Episode 259: Ask Me Anything with Hallie Bulkin, MA CCC-SLP, CMT®, COM

Hello everybody, and welcome to episode 259 of the Untethered podcast. And today we're going to be really untethered because I basically did an ask me anything kind of episode and in doing so, you guys came through with some really good questions. Okay, quick disclaimer. All information, content and material of this podcast are the opinions of 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, Halle Vulcan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner 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, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture.

Tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. You guys came through with some really good questions. Okay, I'm gonna try and answer all of them. One of the ones that I want to talk about first is why do SLPs have a hard time supporting each other? It really undermines the field. Oh, so good. So that one was really fascinating to me and really, really interesting. And so what I decided to do was, was repose that to my 20, almost 21,000 followers. I think I have like 20,980 something followers right now on Instagram. Hello everybody. And I wanted to find out from you all actually what you thought about that. And so I'm not going to read what everybody submitted to me, all the comments and everything in the private conversations because I didn't drop like a text box. I just was like, what do you guys think? And so a bunch of you DM'd me. I, um, but I did screenshot on my phone some of the responses and I want to read what some of you said because I think some of them are so spot on. So one of the responses basically said, I think this starts in school, right? Like even in undergrad. Not just grad school, but undergrad, but especially in graduate school when grad school professors foster this environment of competition, right? We're constantly competing with each other and so this person said, when in reality, there is more than enough work for all of us. We all have our own interests. There are like too many patients and students and clients that aren't being served. So true. And the only thing that we will compete for is possibly a leadership position. Also, unfortunately, since this is a female dominated field, many of us are clicky. So I thought that was a really good perspective. I completely agree with a lot of those points. I will say that, like, I, you know, being the neurodivergent person I am, I don't always feel like I fit in everywhere. And I feel like I made my small group of friends in grad school, but, like, everybody was like, let's go to happy hour and let's go do this. And I was like, I just want to go back to my apartment and do my work and exercise and, like, shower and go to sleep. And so, like, I would make an effort to not be, like, antisocial and, like, go out sometimes, but I was not the person going out, like every Friday or like three afternoons a week. I'm like, how are you guys doing this? Like, how do you do this and sleep and get your work done and all the things right? So. So just being like a human who thinks differently, functions differently, thrives differently from different things. I feel like I try. It was almost also like a tactic with removing myself from some of that competitive nature by not inserting myself into the social side of it. But then again, that whole, like, clicky nature of like, what who was friends with who and what group was what, and all that, you know, was, that definitely rings true for me. I will say that one of my bridesmaids was. Is someone from grad school, shout out to you, Susan, love you, mean it. Let me. So he's going, love you, mean it. And it's true. I love her as a human. I think she's a fabulous human and she lives way too far away from me, so come visit. But this totally starts in school, and even more so than, like, the clicky nature of grad school clinicians, because I do actually think we had a really nice graduate class in my program at Maryland my year. But I do feel like there was. We were constantly, like, pitted against each other. And I can even think back to one situation where I had to go, like, to administration, because I was told that I wasn't being a team player, but yet I was the only person in my dyad who was actually doing any of the work. And I was like, so I should fail on this project because the other person's not showing up. So it's like they then pitted me against that person when I was trying to be supportive to that person, in my opinion. And the person didn't seem to mind it and kind of almost expected it or wanted it, maybe got taken advantage of. I don't know. The bottom line is I was marked down and there were nasty things said to me because of how I chose to handle that. And what I thought was me being supportive and also me watching out for my own grade. Right. Like, if you're not out for yourself, who are you out for? Like, yes, be a team player, but also, like, no one else is going to pick up the slack for you. So there was that. There was also, like, pitting people against others of who's going to get this patient. And yeah, I mean, I. 100%. And, like, grades and all that fun stuff. 