Episode 312: Navigating Airway Health with Dr. Julia Sadove-Lopez, DDS

Hi and welcome to episode 312 of the Untethered podcast. Today we have Dr. Julia joining us. Dr. Julia is the founder of Oris Wellness, a consulting company dedicated to empowering parents with the knowledge and confidence to make informed decisions about their child's oral and airway health. Through one on one sessions, she provides objective guidance on treatment options and helps families connect with qualified airway focused providers. Her mission is to bridge the gap between professional expertise and parental intuition. Originally trained in biological and airway dentistry in Chicago, she now calls Port Portugal home. 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 tetradural 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. Doctor Julia, welcome to the podcast.

Thank you. Happy to be here.

I'm excited to chat and dive in. I know that you're in Portugal now and we're going to talk all about that with my upcoming trip this summer. But let's dive into why we're here today. All things, you know, airway health and your framework and all that fun stuff. But before we do, tell us like, how did you. Because I know we all have a story. How did you. How did you go from, you know, general dentistry to biological dentistry and ultimately into the airway space that you're in now?

Yeah. So I think my journey is a little unconventional. I know that most of us end up in this space from the personal experience, the trials of trying to figure it out for our own children. But in my case, this is a different scenario. I really fell into right place, right time when I moved to Chicago. So up until then I had been practicing regular general dentistry for a few years out of dental school and I moved, relocated to Chicago and ended up finding my way by pure happenstance into what is a biological dental office. And I showed up, honestly was like, I don't even know what this means. And I was really fortunate to find my. My then boss and first mentor kind of took me under her wing and started to teach me all about that world. And that's the first tumble down the rabbit hole, right? Because then you start to reconsider everything you see and look at everything with new eyes. Then from there, I was introduced to Dr. Kevin Boyd and I had the pleasure of becoming his research assistant for a period of time, working on some of his research with anthropology studies with the skulls and helping out in his clinic. Obviously there was a lot to learn there. And in both of those settings, really the importance of sort of interdisciplinary care came into play much stronger than it had been in my general dentistry practice previously. So I really started to rely on having an amazing team of other providers from different medical backgrounds, not just within dentistry, to rely on. And I was so fortunate that in Chicago we have so many incredible providers to rely on. And it wasn't really until I started, I have some nieces that live in Florida and I started first by helping them track down some providers. I started to realize that not everyone had this Chicago level system in place as far as like having it all, the whole kind of ecosystem of care already in existence. So that was for me, kind of the first light bulb. And then as I was making the decision to move to Portugal, I was trying to think about sort of what I really wanted my focus to be moving forward. And I had really loved what I learned with airway dentistry and loved educating families about kind of connecting the dots. I often joked that I was like a professional referral system at that point, because I would see, I was screening, I was screening and seeing these families and recognizing these kids early and sending them to all the right providers. And I started to realize that there were a lot of parents who were kind of looking for help and support in those areas. And so slowly and surely I kind of dived into having my own consulting business to really offer that sort of education and support. So that's how I landed here, with my own company or as wellness that is doing just that.

I love that. I love that. And you really, I mean, I love the journey.

Yes.

Chicago has such a great hub, if you will, even like in the suburbs, like suburbs outside of like, you know, Chicago. Cause I have some friends in that area and even, you know, in, in downtown Chicago area. And it is, it's such a Hub. I feel like we started to develop that where my practices in the D.C. metro area. I moved to South Florida and was like, okay, there's, like, piecemeal providers, and you have to drive a distance, and traffic down here is no more fun than, I'm sure, Chicago and the D.C. area. And I was like, oh, goodness. And so, I mean, I'm very lucky because we've had now two airway, like, one airway dentist and now an airway ortho for my kids. The Ortho is actually 10 minutes from my house, which is like, holy cow, because you drive over an hour to the airway dentist before for expansion purposes. Airway purposes. And. And I was spoiled because up in the D.C. metro area, my friend up there, she was also, like, 10 minutes from me, and she was a biological dentist in the airway space doing expansion and all the things. And I'm just like, I think I'm just gonna fly back up to get my teeth cleaned by you, because I can't find a replica of you down here.

