Episode 282: Healing From a Release with Hallie Bulkin

Hi and welcome to episode 282 of the Untethered Podcast. It is your host Holly Balkan and we are going to dive in. As promised on last episode, we're going to dive into talking about how long it takes to heal from a tongue, lip and or buckle tie release in just a moment. Real quick. If you're an SLP or an OT, join me and thousands of other SLPs and OTs from September 9th through 13th for a free five day training into screening your very first pediatric feeding patient. We are calling the screen the PEDs to feed the PEDs and this is the fifth 15th time I have done this since March of 2020, which is exciting and also crazy to me because we've had over 23,000 SLPs and OTS already go through this free training and over 103,000 of you might be 105,000 maybe it's more have downloaded the free pediatric feeding screening packet that goes along with this training. So join me. We're going to use that packet. You're going to learn how to use it. You're going to watch me screen my 2 year old. Then we'll screen my 4 year old together. So you're you just show up. You don't have to bring any patients, you don't have to have any experience. You just need to bring yourself and the free screening packet that I will provide to you if you don't have it already. And we're going to discover how to make sense of the screening results together. After we go through the screening, we're going to make next step recommendations together. We're going to learn the fastest way to launch you into treating pediatric feeding cases after the screening is completed. So go to www.feedthepedes.com training for for more information and to register for that free training. I cannot wait to see you there. Okay, let's dive in. 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, Holly Balkan. 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, tethered oral 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. All right, so let's say you've done all the prep work, right? For a tongue, you're in lip tie release. Or maybe you're just in the informational gathering stage right now. You're researching, you're a parent, you're a provider, and you're like, okay, we're, we're prepping to potentially have a procedure, or maybe we are getting ready for that procedure already. I just want to know, how long is healing going to take? Well, let me tell you, healing is different for everybody. It's the answer you wanted to hear, right? Everyone heals differently. And there are so many factors that go into the healing process between genetics, you know, the amount of inflammation that occurs, how your body responds to inflammation or responds to the procedure. You know, whether you're healing by primary intention with sutures in place, or you're healing by secondary intention, which means that you're healing with an open wound. There's several phases of healing. You know, beyond all of that information, there's still several phases of healing that we can actually look at to one, ensure the process is going well, but just to be, like, familiar with how the body heals. And I have to credit my friend and colleague Autumn Reed Henning, because I learned this from her. But this is a, you know, this basically follows what is out there in the research and out there in the medical world in terms of, like, the phases of healing. Okay, so, so post op, right after you've had your procedure, if you are healing with an open wound, we want that open wound to be in a diamond shape, and that is how we know that it is properly released. And we're going to watch that diamond shape get smaller and smaller and smaller as you heal, and the color of the tissue will change. We'll talk about that in a second. That's number one. Number two is if you have sutures, we wanted to heal long and strong. What does that mean? You want it to be a nice, like, up and down line with the sutures having pulled the tissue back into itself together, right, to close that tissue up. So you're not going to see that diamond shape if you do have sutures in place. So we're really talking more so to Those who are healing without sutures in place. But this is still going to apply from an inflammation level. The color of the tissue and the appearance of the shape is going to differ. So going with that diamond shape, you know, that diamond shaped wound, post release, days one through four are considered inflammatory phase. Okay. You have a white patch of tissue where the release is done. And, you know, first it'll be red, then it'll start changing colors, and eventually it will become more white. If it's a baby, you know, they may be fussier than usual because that area is sore. It's sore, right? It may be a minor procedure, but you're still going to have inflammation. Inflammation causes discomfort or, you know, soreness. Days four through 20, the proliferation fibroplastic phase kicks in. Okay, so this is where the wound begins to get smaller in size. It might turn to a yellow color. You might see some of the symptoms go away during this phase. And then you move into days 20 through like 12 months. And this is where really your inflammation is gone. Healing has occurred beneath the surface, and really it can take up to a year for healing to fully occur below the surface. The recovery and healing phase is, you know, it is just as important as everything else that we talked about on last episode. Okay. And it's important to, to monitor the healing as we're monitoring the symptoms because they should go hand in hand, right? We should expect that by three weeks out or so, we don't have any more fussiness, we've gained more range of motion. The, the post op therapy and work that we are doing in that pre op therapy work that we did should all be benefiting us by this point. Now does that mean you'll be graduated and completely done with therapy? No, no, not typically. But things should be much easier to address at this point. And a lot of people will see positive, you know, changes in symptoms immediately following the release, while others may not see it for several weeks. Okay. Sometimes we really need to be more healed. And I don't want to say fully because fully suggests that like everything is healed, you know, on the surface level and beneath the surface level. That's not always the case by three weeks and definitely not the case by three weeks because it can take up to a year, as I mentioned, for all of the tissue below the surface to fully heal, depending on the age, depending on how your body heals. But we also need to complete post op therapy. Right? And in completing post op therapy, we are retraining the orofacial muscles and essentially teaching the tongue, the