100%. Okay. Someone else said, I think it has to do with imposter syndrome and their own insecurities. If they critique fellow SLPs, others are less likely to look at the judgmental SLP and notice all of their flaws. All right, I can't say I disagree with that. I think that that is a beautiful point, and I think that's very true. And unfortun, I think it's human nature. I think there's a lot of keyboard warriors in the online space who do this, who tend to feel like imposters themselves. And because of their own insecurities and kind of living in this, like, negative space constantly, not saying that, like, you're a negative person if, like, you have insecurities or anything, but feeling insecure and not learning how to work through your imposter syndrome in a way, which, look, we all have imposter syndrome. Like, I talk about this in my other trainings and things too. Right? We want to try and find a positive way forward and not necessarily, like, use it to keep ourselves where we're at and as a tool to then critique others and put them down, to almost keep us, keep them where we are. Does that make sense? But yeah, so I. I see a lot of that a lot of the time. Okay, now someone else went, oof. Being a new private practice owner and also a new TPT creator, it's so fascinating to see who likes and shares my stuff. I noticed there's a good chunk who do champion other SLPs, and this person, they champion, this person included. Even people who have never met this person in real life. But there is a portion that this person notices, like former coworkers close friends, grad school buddies. Which is most shock shocking to this person who don't support them on Instagram in the ways that they would support that person if the. If the roles were reversed. Right. I'm not really sure what that's about. Maybe they're too steeped in their own lives to notice. It would be a huge help. Or they're envious or. I don't know. I love sharing ideas and posts and giveaways from other SLPs. It's better when we uplift each other. This is like such a fascinating conversation. Fascinating conversation to me. And I actually just recorded an episode on my new podcast for online medical entrepreneur. Well, I'm still figuring out the name of the podcast at the time of recording this episode, so bear with me here, because that's not what it's called. But my new business podcast that I'm putting out, I actually just did an entire episode on this. And how like, to stop the comparison game, you know what I mean? And how, like, we actually need to, like, flex our happiness muscle and flex the muscle of being happy for other people and celebrating other people's wins and what other people are doing and how, like, it may appear one way on the outside, but you have no idea what actually, like, went into it on the back end for that person to get to where they are right now. And so, you know. Yeah. Anyways, I went into this whole, like 15 minute conversation, I think, surrounding that topic. So I'm not going to go into that here necessarily, but 100% agree with this. And I really think that if we're feeling envious of other people, that is a signal to turn inward and ask why? Like, what is it that we feel like we should be doing or we're not doing or who are we being or not being that we're feeling this way. Right. What is that? Maybe it's a. Maybe it'll help educate us more about ourselves and it'll teach us a bit more about, like, what we desire and what we want to do. And then I think we should all focus our energy on, like, doing what? Like focusing on what we want to bring to the world and supporting others in the process of them doing the same thing versus us tearing others down. Because that nobody needs that negative energy. That's not helpful to anybody. Okay. Someone else said that they thought it was also dependent on work environments and the culture of a setting, like a work setting, which can be really supportive or it can really set you up for competition. So true. It can. It's possible to have, like, a supportive circle or not supportive circle. Right. And so, yeah, I've worked in places where there's a lot of competition or I've also worked in places where everyone just wants to help each other out. And I can tell you, we all thrive when we are so invested in our colleagues and in, like, elevating each other and working together. And that's one of the things that I think really helped me survive my first two years working in the schools, because I didn't want to be there. I was working all with pediatric patients, all preschoolers, actually, in the preschool education program. Loved the kids, did not like the bureaucracy of the program, did not like working in the schools. That's a whole nother conversation. But the thing that carried me through, aside from the kids that I got to work with, when I was actually able to see them because the schools made their own rules, were my colleagues. And a lot of those colleagues were not speech pathologists. Most of them were the teachers of the classrooms I was going into. And there was, like, a set of them that really became good friends, that really, we. We