It's hard.

And then even on, like, the MYO side of things. Right. So I love that you've kind of, like, you're mentioning. You're doing the consulting, and you've really evolved into supporting the parents. Because as a parent in this space, it's overwhelming. And it took me time between finishing expansion like that we did before and knowing my kids needed another phase of it and going to this next provider. We just went last week, and she has been on my to do list for, I don't know, seven months. And, you know, so it's like, even someone in this space, I get it. And the overwhelm is real. And I think part of it, too, is just all that information just on top of our daily lives and everything we're already juggling. It's just sort of. It feels like a lot. So will you talk a little bit about, like, what you're doing to help parents kind of maybe overcome the overwhelm or, like, what is it that you do with this?

Yeah, I think you perfectly described that. That's exactly where so many parents just get stuck. They know they want to do something and take some action, but there are already just so many decisions to be made about everything in life, not just about this. And then this starts to feel like there's more and more pressure to sort of make this decision, make it right. I know that a lot of parents come to me so worried about taking the next step and taking that next action item. So that's really, my. My consulting services have evolved in time as I've understood better what it is that the parent experiences, because I actually don't have any children myself. So so much of what I've done is just try to be the professional lens in this equation and provide. I know a lot of families. The indecision and the overwhelm comes from a few places. So I think first and foremost it's coming from inconsistent messaging that is out there. And so that's a function of the inconsistent training that is available as well. You go to one's. The institutions that offer education for dentists and for hygiene and other dental school services are not the source of this education. And so these education items, they have to be piecemeal, like you just kind of were referring to. They really have to come from different organizations. And part of that means that they're. There are professionals learning this system from this school or this system from this school and this organization. So I do think that that is one reason my parents start to feel really overwhelmed. And so originally I set out kind of with the mission of trying to catch a lot of the parents that maybe were in the early phase. I wanted to make them aware of those red flags and connect to more parents and educate with that. But the reality was the parents who were finding me in most cases had already met several providers and were just unclear as to which type of provider they should be seeing, which type of treatment they should be pursuing. And so that is where I started to realize I could be more help and benefit is just by sort of offering a sounding board and a more neutral professional lens, because people are always scared they're being sold to. And that's one of the things that I do feel like in this airway dentistry niche, at the very least, people are in it for the right reasons. I know you can make that generality or that kind of general statement, but I do believe that most people are here wanting to help. But that aside, there's still a huge financial investment that goes into most of these treatment plans. And they're complex. It's not always one stage. A lot of times it's working with ideally various providers. And so just making sure that parents feel more confidence in the next steps that they're taking.

