easier to chew. Like what happened? Like what changed? I'm like, well look at all the work we've been doing, right? Or oh, that didn't hurt when I swallowed it or you know, I haven't been as gassy after eating. Well, you're not swallowing air anymore. You know, it's like there's all these things that they start to pick up on. They may not know why necessarily, but when you do that pre work and then you go through this process of whether it's a tongue tie release, it's myo, it's expansion or it's all of the above. You know, they start to appreciate and own the changes and the improvements and then you get their natural buy in because they're like, oh, wow, like, this is, I'm sleeping better, I feel better, I can chew my food better, my speech is clear. You know, all these just different things that sometimes that we work on directly and sometimes that happen as a byproduct of what we're doing. That's like so cool. That's like just super cool when they can start to like, you know, verbalize like, what they're seeing. And I'm like, well, I'm so glad that you've noticed this. Yeah.

Like, I have clients, moms reach out to me or you know, text and oh my gosh, my. My nephew, my niece, this or that. And so to me I'm like, oh, thank you. They're seeing it, they're looking at it differently and, and so whoever else is in their life, they're going to pass on the information that we're giving them and it's going to start trickling down like little wonderful airway raindrops. So it's really imperative that across the board while we're working with this population, that we're looking at the whole person, the whole picture. I know we say this over and over again, but we need to keep saying it until everybody's on the same page.

Yeah, absolutely. Well, this has been amazing. Tell everybody where they can find you. Your website, your ig, Cheryl.

So my mayo, my health is pretty much my handle on everything. I'm on IG, I'm on Facebook, I'm on I love TikTok and I'm on TikTok is lower, underscore my mayo. And so yeah, you can find us there. Ask me questions. I'm an open book. I love kind of helping people find their journey. And thank you so much for having me, Holly.

Of course.

And I just have to say I love your like, your videos, your reels, your stuff. They're so good.

Thank you.

It's my little creative out output.

I have to say, I love it. Well, this has been amazing. Thank you so much for joining me.

Thanks, Hallie.

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