Episode 293: Finding a TOTs Release Provider with Hallie Bulkin, MA CCC-SLP, CMT®, CPFT™

Hi and welcome to episode 293 of the Untethered Podcast. This is your host, Haley Balkan and we're going to have a short and sweet episode today, but I wanted to talk about something that came up during my feed, the Pete's Module seven TOTS call. And that is the topic of how do we find the right Tots release provider and what questions should we be asking them? So. So I want to dive into this on the episode today because I think this is really beneficial for both therapists and families alike. Right. Caregivers who are seeking this for themselves, for their children. So let's jump 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, up, lips closed, teeth apart, breathe through your nose. Let's get started. Okay, so the first thing I want to say is, without a doubt, we always need to have a functional evaluation. What is a functional evaluation? That is going to be a evaluation such as for a child under the age of four cognitively. That's going to be a pediatric feature feeding evaluation by an SLP or OT who is trained in pediatric feeding and other dual tissues. They may also have a background in myofunctional therapy. That would be great. In addition to that, the child who's over four, up through adulthood even, that could be a feeding therapist. It could be a myofunctional therapist, right? And so. Or somebody who has both backgrounds. And so that might be slp, ot, pt, that might be a registered dental hygienist, a dental colleague, but that's where it stops, right? There are not other professions that are currently licensed or that have the ability to truly provide myofunctional therapy. And I say this because yet again this week, I spoke with a mom who took their child, their infant. They were referred by a dentist to somebody who has none of the above credentials but is doing myo, quote, supposedly did a MYO evaluation on a baby and gave mom some oral motor exercises without a license. Because there are companies out there that will take people's money and train them and tell them that they are OMTs, or tell them that they are trained in breathing sciences or whatever. It's a scam. It is a scam. This is not a thing. If you want to do this work, you got to get licensed. Okay, I'm going to hop off that little side rant. So when we're looking for that release provider, why is it important to start with a functional evaluation? Because we cannot just assess the tissue and know for sure that there's a tie. Why? Because a true tongue tie or lip tie or cheek ties are only present when we see that the tissue is. There is an impairment. Right? There is restriction of the tissue, for example, and there's a functional impairment. That's where I was going a second ago and kind of combined the two. Right? So we've got the restricted tissue, the presentation of the tissue, plus a functionality impact. Right? Meaning there are symptoms present whether they're impacting feeding, speech, breathing. Right? That oral rest, posture when you're not speaking or eating, your rest posture when you're sleeping, your posture when you are feeding or speaking. It's all very important, but that's the function I'm referencing. Okay, so that's that piece. Now, how do we find providers that are willing to work with us and who have the experience to do the release and understand the nuances of, you know, not just getting in there and doing a quick little snip, snip. Okay. Someone says to me, oh, we took them and they got. They did a little snip. Is a little snip what the release provider called it? Or is that just what you're calling it? That's important information. Most people who are educated in the airway space who do tether oral tissue releases, frenectomies, you know, they are calling it a release, or if it's the second time it's happening, they're calling it a revision, but they're not calling it snips or clips because that usually is a very superficial procedure that does not typically get us the functional impact we're looking for. Right. In terms of, like, the full range of motion that the tongue needs. We're not necessarily always getting that. I'VE learned little weird things here and there, such as if somebody releases too wide, they can't go deep enough. And it. If they use scissors, sometimes blood pools and they don't have a great visual field. So lasers are better. Right? People have different opinions. I've been told these things by oral surgeons, by, you know, dentists. Um, so I'm sharing with this with you because there are different ways and people, some people will say, well, it's really all about the tool. And, you know, or not about the tool, but about the person's skills using the tool. Okay, maybe that's true. I'm not here to debate that. But you need to go with the person that makes you feel the most comfortable and who can answer these questions. Okay, so these may be kind of like all over the place, because I'm just thinking of them off the top of my head. So stick with me here. But number one, for how long have they been doing releases? How many pediatric releases do they do on a weekly basis? On a monthly basis? Right. Are they the ones to go to for this procedure? Number one? Number two, what is their process? What does that look like from start to finish? Are they bringing you in for a consult and then making sure you go out and you work with a functional provider like someone like myself, you know, or my colleagues who do feeding or mayo, who then sign off on you being ready before you have the release, who make sure they, you know, they walk you through the active wound care so you know what to do when you go home. And then they're also basically telling you to continue that myofunctional therapy or feeding therapy afterwards. To rehab the tongue, right? To rehab the orofacial structures. Are they doing that or are they just bringing you in for a quick little procedure and sending you on your way? Because if they're bringing you in and sending you on your way, that's concerning. They're not working with a team. They do not have function in mind when doing that. Maybe they think they do, but they have not been properly educated or they've been educated and they're choosing not to use the information that we know best serves the patient, whether it's a child or adult getting released. There needs to be pre op and post op. We see the differences when they are not there. Now, if you have had it done already and you didn't do pre op, okay, it's not the end of the world. It would have been better if you did. I'm