Yeah, no, I love that. And I think you really. You spoke to the dental side of it and like not being educated from these larger institutions, maybe in dental school. Right. And I think the same thing then happens amongst many of these other professionals on the team too, like the SLPs, the. Myotherapist you know, whether there's OT or a body worker or whoever's involved. I think a lot of us didn't learn this stuff in school. And so it's not just even the dentist, right? They're hearing from different dentists, but they're hearing different things from different speech pathologists or OTs or RDHs who may be doing myotherapy. And I think it's just like, why so much conflicting, you know, information? Like, we get that question all the time. And it's, it's funny that we're talking about this because I actually was working on a little product for professionals to educate families. And it's just like this little back end thing that people get when they enroll in something else. But, you know, it was literally a script like this is what you can say to families to explain to them why their pediatrician might be saying X or, you know, and you're saying why and to kind of reinforce this and maybe encourage them to get another opinion. But maybe you help direct them towards where they want to get that opinion because just going to another pediatrician or another ENT that doesn't have that same background is not going to help, you know. And so it is so common that we hear this like, well, you know, one of my favorite things when I was, you know, I'm not treating right now, but when I was like, parents would come to me and they'd be like, well, why is it that you're like the expert in tongue ties and feeding and my own. I'm like, well, because that's who lands in my office at this point. I'm so highly specialized. They're like, well, why is it that you're so confident about what you're telling us? And I'm like, look, I don't know what. He has a crystal ball. We can't tell you for sure what's going to happen if you do absolutely nothing. But I can tell you what's present today. I can tell you what I think might happen. And then it's ultimately I, you know, up to you to then have conversations with other team members for us to all come together. And then you make the decision as the parent as to what feels best for you. Right? Like, I will never push anybody into anything. I want you to feel informed, educated, empowered. And then you do you, you know, no judgment. So it's, it's such an interesting conversation because, you know, I just feel like it comes up all the time. And I remember, like, just especially in my early Days being challenged by. Especially by. Like, some moms would come with the kids. They get. They'd be like, I feel so heard, like, we're good. And then dad would get on the phone or dad would come to the next appointment and grill me and be like, well, why should I listen to you? And this provider said that, and that provider said this, and you said this. And they. I'm like, I can't take responsibility for what anybody else says. I can only tell you what I know from my experience, my education, you know, and. But at the same. To the same degree, I'm like, I get it. I get being that confused parent who's like, why is nobody on the same page? Like, I'm supposed to invest all this time and money? Like you were saying, it's an investment. And no one seems to be speaking the same language.

And I think you hit on such an important point there, too, with sort of. That's one of the things that I circle back to is, you know, we can. We can educate them on what we know, but at the end of the day, there's still a very big, big step that has to be taken by each parent to make the informed decision of what does feel like the next step and what does feel aligned for them in terms of what they feel is possible with whatever set of circumstances they're dealing with right now. Like you mentioned, the drive to see a provider, maybe it's strictly the drive time. Maybe it's, you know, finding the time to get to and from the appointments. There's a variety of factors. And even with kind of knowing which. Which type of approach to take first, I mean, I certainly, in an ideal world, everyone would be doing myofunctional therapy and getting that done. But the reality is not every family is going to be a good fit to take that as the first step. So we do have to meet the parents where they're at and listen to their. You know, there's guidance and there's education that we can give them in terms of making the best decision of what will be the best treatment outcome. But at the end of the day, it's not always going to be what I think is best. It is going to be helping each family figure out what feels doable and what makes them able to take action. If they've been stuck because they've heard that they need to do one step first, and maybe that's just not working for them, then we need to find another path forward.

Yeah, no, I love that. It's. I love the whole like family first, patient first, you know, very individualized approach. And, and just it's, you know, when talking with younger therapists or therapists who are newer to a space, sometimes like, they'll say, well, how do you get the families to do what you want them to do? And how do you get them do this and that? I'm like, I don't get them to do anything. I help them. I help get their buy in. So I help them understand what we're doing and why we're doing it. Because then they have a foot in the game and they are interested in doing it and they want to see the child succeed.

Right?

And like, you know, people say, well, how is it you get people to keep coming to Maya? Or like, they don't stop seeing you and they see you through the end of the program because they understand why they're here in the first place. They understand what we're working towards and we're a team. If we're constantly just prescribing things. I have families come to me. In fact, I had somebody in my messages the other day who was like, well, I stopped taking my kid to Mayo because we were like four sessions in and they were just having them rub their lips together and like pop their lips. And I was like, okay, well did they. I'm like, I don't know what this person was doing or why. So I was like, well, did they tell you what they were like, why they were doing that? What was the goal? I'm like, I don't know that this is an exercise that I would use necessarily. Maybe I use half that, but not, you know, but that's like one of many things, you know. So here I am in my mind going like, what could they possibly be doing? And why were you working on this for three sessions? You know, and the parent didn't know. They were like, I have no idea. I was not understanding how this was going to help us move forward. And I was like, that was the disconnect. This parent was like, I'm not spending my hard earned money and my time doing something that makes no sense to me, that I don't know why we're doing it. I'm not seeing how it's going to help my child move forward. And it just kind of lends to this discussion that this parent was not properly educated and so they didn't feel that it was valuable. Right. And people are going to invest in what they value. So if we don't find value in what someone's doing, you're not going to keep them if they even start.

