Episode 186: When an IBCLC & SLP Talk TOTs Journeys with Gina Motsay, IBCLC

Hi and welcome to episode 186 of the Untethered Podcast. Today we have Gina Motze joining us. Gina is a Navy veteran turned IBCLC mom of four, including twins with one on the way. She's got a ton of experience with ties from her own kids and has been handling many cases in her private practice lately. She lives in an interesting area where she sees a lot of moms near the cities of Norfolk, Virginia Beach, Chesapeake, and also those living in remote or desolate areas in rural North Carolina and the Outer Banks. 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. Dina, welcome to the podcast. I'm really excited to chat today.

Hi. It's so nice being here. I've been so excited to talk to you.

Well, I mean, everyone just heard you're a Navy veteran mama turned ibclc. Will you tell us a bit about like your story and how you fell into this specialty arena?

Yeah, it's. It's kind of interesting. So growing up I saw my mom breastfeeding. I didn't think anything of it when I had my first, so I didn't do quite enough research. So I had some struggles with latching in the beginning and depended on a shield for three months and I finally just threw it in the garbage. I was like, I'm done. Because I did go to an IBCLC in the hospital, but she didn't set me up for a follow up appointment. I didn't know I was, gosh, 24 at the time. So I was one of the only people I knew that was breastfeeding. Really. Out of all of my friends, I was in San Diego away from everybody. I had a few friends that were breastfeeding and they would try to help me out. That's where I was like, I'm just, I'm a research freak. So I started researching everything I could and I worked it out. I Mean, I had everything you can think of that went wrong. Mastitis twice in, like two weeks. Like, it wouldn't go away. Of course they put me on antibiotics when it was probably inflammatory. Just everything you think of, thrush, you know, oh, it was so painful. And really, like, he didn't. He doesn't have ties. I have looked him over. He has a beautiful set of teeth. He's always had great spacing. No speech issues, no feeding issues, nothing. After that three month mark, we were good. But I figured out I'm like, I should have just taken him to, like, I wish I knew about craniosacral therapy, because that would have helped. But I think he was just really tense from delivery. And I noticed, like, in photos looking back, like, he was very tense sometimes, like, turning one way and I was like, huh, Looking back, you know, I.

Would have never known now that, you know.

Yeah. And he was always so happy. So, like, the happiest baby gained. Well, had no supply issues, thank God. I was nervous about that. And then, and then I got pregnant nine months later. And thank God with that too. I didn't have any supply issues. I was so, so lucky in that sense because most women do tend to switch to colostrum in the second trimester. So I was like, wow, okay. So, so pumping at work and everything. And then I had my daughter, Juliana. Yeah, she. She's difficult. Not as a baby. No latching issues. I was never in pain. She. I noticed a few things that were so much different. Like, she coombs positive, so she lost weight rapidly. And then my supply was just insane. Like, I had an oversupply from the start because I had to start. I was pumping in the hospital when she was under lights. They didn't give the billy blanket to make it easier. So I'm pumping and also trying to latch her, and it was just a mess. And I think I created my own oversupply, but I had just stopped breastfeeding too, so I kind of expected it. So because of that and her gaining, she gained weight really quick. Like, the first three weeks, I think she put on three pounds, three and a half pounds. And so, and I noticed something really strange. I was like, this is so weird. Like, she's constantly, like, projectile vomiting after every feed. I think I changed my shirt six to ten times a day. I'm not even kidding. Like, I'm like, this can't be normal. So I started researching and I'm like, I think she has ties. And I was like, I don't even remember, like, where I got it from. I cannot for the life of me remember where I heard about ties. And I'm like, I looked in her mouth and just noticed like a really big. Like it now I know is a double. It was a double tether, lip tie, super restrictive. But I had no nursing pain, so of course nobody took it seriously. They called her a happy spitter.

Even though you were changing your shirt like seven to nine times.

Yeah, I've had another baby. He never did this. Like, this doesn't seem normal. I've been asking people and no one is saying this is normal. They're like, my baby never did that. And it was like, it looked like a full feeding, which it wasn't, but.

And then was. She was still gaining though, right?

So she was literally the fattest baby. BY I think 14 weeks old, she was 16 pounds. So she was a big baby and maybe bigger than that, like 16 and a half, almost 17 pounds. So they were like, it's fine. And I'm like, but something's off. And so it just. It kept going on and on. I kept doing research. I would. I went. We moved. I got out four months after she was born. We moved to Pensacola. So immediately I went to. I was like, I can't find, like a release provider. I didn't know what to do. I was like, okay. So I went to the EMTs and I had two men walk in and they're like, this doesn't cause breastfeeding issues at that point.

Really? I would love for you to school me on this.

Yeah, at that point I was like, you know, I had just started going to school for. For maternal child health and human lactation. So I was learning and I was obviously still researching and I looked at them and I'm like, how do you know that? Because everything I've seen points to say it does. And they're like, well, there's no proof. And I'm like, but we'll do it. We'll just have to put her under general anesthesia and then cut and stitch. And I was like, no, there's gotta be a different.

That drives me crazy. I've actually heard that. I had a military based family up in. In Maryland and they. It wasn't Walter Reed. They went to another. I want to say it was like one of the Virginia based hospitals and the ENT there said the same thing about the tongue tie, because I identified it and this poor child could not elevate their tongue at all.

Oh, gosh.

All kinds of like. But serious health issues. Serious health issues. Because of it. And the doctor said the exact same thing. Well, I don't see it, but I'll release it if you want me to. Like, electrocuteri. And we were like, whoa, back up.

Yeah, Yeah, I hear it a lot up here, Even with the EMTs just saying, we'll release it if we. Like.

Like, if you don't believe it's there or you don't see it, you should not be doing the procedure. Like, and that obviously makes it harder for parents to have to go find somebody else, but, like, it's like psa. If someone doesn't see what you're seeing or doesn't believe it, please don't let them touch your child.