lips, the cheeks, the jaw, right? How to move together, how to work together, how to function together. And we're doing this through neuromuscular reeducation. Okay. There is a newfound sense of freedom, right? Freedom of movement amongst the tongue and the cheeks and the lips and, you know, the orofacial muscles that's going to impact and direct the jaw right where it sits at when, when we're at rest, where it sits when we're feeding, how it moves when we're feeding or eating. So these are all things that we need to keep in mind. And so the thing I want to point out too is that we actually start practicing certain oral motor movement patterns in utero around eight weeks gestation. Okay. We are then swallowing, right, by 12 weeks gestation. So about, think about that towards the end of your first trimester, if you've ever had a baby, right? You know how those trimesters work. By the end of the first trimester, your child is already swallowing. That's wild. And they're swallowing with the swallow pattern that they're going to be born with. And if something is awry, guess what? That's the pattern they're going to be born with. Right? So sometimes they come out and they're already not really fully functional. They're not functioning optimally. And that's why for some babies and some mothers, some, you know, feeding unit, you know, dyads and family units, feeding can be really challenging, whether you're on breast or bottle or a supplemental feeding aid. Because if that swallow pattern is dysfunctional, if something is going on in the oral cavity, it's, you know, baby's not just going to magically feed once they're born. We see a lot of, a lot of families struggle with, with feeding. So, you know, there's some things I want to point out too. If you notice that it takes time for the baby to. Especially a baby, but even an older child or an adult, even, it take time for those functional patterns to set in. For lack of better words, we have to remember that we've been compensating for a very, very long time. And it takes time then for us to learn the correct way to function. Let's just keep that in mind, okay? Especially given that we've been doing this since we were in utero a certain way. And maybe that wasn't the most optimal way. Maybe that was taking way too much energy. Maybe that was causing strain throughout the body. Who knows? Like, we don't know without seeing each individual patient. But the point is it takes time for us to learn the correct way to function. Okay. So we can talk about like hard set numbers in terms of how the body heals, how tissue heals, you know, days, weeks, months. But when it comes to actually regaining function, that really varies. And you know, immediately post op, you might also see an infant spit up more. Right. Because their stomach may need to expand a bit to take in larger feeds that they're not used to. And this is all part of the healing process, but it's something that a lot of people don't talk about. And so, you know, we also see sometimes that infants might feel they may feed well initially, but then we see that they stop feeding well several days in or a week in sometimes, because now the inflammation is really kicked up and they're uncomfortable. Right. So it can be a whirlwind of experience when it comes to feeding in a whirlwind of emotions. And you're like, well, wait, it was working. This was going so well. I mean, such improvements immediately following the release, why are we going backwards now? Four days after that? Isn't that's to be expected, unfortunately, does it doesn't happen with every child, but that can be expected. Okay. Now the other really cool benefit is that. And this can happen at any age, but you can become a quiet breather for the first time. And so this can be really scary and shocking to some parents because, you know, it's like parents will tell me, I just kept going in and I finally just slept on the floor next to their crib because I, I've never heard them sleep so quietly. And I was like, I was like, are they, are they alive? Are they breathing? Like sticking my finger under their nose to make sure I could feel their breath? Yes. Quiet breathing is one of the main goals. And it's also another thing that somebody should be educating parents on, caregivers on, because we want that noisy breathing to go away. We want, we want quiet breathing to show up. We want that to replace the noisy breathing. Okay? Now as healing continues and skills increase, you know, we have that quiet nasal breathing to look forward to. Closed mouth posture is something that we want to look forward to and we want to work on. Getting the tongue up to the roof of the mouth is another one of those. We want full smiles with less like of our gums showing. Because if we had a lip tie or something that might be pulling the lip, you know, really thin and inward improve sleep. And, you know, we want infants to be content, not gassy or colicky. Right. They may have quicker feeds. We may see weight gain if weight was an issue. That's not always an issue. But if it was, you know, in infants or children who are really struggling in this area before release, we may see less grazing, less gagging or choking, no more hiccups, reflux, indigestion, tongue twister today, constipation and even like more clear speech or even children who become more verbal when it's more comfortable or easier for them to verbalize. You know, so those are the kinds of things that we do see post op, which is really incredible. But we have to remember that we need that pre op and that post op therapy to get to that point so it can be such a gift and such a blessing to have children released and adults, children, you know, and adults, people of all ages when it's approached like correctly by a well trained team that speaks to each other. Right. So our advice for for optimal healing is to really listen closely to your team and your release provider and the instructions and when it comes to like the timing of stretches and any other post op information they give you to continue your post op therapy with the feeding therapist, you know, and our myofunctional therapist as we talked about on last episode. And really this is real. This is what's going to help you get the best results and it's going to help direct the ship on, you know, the timing of that it takes to heal as well. I hope this is helpful. Don't forget to join us for the free five day training to screening your first pediatric feeding patient from September 9th through 13th, 2024 at feedthepedes.com backslash training. We'll see you there. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebalkin.com or pop over to Hollybulcken on Instagram to get all the latest updates.