Absolutely. It's so important to find what motivates like, each parent and each patient to either see immediate progress if that's what they're looking for. And I know immediate progress isn't always available, but whatever we can do. Yeah, just set them up for like, what is the biggest area of concern or maybe the biggest symptom that they want to address. Because if we can hone in on that and maybe work towards what's going to address that symptom, then I do think that buy in is going to be a lot better as they see how that makes changes in the health of their child. And if we can start with one visible win and one step that is showing improvement, then we can get more buy in.

100%. I love that you said that. A visible win, even if it's small, even if it's just like, hey, I'm just trying to help your child do X and they do that little movement with their tongue or, you know, it's like, oh, okay, progress. Right. And I think it's just psychologically, like, parents need to feel like we're making progress, which we are, but we're not always pointing it out. We're not always explaining it to like the 10th degree and just helping them realize that this is part of the bigger picture. Like, we're working towards X, but we have to like break it down into little steps in order to get to that end goal. You know, I think that really helps parents kind of like grab on and hold on. And, you know, I like to always assign, like, my homework is usually something that they really secure. Succeeded with in the session that we're going to then work on generalizing at home. Because if they already had success and the parent knows that we had success, they feel more empowered. They're like, okay, you did this in therapy. We can try and do this at home, work on generalizing it. And they, they understand again why we're assigning that. And they're going to have less frustration at home because the kid already had success in therapy or the parent or the adults, if we're working with adults, you know. So anyways, I'm sure we could probably share like 500 different strategies here, but I know you have a framework. You got your sponsor, your smile support, Stairweps. Stair. I got to talk. Stair steps framework. Will you talk a bit about that? Like, what is it? How you developed it? What does it do?

Glad to. So again, that was a more recent development of mine. I was Again, as I realized more and more parents were really trying to understand what are exactly the nuances between why they might be choosing one type of treatment or another, it started to occur to me. It's taken me a long time to even understand as a dentist what some of the nuances are between these different approaches. And so I was trying to think about it, and what I really see as a difference is as we move through, I've got sort of three groups, three categories. We'll say the entry point is the natural nurturers. Then we move on to the guided growers and then the foundation fixers. So as we move from one end to the other, I will start by saying I do believe that there's a place in time for all of the dental and allied health professional treatments that are coming into play in this framework. And again, going back to, like, what's the right thing for each family? That's what we have to figure out. And so as we move through each category, we really start in a place where there are certain treatments that may be less forceful, more natural, but with that becomes the reality of a higher degree of less predictability. So we might have the more natural approaches that someone's interested in. And I think that includes therapy. I think that includes a lot of the preformed appliances that are on the market. There are so things like the tooth pillow, the myobrace, things of those of that nature. There are a lot of parents who are first seeking what can we do either early on, when maybe no one else is seemingly providing options for my child. So a lot of the recommendations that I have for families that are looking for what can we do early on? Will fall into those categories. But a lot of parents have a preference for that. And I think, again, that if that's your preference, that is totally fine. But I need you to know that it's going to be less predictable than some of the things. As we apply more force, we're going to also see a greater degree of predictability in how the treatment results happen. So as we continue into maybe the guided growers, we could have more things like removable appliances or some of the functional orthopedic systems, which I'll explain a little more about too, because that's not as common in the US So we can talk a little bit about globally what's going on too. But yeah, in the beginning, a lot of people have questions about things like the alpha plants, and that would be more aligned with, like a natural nurturer approach, whereas we can move through and then Even up to the foundation fixers we're going to have. That's where things like braces are going to fit in. And I hear a lot of families say, I don't want to have braces, or I don't want my kid to end up in braces. And braces are just the tool. Braces are not necessarily the enemy here. We have to look at the fact that we. The reality is a lot of people think that because a lot of the providers who use braces are prescribing to an older thought system. But there are people who are trained and qualified to use things like braces, or I put rapid expanders in that category. There are things that are going to apply a certain degree of force. And again, that's not necessarily bad. We just need to understand is this the right fit for your child? And is the provider who's using these tools thinking about all of this within the right context? So that's kind of an overview of that system.