I know, and I have a story about that, too. But, yeah, I was like. I ran out of there, and I was like, you want to set the appointment? I was like, absolutely. I switched from prime to select so that I could just take her out wherever. And I was like, this was the worst experience ever, because I also had, you know, I had one random checkup, and I actually, like. I booked it mostly so that I could actually get my free breast pump for once because, like, they started covering it. So do you think your supply is okay? And she was 10 months old at the time, and I was like, look at her. What? So I was like, this place. They're clueless. And I'm not really shocked about that in that area. It's gotten better. But, yeah, Penn school was really lacking. And then I finally found somebody. I was asking around, asking around, and I finally found a dentist that's like, I do, like, two of these a day. It's like, yeah, get her in. And because her teeth. I think she was 20 months old when I finally got her in. Her teeth were decaying rapidly. Wow. It was really bad. Like, I said, she. I spent a lot of money on this.

Was it just like her upper central incisors, like, on either side of the.

Tie or the front? And it started even going farther, and he's like, yeah, this is like, there's pockets back here. So I was like. And I had taken her to a dentist prior to that that told me to stop breastfeeding at night or brush teeth after. And I looked at her, and I was like, you don't know what you're talking about. You should probably not. Yeah, I was. I was arguing with her. Bring in the research papers. And I was like, no, I'm fine firing you.

Like, I'm not proving anything to you.

Yeah, I'm like, you can look. It up yourself. Like, you're a little behind. You shouldn't be telling parents that kind of crazy. And so I fired her. And I went to this other dentist, and he was amazing, and he was very empathetic about everything. And it was just like. I was like, finally I found somebody that, like, could help me. And he. He helped so much with her teeth. And once he released it, there was no more issues with that. And then I was like, if there's a. If there's a lip tie that bad, there's got to be a tongue tie. So that got dismissed. And I was like, well, I guess I'll do that later. And at the time, I was like, I don't know what to do. So that area is just. They lack a lot. Like, I don't even think that there was a myofunctional therapist in the area. I'm, like, thinking about it. Yeah. And so we moved here, and I really. I just started noticing her compensations getting worse and worse. Her sleep. She started bedwetting. She started sleepwalking. Her. She's now even. She's got, like, ADHD type of behaviors. But I. I know it's not adhd. She's a very typer, excited kid, which I love siring. But she. Yeah, she. I can't say her Rs or Ls. And it was mash. She was mashing. And she was thrusting her tongue forward. And so I put her in speech language. I don't. You know who Leah Shy is?

Yeah.

Yeah.

So she actually was one of the initial creators on my course. And so she's a lot of work with me. Like, we've done a lot of work together.

Yeah. I thought you guys knew each other pretty well. And I couldn't remember, but, yeah, I went. I went to her office and started going there. I have to get her back in. It's just been. It was a crazy summer. Really crazy. So Dr. Hamlin was who did the release, and she's, like, one of the top in the area now, and I love her. And I. There's a cranial psychotherapist out here. Give them a shout out. Liz Chandler. She's amazing. And then Dr. Hamlin, like this. We all work so well together, and we love communicating. And so the reason I found Dr. Hamlin was because. Because I had my twins in April 2020, you know, when the world shut down. I noticed right away, I looked in their mouth.

Babies and twins, nonetheless.

Yes. And I was like, oh, man. And I looked in their mouth immediately. I was like, Let me get in there. And I was like, oh, my goodness. And it was. Both of them were just so, like, it was bad. So Isla was the one that I ended up doing the releases for because I couldn't mentally at the time handle doing two babies at once. Crew. He had still kind of does. Has a high palate, but, like, his function is, like, perfect. His teeth look really good. It's so weird, but I noticed his speech is a little off, so I'm going to be putting him in speech, too, so I'll probably just throw them both in and. But he always. He didn't have any issues, except the first week, he was very ravenous. And I noticed, like, his suck was so much stronger than hers. And I'm like, it's his high palate. I just noticed because. And then after that first week, it was fine. I'm like, this is the weirdest thing.

And then, so interesting how babies. I mean, you got to see it firsthand how, like, two babies who maybe even sometimes have a very similar presentation function so differently. Right? And it all. We say, like, it comes down to function and, like, monitoring to know, you know, everyone always, like, I got people who come to me, they're like, well, my child looks like they have a tie, but they're functioning really well. And it's like. Like, you and I were talking before the podcast. Well, some children compensate really, really well, and sometimes they can maintain those compensations, and sometimes those compensations fall apart. And so interesting to see. See this, because I'm like, look, it's one thing if a baby's, like, compensating and struggling. It's another thing of a baby's compensating and thriving. Like, we probably don't want to rock that boat right now.

Let's.

Let's monitor and see what happens. And, like, we're not waiting for something to fall apart. We're basically monitoring, like, very actively so that we know if we need to intervene. But if a baby's feeding well, like, we don't want to mess with that necessarily. Like, art and science and, like, it is.

And that's something that I always tell people is like, you know, if things are going really, really well, it's up to you if you want to be the one that. Yeah, yeah.

So, like, look, things could worsen. Like, there's no guarantee or magic. Yeah, yeah. Like, we don't know. And sometimes even those kiddos who need it so desperately, it gets a little worse before it gets better. And it's like, I like to make sure that like, our babies that are going in for releases that they have a. Okay weight so that if they're like fifth percentile, we drop the first percentile. We're not like headed towards a feeding tube. I mean, it's like you have to know the patient in front of you and you have to really know that dance of like, what can we get away with right now? Especially if they don't improve very quickly following the release. Because just it's. Everybody heals differently.

Yeah. And you don't know when everything's going to go down and the. It's just going to blow up in your face. And that's what happened to the eye. So I was really monitoring their weight. Right. So I'm doing like weighted feeds. Everything. I'm like, okay. Every day I was weighing them. I'm like, something. Something's off. I just had that gut instinct, keep, really keep an eye on Isla. And thank God I did because I noticed like the latches between them too, because I was, you know, nursing both of them at the same time. And I'm like, hers is extremely weak. And she just had, you know, like very. A very weak jaw. She was mouth breathing all the time. I'm like, I just knew. I'm like, this girl, she's gonna. She's eventually just gonna give up. And like at 10 weeks, like, yeah, she was not. She wasn't trying as hard as she had before to really.