elevated each other. We worked well together. It was like teamwork makes the dream work. Right. Kind of, like communicating. And I know that's a different setting in terms of, like, me plugging into someone's classroom versus me just being supportive of a colleague who's, like, completely unrelated to all the work and caseload that I'm seeing. But we're. We're all doing. We're all on a similar path, if that makes sense. And I think the more that we can, like, lean into that and support others, the more we all thrive. So I really love that perspective. Okay. Someone else said, I'm all about supporting one another, especially in this relatively small field. Yeah, guys, it may not sound like a small number, but there's only 220,000 ASHA members, which is, I believe, the bulk of SLPs and audiologists in the United States. So when we keep that in mind, we are a relatively small field. That is a tiny market. Now, 220,000 may not sound like tiny, but it's tiny. It is tiny as far as, like, markets go, especially in the online business. Conversation for another day. But someone said, I'm all about supporting one another, especially in this relatively small field, to better, better educate other professionals about our benefit and purpose. That goes into that whole teamwork conversation. But also, yeah, now we're getting into, like, how do we educate other professionals and elevate ourselves in turn by doing that. We're Elevating our colleagues. Right? Yeah. I mean, it really benefits everybody. I've never really been the type to be rude or put another person down to, quote, unquote, get ahead. And I'm thinking that maybe some personalities just are not confident enough within themselves to be kind and open. I don't know. But it does bother me that negative people like this exist. But so again, we're coming back with that whole negative and someone else is just like, they're miserable people themselves. There's probably some truth in that. So this kind of goes back to that first comment that somebody made that really suggested that these people are maybe unhappy or they're kind of just. They're always working from this, like, competitive nature, dealing with imposter syndrome and their own insecurities and all that stuff. So not going to like, be the nail on the head here. But I think there's a lot to be said about working through imposter syndrome and the ways that, that I've taught others how to do this is to really hone your skill set to find a mentor to buddy up to. You're probably going to have to pay them in most situations. Just going to put that out there because people are worth their time. Right. You want a good mentor, like, set aside a budget for that and identity. Like, what do you see yourself as? How are you showing up in the world? Who are you being? Who are you being versus who you want to be? I. I know some people sometimes show up miserably in the world and they're like, that's not how I want to show up. I don't want to show up as this person, but I just can't seem to snap out of it. Okay, well, who do you want to be? Start focusing on being that person and doing the things that person would do on a daily basis to work yourself out of whatever funk you're in. Right. You to step in and look, I'm not talking about mental health here. I'm talking about people who don't identify as having a mental health issue, who maybe truly need some other supports. Right. I don't want to downplay that. That's not what I'm talking about. I'm talking about people who are constantly like, I want to be successful online, but then they don't actually act as the person who has online success or they don't act as the person who can then go do the things to have that success they desire. Right. They kind of work from this backwards place. But anyways, conversation for another day. Okay, let's move on to the other questions that came through. That one got a lot of attention and people like, some people even messaged me. They were like, oof. To like the SLPs being so, like, competitive and everything. There was a lot of, like, other messages that came through on that. Okay, we already did an episode on the Asha dues increase, which was one of the requests that came through. Go back and listen to that. That was a couple episodes ago. There was another one that said there's an account that calls your entire account misinformation. I don't know what to think. Okay, so here's the thing, guys. I am working from a place of maintaining my inner peace this year. And what that looks like and means for me is not. So I'm engaging with people who want to have conversation, but I'm not going to waste my time or energy or engage with people who are constantly there to either try and tear me down, like that is their intent, or who are sharing misinformation that is not rooted in science or education or experience or patient care and patient goals. Like, if they're just sharing what they believe to be true and it's not actually rooted in any of those things. No. Move on not doing it. So I could venture to guess, like, who, like, what this account might be because this person in particular blocked me so several years ago online. Fine.

Whatever.