not going to sugarcoat it. However, we can still help you okay? It just oftentimes is a little harder, takes a little longer, might cost a little bit more money. Right. And so I share this for people mostly who are at the beginning of this journey who have not gone through this process, who are trying to figure out if they want to do it or not. You know, it's okay to ask questions like, who do you work with in the area? Who do you refer to for myo or feeding who? You know, like I said, what is your process? What is. Do you use sutures? Do you numb the site? Is it a local anesthesia or a sedative? Or do you only do general anesthesia? You know, these are important questions to ask because one, I know for some people who come our way, they don't want general anesthesia, but they're okay with like a local sedative. Others want sutures placed on like a toddler or older. They're not going to put them, you know, into an infant's mouth, typically, but they want on like older children, toddlers or older children, because it can be challenging to get in there and do the active wound care stretches to keep the. To kind of guide the healing of the wound after the procedure. And sutures prevent you from having to do like that same level of active wound care. You basically move into some stretching exercises and then into your functional exercises, or do they not do sutures at all? And maybe you want sutures, right? So it's. There's all kinds of questions and really, what, what feels best for you when you do a consult with somebody is typically what I'm going to say, go with that person, but make sure that they are taking the right approach and that they are taking a team approach, because that's when. That's what's going to best serve you or your child. Where do you find these people? You can go into mom groups on Facebook, parent groups on Facebook, and probably put in the word tongue tie. And you're going to pop up a whole bunch of discussions on where people go for tongue tie releases. And then you can basically take that list and figure out from there, you know, make your own phone calls, do your own research and figure out from there, like who to go to. Maybe you'll find someone else along the way. But that is a really quick and easy way to do it these days because there are entire, like Facebook groups just dedicated to tongue ties by state, by area, you know, mom groups, like I said. So definitely look into that. Now, I will caution you that sometimes the most referred to person is not always the best we've had that experience in the area where I used to live. That person took insurance, however, so they were always the top recommended. But I will tell you that we had patients that had really bad experiences there. So if you're a provider, it is your responsibility to do your due diligence and to make sure you know who you're referring to and you're not just blindly referring because ton of their moms on a Facebook thread said, this person's great. Okay, so do your own research. Therapists and parents, I really encourage you to do your own research as well and follow your gut. Who feels like the best fit for you and your child that may be very different than the next person, and that's okay, right? But a lot of you I know are like, what questions do I ask? What's the important thing to worry about? I had done an episode a while back with Dr. Rashida Joshua, and she went over, like, their process. So if you want to hear, like, what I think a very good comprehensive approach is, then I invite you to go listen to that episode. I will look it up and tell you what episode. She's actually been on the podcast twice. She was episode 35. But the time that we talked about, like, the evolution of her practice and basically, like, how we work directly with her practice, you know, we have shared patients. She has revamped, even revamped things, but she shares her. Her way of, you know, approaching this, and I think it's a beautiful thing. And that's episode 197. Okay, so definitely something to go check out. Really good conversations. She is a pediatric dentist. She's highly specialized in this. And that's it. That's all I've got for you today. If you have more questions about this, I am always happy to chat about it. You can DM me at Hallie Balkan on Instagram. While I cannot diagnose online or give medical advice, you know, on your child's case per se, I do have directories where we can connect you with others who are, you know, qualified to assess the treat screen at the very least. And so if you go to pediatricfeedingtherapist.com that is one of those sites. All of those people have taken my Feed the Beats course. They're all either speech language pathologists or occupational therapists. So you know that you're getting somebody who is qualified to work with your young child. And then, you know, in the feeding realm. And there they all have some training in tethered old tissues or mayo as well as it as it relates to that population because of what I've taught inside my course. Okay, if you're looking for a myofunctional directus myofunctional I'm like looking at the word directory while I just said that. A myofunctional therapist, not directionist combined directory and therapist. That was fun. I like to do that. Sometimes they make up words. We have a brand new directory so there's only like a small number of members on there. But go to the myo directory.com and that will give you a list, like I said, smallest right now, but growing of individuals who can take more of a MYO approach. But again, keep in mind that's really for children who are at least at the age of a four year old cognitively, because that's when you can start traditional myo. Otherwise we're going to adapt the MYO to what we're doing in peat feeding and that is the pediatricfeedingtherapist.com directory that I mentioned. All right, hope that is helpful. Always here to answer questions. You're welcome to email supporteedthepedes.com Also, if you have questions that you want discussed or answered on the podcast, I haven't actually said that in a while, so I wanted to throw that idea back out there because I'm always open to topics you want discussed. If there are certain people you want to hear on the podcast, send them our way as well. But that's all I've got for y' all today. This is Hallie signing off. 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 Podcast and share this episode on your social media platforms. You can access free resources and all I offer@halliebulcan.com or pop over to hollybulcan on Instagram to get all the latest updates.