Yeah, you see that in your practice where like babies will go and like that. It's sometimes between like the three to five month mark. Like, even if they were like managing to hold on or they were compensating really well, all of a sudden it's like certain reflexes integrate. Like the swallowing reflux, you know, starts to integrate and just. Or the automatic swallow reflex. Like, we see things happen. And I feel like some of these babies are like, no, I'm done.

Yeah, that's exactly her. And she, I noticed her. Her stools would go like, she'd go a day between sometimes. And he's pooping like five, six times a day. And I'm like. So I brought it up to. Because we see a family doctor here, and he was like, I'm not worried about her weight because she's on a growth curve. And. And he wasn't concerned about the pooping, but of course I am. I'm like, I know that most people. Yeah, most doctors don't care about that. They're like, well, they're gaining. And I'm like, if, like Adults have to every day. Babies should. And this started early on. So I kept a close eye on her. Ten weeks, she stopped gaining. And it was like she was nursing just as much as crew was and she was not gaining. And it was like, that's when I was in frantic mode. And I'm like, yeah, we got to get this taken care of soon. And just finding somebody with the world just shut down in July, I'm like, so I had someone tell me they could, and then they were like, they don't. They didn't really do them. And I was like, no. And then I finally, you know, I went and saw a craniosacral therapist and she's like, I know somebody that can do the release. And she's amazing. And I was like, tell me. And she said, you know, doctor. Yeah. I was like, oh, my gosh. Finally. And she said, Dr. Hamlin. And so I was like, awesome. So I called the office and she got me in pretty quickly. Within like a. I think it was a couple weeks. It went in like mid August of 2020. I got. And this is another thing she had. They're almost like indents from her buckle ties being so tight. I've never seen them, like, even to like, even on babies. I see now. I've never seen them as tight as hers. It was insane. And then, you know, she had a posterior tongue tie and a lip tie and I was like, so she got all four done, same day, guess what, A week and a half later, she had put on like two pounds. Wow. Yeah. That's amazing.

I always, like, wonder like, what Lily would have been like had we actually done that when she was an infant. Because she was the same, like first percentile, but always on her own growth curve. And it would nurse like around the clock, but, like, was the tiniest little thing. And to this day I joke. I'm like, the kid could barely wear normal pants. Like, she's got the tiniest waist and she's seven. Like, it's just, it's interesting to me. And she had 24 months, but I'm like, what would have happened had she had a release, like in infancy, you know.

It was so cool just seeing her change her face, change everything. And she was. I had a really hard time bonding with her and it literally broke my heart because she was so stiff. So stiff, so angry all the time. She would high pitch scream and I would nurse her and just hand her to my husband. I'm like, I can't. Like, I was about to have a mental breakdown. Anytime he was home, I'm like, please, just take her. So I just nurse, and he would walk around, and that's all she wanted to do. And then until, like, the release happened, she was a completely different baby. And then finally, I was like, this is how she's supposed to be. Because I had never had a baby. Out of the four of them so far, just, she was the only one that was like that. And I was like, this is not normal either. Like, she was so stiff, and even at cranial sacral therapy, she was screaming the whole time, just mad. She didn't want anyone touching her. So, of course, like, when she got her releases done, she was also very mad because she hated being swaddled. I didn't swaddle anyway, because I'm like, there's no way.

Like, I didn't care.

And so when she had to get swaddled and restricted, she was mad. That's what she was mad about. It wasn't even, like, getting the releases done. Yeah, it was a swaddling. It was a swaddling. She was angry. And then as soon as they undid.

It, she was like, it's so amazing. Like, Lily. So this, of course, is before, like, the recall of the rock and play, but, like, Lily slept in that till she was, like, I don't know, almost a year old, like, when she was an infant. And I would put her in, like, a sleep sack so she wouldn't, like, roll herself out. Because she also rolled early. Yes. She, like, had to be on an angle sleeping, but did not want to lay crib, even, like, on, like, even on a pitch. And either that or she was attached to me in my bed, like, and she was literally, like, on me all, like, 24 7. So I used to, like, joke that basically the bars closed, like, milk bars closed. But no, Lily's still here. Okay. So, I mean, it was just. That was our reality, and it was, like, painful. And I also, like, I talked to Taylor Kulik. I don't know if you follow her at all.

Yeah, I do.

We talked when we recorded together. I remember if it was, like, my podcast or hers, but I was like, yeah, wow. I never. Guess I never really stopped to, like, not say out loud, but, like, really, like, come to the realization that I also did not bond as much with her as I did with my second. And, like, that mom guilt of, like, not bonding with a baby because of, like, all that you've gone through. And not to say we didn't bond, but definitely different. And, like, when you're that exhausted and all you're doing is trying to feed your baby and they're miserable, like most of the time and because they're uncomfortable and they don't feel good. Like, I would put her in a sleep sack and she would Houdini her hand, like up and like, her hand, she wasn't like swaddled.

I.

When she was an infant, like newborn and she was swaddled, she would do that too. So I'm like, I just should have known from like day one my kids could hold their. It's up straight at first. Like they were those tight.

You know.

All the things I know now, but it's just. Oh, it's also fascinating when you start to realize, like, this is not normal. And I like, would love to see every infant have sex. Some form of body work. Whether it's like chiro osteo cst, like it's traumatic to be born, whether you're a cct. It is traumatic for mom and baby.

To go through birth. Yeah. And that's like one thing I always go over with mom and baby. I'm like, how did delivery go? And I was like, you know, it's not only traumatic for youth in situations, but for your baby. And sometimes. Yeah, I'm very pro body work. I did it after Juliana and it was like, really life changing for all of us. But. And then we moved and I'm like, yeah, we don't know anything here.

I mean, we moved a year ago and I'm still like searching for my. You know, I found some individuals down here, but it's hard. And everything is like 45 minutes to an hour away. And I'm like, come on, can't somebody be like, bye? Like we like 15 minutes, 30 minutes max.

Yeah. And I like having reviews. Like, I like hearing like, okay, how was your experience? And. And that's the other thing is like, I. I see so many patients that are like so skeptical. Skeptical about so many things. And then they hear so many different things, especially from their pediatrician, which I know that they have their place, but a lot of them do not refer out, so.