The one issue I take is when misinformation, medical misinformation is spread. One, it's unethical. Two, it's actually dangerous on a public level, like public health level, because there are patients and parents of patients who listen to what we put out. And we have a ethical responsibility, a legal responsibility to not spread medical misinformation. So what I share on my account and my podcast is rooted in science. It is rooted in experience, which is part of the evidence based practice triangle ebp. And it's rooted in what I say, experience. Science education from reputable sources. Right. I wouldn't be teaching this if I didn't actually feel like it works or if I didn't feel it was safe. Safe or I didn't feel it was effective. Right. Effective and works are kind of the same thing, but you get what I'm saying, right? So I. I'm not gonna like, go toe to toe with somebody and I've moved away from the things that make my heart palpate and kind of make me feel like, oh, gosh, like, wow, like, ah. And then all day long I'm just kind of like a wreck. Like my Nervous system is just wrecked for the day because, like, I decided to engage with somebody who was like, really coming at me, I'm not here for that anymore. I'm here for the therapists that believe in science, that believe in evidence based practice, that believe in putting their patients, desires, needs and goals first, and who also are supportive. And look, we're not always going to agree on everything and that is okay. But we need to be able to dialogue and have healthy dialogue and not just block somebody or delete their comments because we don't disagree with them. Look, if someone's engaging in hate speech, that's a different conversation. I just made a new word bullet. Block and delete, bully them all the way. But if someone just has a difference in opinion or wants to discuss a research article or says, hey, you know what, I see what you're saying, but I've had patients that actually have had a lot of success from this and it's completely safe, ethical, and supported and backed by science. Hmm. Yeah. Yeah. Let's just, let's all, let's all work towards being the best versions of ourselves we can be. We're all lifelong learners. I can guarantee you some of what we know to be true now may change seven years down the road. So as long as we're evolving with that and we're not getting stuck in the past and, and not evolving with our patients and with medicine and with science, like, yeah, I mean, just be the best version of you you can be and put your patients first, please. Okay. All right, the next question that came through. Can lactation help babies with solid foods? So whenever I have a question about scope, what I like to do is I like to go to my colleagues who are like IBCLCs, for example, International Board Certified Lactation consultants. If like the questions about what can lactation do versus like a feeding therapist, slp, ot, pt, what can an SLP do versus an OT versus a pt? What can my therapist do? Like whether, if they're an RDH versus an SLP versus a dentist versus an OT or PT or whatever, right. I like to go and I like to look up the scope of practice, whether that's somebody's state license or it's a national board or whatever, I will look at up what it says is required of them to get said credentials and then what is involved in their scope of practice. Now this is, it's just something I'm curious about. So that's why I do that. Am I saying you have to do this? No, absolutely not. It is actually really hard to find detailed scopes. But the IBCLC or ibcle, you can go and you can find their scope of practice and read for yourself. I'm not going to come on here and read it. What I believe people are seeing a lot of is ibclcs teaching like baby led weaning, which somehow has moved out of being like a feeding therapy modality and into most, mostly like transition to solids. And so I do think there's a place where people, especially like a nurse, for example, in RN can educate on that. But as soon as there's an issue with the solid feeds and it's no longer just like, hey, introduce some of these foods to your kid, or hey, here's what baby led weaning says about it. Because I actually like. I prefer to follow a baby led, like meeting a modified baby led weaning type of approach, which is something that Jill Raven was on the podcast a really long time ago and talked about. And I really like her conversation around that because I think there's a place for baby led weaning. But I also think there's a place, especially in certain cultures, for spoon feeding a child and for purees, how we eat them as adults. So why would we not have a child introduce that sensory experience early on? Getting messy is really important, right? There's all kinds of things we could talk about, not what this episode's about. But I share this because the question, you know, was like, can lactation help babies with solid foods? Maybe they can educate on starting solids to a certain extent. I actually don't know the answer to that without looking it up right now. I feel like I've looked up in the past. I just don't remember. But no, beyond that, they cannot do feeding therapy. If there is a problem with babies transitioning to solids, even though they might be breastfeeding and still. And. Or still bottle feeding. No, only feeding therapists. Only pediatric feeding therapists, which by definition and licensure are SLPs, OTS, and some highly trained PTs. Those are. That's who you go to for that. Okay. All right. Who can diagnose a tongue tie? Oh, you guys are coming in hot with the questions. Okay, so. So who can diagnose a tongue tie? Well, it