And they're also not usually specialty trained in the work that you're doing or the work that, you know, I'm doing or my team, you know, it's like, I feel like they only refer out when it's become a medical emergency or we're out almost at the point of medical emergency.

Yeah. And I recently had someone that their baby, in my terms, was failure to thrive. And the pediatrician, they were like, it's fine. I'm like, this baby's almost a month old and not back to birth weight. What are you talking about? Yeah. And then, you know, I gave. I gave her a very popular. I'm sure you know who it is. The Dr. Ent in New York, Dr. Siegel. I gave that information, and I was like, I think you should get. Go to him. And I think you should get an actual diagnosis from somebody who is also a doctor, if that's who you want to listen to, and give you the correct information. Because he knows his stuff and published. He's.

Well, you know. Yeah, he's well known. He does lots of these.

Yeah, yeah. And nope, she got skeptical because the pediatrician. And that happens a lot.

A lot.

Yes.

More than it should, fortunately, which is my passion behind all of this. I'm like, if we can put, like, the right information in the hands of parents, they can hopefully make their own decisions, you know, like an educated decision. It's like, if you know that this could potentially help your child and you still choose not to do it, okay. You're. You're making an educated decision. There's no shame in the game. But if you are almost, like, scared into believing that this is not going to do anything for your child and everybody's just happy cutting tongues, like. And lips, of course you're going to kind of go, like, you know what? This is not for my child. I don't want you cutting them. Like, that's. It sounds like a scary thing when you don't really understand the benefit or how many children it's truly helping. And it's also like, we're not just going around cutting, you know, tissues.

Yeah, everyone has a frontal, but is it restrictive? And that's what I say to the parents when I go see them, because they're like, is it, like, necessary? I'm like, honestly, like, I'm going to lay out all the information. I'm going to go over all with you, and that's for you to decide. And I'm going to give you multiple, like, referrals and references, and ultimately, most of them end up getting a diagnosis. Some of them don't. But I've had a couple of situations where I'll get somebody after a release in the pediatrician's office. In the pediatrics. Yeah, yeah. So you know how that goes. They. They get a snip, snip, and I try to explain. You notice this, probably if it was anterior, you probably missed that. Posterior tongue tying. That's why you're not Seeing certain results, and then they're just, like, so skeptical about it. And I was like, yeah, that's why it's really important to, you know, get a full assessment done before for. And it's not their fault, because if they're desperate and they really want to see something improve. And, I mean, I've been there. I think we all have been, like, making a desperate decision. But it's kind of like you trust.

The professionals in front of you. You figure that they have your best interest and your baby's best interest in mind. And, you know, professionals are. Well, meaning. However.

Yeah.

If they're not specifically, like, trained and they haven't done a functional assessment like you do or I do or, you know, and like some other dentists even do, there isn't some type of a functional assessment being done. Meaning, like, is this interfering with tongue elevation? Lateralization? Meaning it's, you know, interfering with. Obviously, these little infants are not speaking yet, but that could come later down the road. But mostly feeding, right? Mostly. Whether it's breast or bottle sleep, Is your mouth open or closed? Is a tongue up on the palate? You know, all these little things that we look for, and there's obviously a lot more, but, like, those are some of our main goals. If someone. If no one's even really looked at that, and they're. You're just like, yeah, I'm struggling to breastfeed. You're like, okay, let's do a little sip. Snip. Like, no.

Yeah, I. I know I've had.

Thank you so much, but let me do my research.

Yeah, I know. I tell them, like, don't just. If they say, oh, do it right here in the office. Don't, like, just don't like form of prep. Yes. And I've had. I mean, there's an entity out here that said, I'll cut it whether there's one there or not. And I'm like, then what are you cutting? Yeah. So I was really upset about that. I was like, oh, my gosh, no. And I've talked to other lactation area about it, and I'm just like, that's really scary because what are they cutting?

Yeah. Right.

Are they causing more pain?

Well, and if the frenulum. I mean, like you said, we all have a frenulum, but if it's not too tight and they potentially cut tissue that's pliable and then it heals on itself. And because tight. When it wasn't a problem in the first place, we have now created a tongue tie, and then the scar tissue.

Right, right.

And I mean, and now we've created a host of issues. So, like, no, we don't just want to cut.

Just to cut. Yeah. So, you know, that's another thing. Like, at least for me, I see more often than I want to. And a lot of them team, though, right?

Like, it sounds like you've got a pretty team there. And now you're like, kind of rural as well. So is your team close by to where you are? Do you have to, like, your people have to drive? Like, what's drive?

Sometimes it's really hard to talk people into doing body work. And I know because it is a drive. I mean, one of the people that I've seen is two and a half hours from where they are. I'm an hour and a half from them. But then you tack on an hour and. Yeah, so it's like I try to give them stuff at home that they can do. I try to send them, you know, links to things that they. Videos that they can watch, like anything that can help them. And that's another thing. I got a lot of people who are like, what do I do if, like, I don't have, you know, anybody around me? Like, what do I do? And I'm like, that's where virtual can be really helpful. But it's a lot on you.

Right.

And it's. It's up to you, like, if you're going to do it, how often you're going to do it. And a lot of them will make the drive to go see the release provider, but sometimes not a lactation consultant and sometimes, you know, not the other therapies that are needed. And I know that cost out of pocket is another worry. So. Yeah, yeah, yeah.