depends on your license and it depends on your training. So who is properly licensed to diagnose? Like, I know, for example, I have colleagues in like New York and New Jersey who say, yeah, here they say, like SLPs, for example, cannot diagnose tevidural tissues. Okay, but where I'm licensed In Maryland and Florida. There I've been told I can. It's not in writing, but I've been told if you're. If it's in the scope of what you do in terms of the work you're doing as a feeding therapist and specialist and myofunctional therapist, you know, under the realm of being an slp under your license as an slp, because those are domains that are covered. Right. And you're trained. Yeah. You can diagnose it's tight tissue. I'm not saying they need a procedure that I cannot do that is out of scope, that is a surgical procedure. But what we deal with, like as SLPs, for example, in my, you know, and under the realm of myofunctional therapy or pediatric feeding, we deal with soft tissue that is written into the scope of being an slp. I can assess, diagnose, and even treat soft tissue in a certain way. Not surgically. Okay. But through the therapy that I provide, my therapeutic intervention, I can't diagnose hard tissue, like bone, for example. I can't treat bone. Can bone shift? Can things change based on my interventions and working with soft tissue? Sure. Right. But I can't say it's going to. And I can't say that a certain. I can't say expansion is needed. I can say that the palate looks narrow and I can describe it. I can't diagnose it, and I can't say expansion's needed. I can't. I can diagnose a tongue tie. I can describe it. I can refer for a release consult. I cannot say a release is needed. Right. So I think there's a lot of nuances that we need to focus on, but it is my understanding that SLPs, depending on what state you're located in in the United States, can diagnose tethered all tissues. And then medical professionals, Right. Technically can, but also they need to have the proper training. So I don't care if you're a dentist and airway dentist, a biological dentist, an orthodontist, a oral surgeon, an ENT, MD, you know, pediatrician, whatever. There are people who have very specialized training and there's people who don't. So just because someone has the credentials does not mean that it's appropriate for them to rule in or rule out tether oral tissues, because we have to look at function. So the person who can do the functional evaluation, like myself, right. Slp, ot, pt, rdh, I don't know if you guys are able to diagnose. I've had people tell me you cannot diagnose period outside of the supervision of like a dentist. So somebody correct me if I'm wrong, but I believe that there are certain diagnosis and it may be state independent too, like based on like where you are in rdh. So I'd be curious for somebody to reach out and like educate me a bit on that. And can you all diagnose tetheral tissues? But yeah, hopefully that helps a little bit. I can only speak to what I know. And as I mentioned, I am open to others sharing with me scopes of practice and, and not just coming to me and saying, oh yes, this, this, you know, OTs can diagnose well. Okay, cool. Does it say it anywhere? Does it say in your scope of practice that you can. I think I've had Otis tell me they can't diagnose tether oral tissues. So I'm going on hearsay from some professional, some professionals. I just know again what I can and can't do. Okay, another one with the weighted question here. I'll do this one next because it's kind of related to what we were talking. Yeah, okay. How can dental hygienists work across state lines doing myo? Don't they need a license? This one's a little mind boggling for me. I'll tell you why. I have a lot of dear colleagues in the MYO space who are registered dental hygienists who are highly qualified, trained individuals who do mayo. What some of them have told me is they can't practice mayo under their RDH license. It's like if they're doing hygiene work, they basically have to do hygiene in the morning and then they can do myo in the afternoon. That's like, if they're working in a dentist office doing this, for example, then I've had people tell me, oh, we hang our hat on the wall to do myo, meaning like we basically take off our, our RDH hat, we take off our hygiene hat, our license, we hang that on the wall in order to practice mayo. That's really confusing to me. I know I've had some people explain this really well to me in the past, but I'm not remembering the explanation. And I want to say it made sense. But at the same time I come back to. I had to go to school for six years in order to get my current license, which also after the six years required a full like year of working. Before I actually got my full license, I was on a limited license. So I technically had Seven years under my belt before I was fully licensed to do what I do. And in that, in what I do, that includes orofacial treatment, you know, assessment and treatment of orofacial myofunctional disorders, mild. So I don't know because we are regulated. And I actually just recorded an episode about how Mayo is not the wild wild west and how it is highly regulated because it falls under certain professionals licensures and you do need to be licensed to do Mayo. So I personally, in my experience, it all falls back under license and you need to have a state license to practice any form of medicine which MYO is in a given state. Unless there's some kind of interstate compact or something, which like Asha for example, has been working on for SLPs. It's not here yet. But I think last I checked they had 23 states. Maybe it's more