It's the costs. I think that's a great topic because we see how. Well, I mean, you and I both have children who have gone through this, so we can see in the cost of what it costs, both with infants that have releases as well as other. Like Mia, for example, went through PT on and off for eight months, and then we went to CST and Osteo, which was like the saving grace at the end of it all. And then we went, and now she's going into upper and lower appliance. And her sister, you know, wasn't. I didn't discover it until she was already 24 months old and came back from my first myo course, flipped her over. Like, we were done breastfeeding at that point. But I looked her and I was like, oh, we probably could have still been breastfeeding. If I had known that you were okay, well, then, you know, we made it 13 months. It was really painful for me, so I'm gonna pat myself on the back there. But, hey. But it was the same, right? Like, I tried to take her to the IBCLC at the pediatrician's office, and it was like, I always say this, like, taking your car into the shop. Like, she was like, basically, like, just get her naked and blow on her. Keep her awake. Like, one of the suggestions was like, you know, kind of spritz water. Like, don't think your dunk your hand in water. And I'm like, I'm not putting water on my baby's face, like, to wake her up, like something else. And basically told me I was positioning her wrong. She positioned her on, like, a breastfeeding pillow and was like a football hold, you know, position or whatever. And I was like, okay, yeah, great. And went home, could not recreate any of it. And I was like, okay, we're back. It's one. And I am basically that mom who went through the entire first year, just kind of like, well, I guess this is just how it is. Until I had my second child, and I had fallen into Mayo, and I actually took my course. I was supposed to take it, like, in September, found out I was pregnant, moved it up to, like, June, took the MYO course, and then went through certification while I was pregnant and, like, completed it, like, right before she was due. And I'm like, yes, I'm that crazy person. And. But, like, when she, you know, when she was born, I was like, I'm just going to Enjoy for the 21st, 24 hours, I am not looking at her mouth. And the second I laughed her to me, I was like, oh, man, I already know. It's Lily all over again. Like, here we go. So I was like, I barely have to look. It was also interesting because at that point, like, the hospital had gag orders, but if the pediatrician diagnosed it, then they could talk about it, like, the outside pediatrician. So, you know, like, I'm. I'm a feeding, you know, specialist. I'm an slp. Like, I. I work with infants. I'm like, my child is tongue and lip tie. And they're like, oh, wow, look at that. Like, nobody agreeing, but just like, do you need. You know, And I was like, can you help me? Like, position and whatever. And like, they were great. Like, they were really, really wonderful. And I understand, like, they have a tough job. Like, they can't talk about it, like, they can lose their job, you know, Like, I'm not hating on them for that. It's the hospital. It's the problem. So then my pediatrician comes through, and I show them, and they were like, oh, yeah, we see it. And, like, I'd already established a good relationship with them. Like, they knew what I did, and so I don't think they would have assessed for it or looked for it, but because I said something, they were like. They looked and they're like, oh, yep, we see what you're seeing. And I was like, yeah.

Do you.

Want our hospital surgeon to release that for you? And I was like, wait a second. My baby didn't have ties, like, 24 minutes ago, but now that the outside pediatrician identified it, now you. I was like, don't touch my kid.

Yeah, No, I.

No, no.

Yeah, that's. I always try to tell people, like, they're like, how come you know so much about this? But then, like, the hospital obviously barely went over anything with me, and I was like, you know, they have gag orders. They learn different things than we do. It's up to them as well. Usually they're RNs first, and then, so it's like, we're pretty different. They handle, like, the first, like, 24 hours, usually, unless they go to the NICU or something. But I'm like. For me, like, I'm constantly doing continuing education. I get all the complex situations, and it's like, really. It's really tough for me, too, emotionally sometimes, because I have parents just crying to me and just, like, desperate and just. And then I'm like, I feel so bad.

No, it is, like, it's very. Especially if, like, you're that type of person who, like, takes on other people's energy and everything. Like, it is a physically taxing space to work in because you're constantly taking on the energy of, like, you're the dyad. Like, not just the baby, but, like, the mama who's really struggling. And then sometimes you've got the parent who. I don't know. We get a lot of dads who, like, are like, is this really necessary? Do we really need to do this? Like, does it really a problem or like, yes, it's really, really a problem. Like, please, can you not make the situation worse? Leave everybody else questioning.

Yeah. And then at the same time, it's like, another. Yeah. And once they're like, I feel heard finally, and they're just crying, and then I'm like, I empathize. I understand, because I have been there too, Once somebody finally took me serious and I give them their referrals and I help them with prep. And that's another thing that's very important, the prep work. And it makes us so much less traumatic. And I don't think that's talked about enough because it also. It helps so much with the aftercare. And yeah, a lot of people come to me and complain about that. They just, like, rush it and they go in and then they seek the help after. And I was like, if you had.

We can see the difference. We can see the difference. Like the. The parents and the babies who kind of rush in, like, not really prepared. It's one. I mean, the nervous system, right? Like, the baby and moms really, like, everybody's kind of just like in utter chaos and fight and flight. And, you know, I always tell parents, like, we've been rest and digest, right? We want to. It's. There's going to be some. I don't want to say trauma, but, like, there is some trauma to the body when you go through any type of a procedure. So if we can prep the body for that ahead of time and we can get everything aligned with the beat baby, and then we can get you aligned, you know, and then we also make sure that everybody knows the protocol and that you feel comfortable going in your child's mouth to help, you know, guide healing and whatever else needs to be done. You know, it makes for just a much less stressful experience and a much. I don't want to call it an enjoyable experience, but, like, you can almost make it a bonding experience and you can make it a very positive one. And we see a massive difference in not just, like, how parents feel and how the baby responds, but the healing. And then the benefit of function increases as a result as well, because now we're all on the same page and we can actually, you know, what's the point of going through this procedure if we're not going to do everything we need to do after the fact? Right. But that takes ahead of time. So. I know I'm preaching to the choir here.

Oh, yes. I totally get it. And, you know, I see the difference too, is, like, when they really take it serious. Some people, they don't. And that's not. I mean, that's on them. I give them, you know, I lay out the cards and I'm like, here you go. Here's everything. Yeah, it's on them to do it. So then, like, sometimes I can notice, like, afterwards is like, when people are panicky versus, like, very Confident. And that's when I usually get a call back and I go do a checkup and, you know, go over everything again to refresh them. But the other thing, I worn them ahead of time is like, you know, the fascia along with. It's like the tongues of the rudder. The fascia and the nervous system all are pretty intertwined. So if you notice your baby afterwards is like, sometimes they have the nursing strikes because they're just. Their nervous system is just overloaded after that. So they'll have like a 24 hour, I'm not nursing kind of thing. And then the parents freak out. And that's why I always warn them ahead of time. I'm like, you don't know what's going to happen until that release happens. You have no idea how they're going to handle. I've had babies where they are, like, smiling through the stretches and they're fine.

Yeah, they're perfectly fine. I mean, it's so much about, like, how their, their nervous system is prepped and how they respond to what's going on. And like, that's. I always tell parents, like, I don't like to do anything surrounding a feed because I don't want any negative association. But, like, do it when you diaper, do it when you're playing, do it at other times so that it's like, there. It's a separate experience. And I'm telling you, these babies are like, so much. I mean, I'm not going to say every baby's like, hey, let's do this. But like, they're so much more relaxed and you don't want an upset baby, especially before you go to feed them. Like, that's never ideal for anybody.

Yeah. And I tell them the same. Yeah. I'm like, don't. I would not do it around feeding. If anything, I would probably, you know, wait a little bit and then do it during the diaper changes or play time, when you're doing tummy time. And then you just kind of play around with them. And I always reiterate, you know, like, allow them to let you in. Don't just force it, because I always notice them. And that's when it makes it hard. And they kind of restrict everything back. And they're like. And they're like, it's really, really hard. And I'm like, kind of just play around first, rub their gums and then go under once they are, like, comfortable with you being in their mouths. And that's why the prep work helps.

When they're used to it, it's so important. And I, it's like we can preach this all day long and there's still going to be plenty of providers out there who unfortunately just release without any prep or, you know, I've even seen it where some of them will say that they require it, but. But then like someone comes in for consult and they just release same day. And I'm like, wait, what happened? Like we referred them, you knew they came from us. Like we have this, like, we try to have conversations with providers where we're all on the same page and we all kind of say, okay, yes, this child is ready, this dyad is ready, this, you know, family unit is ready to proceed with the release. And that we all kind of like sign off on. You know, some actually, some people actually have actual forms that we sign off on and then other ones, it's more like a verbal sign off. But then it's always interesting where you get someone who like you thought was on the same page and all of a sudden they're releasing kids without free, you know, any. Yeah, like, it's just, it's an uphill battle.

There's only been two times where I'm like, I don't even care about like body work beforehand because this baby literally can't feed because it's like a tied to the tip. I'm like, I will help them through it and just keep going to their house after and get them in. And that's. It's always people. People that are like really far away. Of course. Yeah. And those were situations where literally one baby didn't sleep for 24 hours. And I don't think the parents realized it because the baby couldn't actually latch. And it was scary. I was like, yeah, we gotta, we gotta get things going. We gotta get you pumping. And like we worked it out and I went with them to the release and I helped him right after. And it was like, it was a very, very restrictive tongue tied. That was actually in my opinion like one of those ones that you're like, you. Yeah, you can't. If your baby can't even really drink from a bottle. Like, this is, this is one that I'm like okay with and I will help you with the therapies after and we'll get you in body work. And they usually listen if they do it, but it's like that's a rare situation in my opinion. Yeah.

Yeah, it's. It's not like we've had some situations where we like I had a kiddo come who was like super close to being put on a feeding tube. And this parent thought for some reason the child was like nine months old or maybe six months old when they started with me. And I remember the parent kept saying to me, but a baby can't go in a feeding tube until they're a year old. Right? And I was like, who told you that? Like, why? It was just like, it's the kind of information, whether it was shared like accurately or that's just what the parent heard or you know, it's, it's so I love how like you're, you're so passionate about education, which I think is so important because we know it's a lot of information and it's a highly, like we talked about, it's a highly emotional and like energy draining experience. And to even remember half of what a provider tells you, like one versus the other and then to have providers telling you opposite things. So it's like things are like one provider is not reinforcing the next provider. Like, that's why I'm like, oh, when we can have a team that's all on the same page. It's just, it makes it so much easier for everybody, like including the parent. And look, I'm all for having different views and doing your research and deciding what's the right path for you, but at the same time I find that a lot of like the doctors or professionals who are speaking like against a tongue tie release or even just an evaluation for it to figure out if that's what's even going on. They typically don't have any education in the space or their education was literally like 30 minutes in like med school years ago. Like, and then there's like us who like we're like knee deep in like thousands and thousands of hours of education surrounding like myo Tod. It's like airway. Like I'm doing the pee beatings, you know, it's like, oh my gosh, like why? It's just so, it's. Yeah, it's a little frustrating and I always encourage parents. I'm like, you can read all the research you want, you can go to Google School Scholar and you can type in tetheral tissues. There is actually like a good amount of research surrounding breastfeeding, but we know it impacts more than just breastfeeding, right? And there's more coming out on speech. Like there's a couple articles that have been published now. I think there is more. I think the tricky thing too is understanding like the impact on solids, like as we transition to solids. You know, it goes beyond just breastfeeding. And so yes, maybe the babies made it and compensated really well until the six month point. And now, well, it's time to start transitioning to solids and things are not going well. And I recently like, episode on this topic because I'm like, we see a ton of these kiddos. If they don't fall apart around like the three to five month point, like with breast or bottle feeding, all of a sudden, like some of them really fall apart around solid introduction. And it's like, what happened? Like, why don't they take anything?

Yeah, yeah. And that's one thing. Everyone's shocked when I'm like, stop saying food before one is just for fun because. Thank you. They're so. And they're like, you're an ibc. I'm like, yeah, but like, but you'll educate on that. You can still like, hey, why though? Like, I'm like, it's not just about calories at all. It's sensory. It's learning how to chew and swallow correctly. And any time I have somebody that comes to me and they're like, well, my baby just like will not eat solids. And I'm like, go to an SLP immediately. Get it. Nip it in the butt now. Figure out what's going on. Don't wait. Because if you. I'm like, I can't help with that. That's not in my scope. You need to go see somebody that knows what they're doing and figures. And it's funny, I've noticed a lot of those kids have really high palates too and gag really easily. Yep, yep.

Tongue is low and forward sometimes they may or may not have a tie. Right? But like, we don't know until we really get in there. But oh yeah, we see the gag reflex that should have been moved back already is usually sitting kind of too far forward. And a lot of these kids are again living in fight or flight. Right. And not that whole like rest and digest. Their nervous system is like constantly on edge. And now we're basically bringing these new textures, smells, tastes like this whole sensory experience at their expecting them just to like take it willingly. And they're like, pump the.

Yeah.

You know, and it's. And then if you have a tongue.

That doesn't know what to do and.