that had signed on and said, yes, we'll be part of this. Meaning if you are licensed in one of those states, you can then practice across state lines on any of those states that are part of the interstate compact without actually paying for an additional license or having to go through the whole licensure process. Maybe, I don't know. Got to see what it comes through. All this. Don't, don't, you know, don't hold my word on all this, but that's my understanding of the interstate compact. But there isn't one that exists that I know of. Like, I don't think that an RDH who does hygiene work in like Florida could go to Maryland and do hygiene work there without getting a Maryland license from the state. Again, somebody tell me if I'm wrong. And I believe Mayo should fall similarly under that state licensure like it does for every other professional who does myo. But again, feel free to reach out and tell me, educate me if you will, if you have other evidence to support otherwise. Okay, last question. Then we'll wrap this one up because this is getting a little bit lengthier than I anticipated. Does oral motor help speech articulation? I hear so many conflicting things. Conflicting things. Does oral motor help speech? Yeah, yeah, actually I've done episodes on this, so I'm not going to belabor this point. I also just did a really good episode recently with Jen Moore and we talked about like childhood apraxia speech and prompt and oral motor and speech sounds. And then I also recorded with Alana Bondar, who also talked about similar topics. I'm trying to look back here and see what other episodes I have discussed, but I know I'VE got other episodes on the podcast where if you go to untetheredpodcast.com and you go to little. The little search, you know, I not. Eye glass, looking glass, Little looking glass, whatever. Whatever you call those little things, you click on that little search thing and you type in speech, oral motor. What? I can't spell. Let's try that again. Speech, oral motor. And you look that up, that's gonna pop up a bunch of episodes. So it did pop up, episode 255, and that's the one with Jen Moore that you're going to want to listen to. It popped up a whole bunch of other episodes, too. So I would say read through the episodes that pop up. I know that there are some that I have, like, on speech sounds just in particular. So if you just type in, like, speech sounds, that should pop up some episodes. And I do have one that, like episode 193 on, like, how tongue ties and speech are related. And that kind of goes into that oral motor conversation, too. So you might want to listen to episode 193. All right, I'll let you search the website otherwise. But I know I didn't really fully, fully answer that question. Oops. Hold on. I want to pop it back open and revisit it again. Okay, so, because oral motor helps speech articulation. Yeah. Yeah, 100%. I mean, the bottom line is we need to be able to control our muscles, our articulators. Right. Our lips, our tongue, our jaw. They need to be able to work independently of each other as a child matures and grows. And more speech sounds like clearer speech is expected. Right. By, like, age 4, we should understand 100% of what a kid is saying, even though they don't have technically all their speech sounds in yet. Yeah. When I look at these kids, a lot of these kids that are unintelligible, they're hard to understand. They got oral motor things going on. They got orof facial things going on. So it's 100% related. It's. And it's kind of funny that we're still having this conversation because. Hi, like, if you can't walk, what do you do? You go to PT and you work on the muscles involved. Right. You work on, like, if there's an injury, you're going to work on strengthening, you're going to work on range of motion. Wouldn't you think it might be true for, like, the articulators, the muscles, the fascia in our body that supports our ability to speak and eat, chew, swallow. I don't know, just, just some food for thought. All right everybody, this was fun. We'll do another one of these sometime because I love these kinds of questions and I love just kind of being completely off cuff and just chatting with you all here. So I hope this was helpful. I hope this was a little bit, you know, I'm sure I said some, some things that are going to anchor some people. So, you know, feel free to DM me and let me know how you're feeling and doing a conversation. My inbox is always open as long as you are kind and you allow me to stay in a, you know, well, actually nobody else controls how I feel or what place I work from as long as I am able to maintain my inner peace in talking to you. And it doesn't feel like a combative conversation to me. It feels like a educational, like, I don't want to say proper, but like educational conversation between two colleagues who are trying to better understand each other and who are open to having their minds changed on both sides of the conversation. Like, I, I welcome that. That is more than welcome. If you're simply there to just like, hate on me and drop your knowledge and try to like, get me to see things your way and you have no interest in having dialogue. Like, don't bother messaging me. But if you're interested in the dialogue so we can have a functional conversation, this is how we both learn. This is how we all start to align with each other and like get on the same page. Those are the kind of conversations that I live for. I welcome and I think that we all can thrive on. So all right everybody, this is Hallie signing off. Thanks for listening to this podcast.

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