Like, maybe they're not saying pump the brakes, but you put it in their mouth, they push it all right back out and you notice like, it's. Nothing's really staying in. You're like a couple of weeks into this, like, and should be able to spoon feed after the first, like, several.

Trials, just keeping it in their cheek, even. And I'm like, yeah, that's not really. And that was another. Patience.

Yeah.

Yeah. And that's another thing with Juliana is, like, I noticed. That was another thing I noticed. I completely forgot about. But she didn't start solids fully until, like, eight months. She would just gag on even yogurt. And I'm like, what the heck? And that's one that really, like, my mind just went, like. And of course, I'm, like, researching that. And I was like, you know, Dominic never had an issue with solids at all. He loved him. He ate really well. And then she took, you know, eight months until she started to really. And now, like, she's having to pick it out of her, like, palate and, like, her teeth in the back. And I'm like, yeah, yeah, it's. Yeah.

I always say if you don't deal with it now, you're probably gonna deal with it later. But you pick. You pick when you wanna, you know, help the child out.

That's cool.

Fine. But, yeah, I love how you said food before one is not just for fun. And I actually had, like, an episode titled that, like, way back when, in my first year of podcasting. I can't remember what. What number it is by any means you can. People can Google it. But I was like, I. I started saying that because I was hearing a lot of SLPs say, like, food before one is just for fun. People don't worry. And I'm thinking, like, food before one is not just for fun. Like, no promoting this. Like, I'm sorry, but it's not about, like, the calories like you said. Like, yes, we still want to get, like, a majority of our calories from breasts, you know, or the bottle. But we have so much that happens from not just, like, an oral motor standpoint or sensory systems, but our gross motor, fine motor. I mean, it is a full body experience, and we're missing out on so much if we constantly just look at it as, like, it being a fun little activity. And it's like, we can make it fun, but it's not just for fun. Like, there's a lot of development that's happening around that experience. So thank you for saying that. It makes me laugh. Yeah.

And I mean, I. Having the experience myself, I'm like, no, this is very important. Very important. And then, yeah, I tell everyone, like, it's. Everything you're doing when they're a baby is Preventative care. I'm like, do you want to spend money now? That's. It's probably going to be a lot less or, like, spend thousands on ortho and, like, yeah, it's because it's gonna lead to that. And I. I know. Because of Juliana, I. Yeah, same, same.

Yeah. Also, like, gone through my own stuff with, like, my nose surgery and expansion and all the things, despite having had expansion embraces as teenage, you know, well, not even a teenager, like, right before my teen years and. Oh, yeah. Oh, yeah.

It's.

It's fun.

I know I have to do it for myself even. I'm, like, constantly biting my own tongue because my mouth is so small. And they're like, you just have a small mouth, but your teeth are beautiful. I'm like, I'm not comfortable ever. And I only have one beautiful before, too.

And my husband's like, why did you mess them up? Breathing is really important to me, honey. Yes.

Work. Yeah. I'm like, wow, I have a tongue tie because I didn't realize it didn't click until, like, probably last year. I'm like, duh. Like, because, I mean, my sisters all have one. They're in denial about it. But.

It all unravels. I swear, like, every family goes through this process. Once you realize, like, a member of the family has ties, everyone else starts to, like, things start to click. And then you kind of go, like. Like, a lot of parents will ask me, like, do I have a tie? Does my husband have a tie? Does my brother have a tie? And I'm like, well, we would have to do an evaluation on you all, but if you're telling me that you have these symptoms, I highly recommend an evaluation.

Yes, I know likely, but I can't confirm or deny. Yeah, I. It's really funny because I only have one wisdom tooth, and it popped through during my twin pregnancy. Interesting. I was like, I'm sorry, because my. My teeth started to shift, and I was like, what's happening? And I'm like, gosh, now I'm going to have to spend a lot of money to, like, just figure out what's going on. I need to. I'm just waiting until I'm not pregnant because I'm like, I'm so interesting.

There's a dentist I'd recently connected with on Instagram, and he was just posting about, like, wisdom teeth and how, like, we don't actually need to remove them unless they're causing, like, actual issues. And we were kind of getting in this conversation, and I was like, do you also believe that the jaws can start to shrink if we remove, you know, the wisdom teeth. And basically, in short, the answer was like, yes, because of what happens when you remove the tooth. But I was just like, huh? So we already have, like, these shrinking jaws.

Right.

Just as society. Yeah. And then we start removing teeth, and then we do a lot of other retraction dentistry, which is just like a big no, no if you can avoid it. And if you have to retract, it's like you want to put something in its place, which, again, money. Right. It's it all. So that's oftentimes a big determining factor, unfortunately.

But, yes, I'm. Yeah, I've been really diving into all of this, and it's like, you can tell people who just. Who are passionate and enjoy their work and other people who kind of just want to make money. And I. I am definitely I'm gonna get work done, but I gotta focus on Juliana first.

And it is so true. It's challenging. I started with, like, Lily and then did a little Mia, and then I was like, I should get my tongue tie released. And then I went into my expansion while Lily went into hers. And now Lily's in a different type of expansion, and Mia's going into hers, and I'm like. But it's also like, I've tried to stagger some of it a little bit so it wasn't, like, everything at the same time. And now we're just like. I'm like, what the heck? Like, now we drive over an hour to our dentist in North Miami for their expansion and everything. So I'm like, can we put all these appointments together as much as you can?

Yeah, it's a lot. And, you know, I try to, like, really tell everyone, like, it really is preventative care to get everything done now. And then it's so much less stressful. It might seem stressful in the moment, which it is. I mean, for any age, really, it's.

More than, like, preventative. Right. Like, so some of it's preventative, but some of it, you're actively treating a problem that already exists. Right. I mean, so it. You're doing both, really, and at the end of the day, you can figure out a way to do it earlier is always better. And I always tell people, you haven't missed the boat completely if you're doing it later. Like, don't think that's what we're saying can. Yeah, like, there's adults through all this, too. It just becomes more expensive, and it takes longer. I mean, Quite frankly, like, firsthand. That's been my experience.

I've gotten so many people that come to me and they're like, is it too late? My baby's like X months old, like five, six, seven. I'm like, no, no, it's not like, it's, I'm like, there's adults, there's probably people in their 70s doing this. Like, literally, it's, there are, there are, it's never too late. And I'm like, it does, it can affect your airway and later in life you might have sleep apnea and all these other issues.

And we're seeing sleep apnea. I mean, it's happening clear and earlier. So it's, you know, arguably. I always say to the mom is like, trust your momma gut. If you feel like something and nobody's listening to you, like, keep going until you find that provider or reach out to one of us. And like, we will help you find somebody or connect you with somebody in your area who gets in, who can maybe help connect you, like beyond, you know, because it's, it's, I feel like we are so, we're living in a world that's so connected in certain ways, but so disconnected in others and like the ways that matter.

Yeah. And I, I mean, because I work in this field, I feel like I'm seeing it more often and it's just like, huh. And I'm like, maybe it's like an epigenetic issue more than.

Oh, yeah, I fully believe that and teach that.

I mean, our jaws are just getting smaller and smaller. So of course, like it's not going to detach in the womb like it should if there's no space.

And I, I, I do believe it's epigenetics. And I also feel like, because we're specialized in what we do, like we get those patients right, like they're coming problems. We're going to see a higher incidence, like within our own patient caseload. At least that's my belief that, you know, we looked at like all the babies born and the past month in our area. So, you know, I think I always have, like, I've had parents say to me, does every child that you see have a tongue tie? And I'm like, oh, actually not. But a high number do because that's why people come to me. They come to me when they toing other people and they've been turned away and the problem's not getting any better and they finally find their way to me. And so, yeah, I do. You know, we do see A much larger number probably than like the person down the street who's working on speech and language with 2 year olds, you know, because that's, that's my specialty, so. But yeah, 100% epigenetics. And I love looking at the work. There's like more and more work being done on like the pre. They look at like prehistoric skulls. Have you seen any of this?

Yes. It's so interesting.

Kevin Boyd and Mariana Evans and some others. And so it's very, very fascinating to see. So, like, yes, we can all agree that our skulls are shrinking, our jaws are shrinking. But even within, like, within our jaws, we cause a larger issue with like retraction dentistry and, you know, headgear and all that stuff. Like, that was so popular when I was growing up and when others, you know, older than me. Oh, okay. A lot of that restorative dentistry and stuff is actually causing a lot of harm. Interesting. All right.

Yeah. And it's so funny, like, looking back, I remember all of my, except for me, all of my sisters, my three sisters had a gap in between their teeth and they told my mom it was a muscle. And the muscles, just until you cut the muscle. I'm like, what? So they had it wrong, obviously, but I was just like, mom, that's not true. And I keep trying to like reiterate it to her. I'm like, there's not a muscle that's causing it. It's the frenulum and it's restrictive. I'm like. And then I'm like, yeah. And like. And they have tongue ties. Like, I can literally see them. And you can tell just by so much. And my youngest sister has a lot of health issues. And I'm like, go get an, go get a sleep study an airway scope. Go get a diagnosis for your tongue tie because, like, you have one. I'm sorry, you did like, I can't diagnose you, obviously, but I'm, I'm in this enough to where I.

Family member that you can have that conversation with. Yeah. Tell everybody. I'm like, if nothing else, especially for like older kids and adults, like, a home sleep test is very easy to come by. You don't have to go to a sleep center. You will probably. You may pay out of pocket, but maybe not depends on like your doctor or your dentist, if they have money and they're not super expensive and like, you can do a study at home. And then I always tell everybody, like, to contact Ken Hooks. I'm like, even if you do it and it's Covered through. If you don't really pay 100% out of pocket because you can get it covered through, like, your dentist or your. Your md, then ask for the raw data and send it to Ken, and for, like, $50, he'll read the raw data and tell you a very different interpretation of what you might have received from your doctor or, you know, wow, that's really cool.

Yeah.

So I'll have to send you later, but it's really very cool because, you know, like, he went over and we did an episode where he went over my results, and I have upper airway resistance syndrome, but, like, don't have sleep apnea. But I never go into REM sleep and rest in REM sleep. The second I go in, my body's like, nope. And I come, like, right out of it, but I don't. Yeah. So, like, I basically am, like, one of those missed cases and came to realize, oh, it's because, like, I have a deviated septum and I don't breathe out of the left side of my nose, and I have enlarged turbinates and nasal swell bodies and. Okay, so Halle's breathing good at night. Cool.

Cool.

No wonder I'm always exhausted. Right? So, yeah. In camera stuff, but that's a combo for another day, so.

Yeah, I know. I really like how Autumn talks about hers and the training and, like, shows photos, and she's been, like, updating people on it. I'm like, yes, I love looking at her results. And then I think, you know, Megan Thornberg, she. She's been doing some work on herself, and I talk all the time. Yeah, yeah, yeah.

No, it's so fun in this space, especially when you can, like, connect with other two. Get it? And that's. We always say, come hang out with us. Like, we're a fun group, and it will help try and connect you with people in your area. So. Well, this has been amazing. Thank you so much, Gina, for joining me and sharing your story and your kiddos and, you know, all the work you're doing. It's. It. We need more people. We need more IBCLCs like you, who can, like, get out there and educate the families and who play. You play such an important part on the team. Like, I don't do breastfeeding. Like, I'm not trained in that. And so, like, we collaborate, right? Like, we collaborate between us on what you. You do what you do, I do what I do. We talk together. Like, we figure out, like, I know we're not on the same team, but, like, we figure out like ideally the best approach for a patient. And so we definitely, we need more IBCLC who are doing your work and educating the families and really just, you know, out there helping families navigate this space because it's so challenging.

It is. And I have so much respect for you guys. Like, I was even looking into becoming an SLP and I was like, I don't think it's going to work for a while. It's a lot of schooling. But I was like, gosh, it's such a cool field and I respect you guys so much and I try to refer out as much as possible.

Thank you. I appreciate that. No, we all need to come together and work together for the benefit of our families. So thank you. Thank you. This has been awesome and we'll chat soon. Thanks for listening to this podcast. If you want to hear more of these Myo Tots Air and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on my Facebook page at halliebulcan biz, on Instagram @hallebulcan. 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.