Love that. And I think that's super helpful to think of it that way because a lot of families will come to me. And I think parents, without really having a good idea, they kind of look at some of these things that are marketed on, you know, Instagram, some of these guided growers, as you call them, you know, these tools, especially for the earlier ones, you know, they kind of look at it as a replacement. And I think that, well, maybe for some kids it might be, but for others, depending on the age, depending, like you said, there's just unpredictable things that we don't know yet. Um, but for many kids, I've seen that they, you know, even if they start there, they then go into like a fixed expander or some type of other, you know, hardwired appliance. Um, and I think that it's a really just. It's a really great way to look at this. I like that you kind of put a, like a framework behind it. Because I think visuals and just like categorizing things and super cute names like guided growers. And, you know, I just think that's. That's the stuff that parents kind of go, oh, I get it now. Like, I get. I mean, even to me as a provider, if someone had said that to me seven, eight years ago, I would have been like, oh, I get it now. Whereas, you know, like, I went into a practice that had a dentist, Northro Biological Airway Centric, you know, and they had an arsenal of different things that they use, like from the ALF to the DNA vivos to Hardwired options, you know, not hardwired, fixed appliances. And so it was, you know, I was like, oh, well, obviously they offer different things. So it's very individualized. This is really cool. But, you know, it's hard to find places like that. It's hard to even find a place that offers one of these things, let alone a mix of them. And so very luckily, the ortho that I just started taking to my kids to here in Boca, she just recently, she was working with somebody else before, but she's recently opened up her own office and very convenient, which is so nice. She offers, you know, a variety of these different types of appliances as well, which is really nice because we went in and I was like, I don't know if she's going to recommend Marpy for my kids or like a Haas that's fixed or clear a liner or you know, like, I don't know, you know, or a myo brace or. I don't know where we're headed. But I know that she has also just, she's got a toolbox, you know, and so I think it's very cool to see the differences and to understand, you know, more about the appliances because we get asked that in my, my membership even like people are like, can you do a training going over all different appliances and what they're for and why someone might pick this one versus that one. And I'm like, I can bring in a airway centric provider to do this that moves teeth for a living. Because I don't but that a couple years back and I'm like, I'm sure we probably should do another one because I feel like there's more things now on the market that have become, not that they're all new appliances, but they become popularized in a certain way, right?

Absolutely. And that was one of the things was I, I actually kind of conceptualized that system sort of behind the scenes. I didn't realize that that was something that I was sort of understanding where each parent was at. And I am working on getting a more public facing little document where parents can take a quiz and see like, what's your airway style? Or kind of have an idea better of like what might be a better fit for where to start with and kind of going into more supporting information on each of the different like categories and what's available for each of those.

So.

I know you're right. I even again, as a dentist, when I first found my way into this, I know, like at Dr. Boyd's office, they handed Me a sheet of, of all the different appliances they were using. And I had been through dent school. It wasn't like I didn't have the basic training, but I looked at the list and I was like, I don't, this is all very overwhelming to me. So I think it's something that it's taken some time to, to really understand the differences and I want to be able to support a lot of parents in figuring that out. But also one of the things that's been helpful is being able to also help other providers, whether it be some of the other myofunctional therapists or otherwise that are interested in learning more, that I can still kind of make some of those kind of supporting references for them to understand.

Yeah, I mean it's all, I feel like it's also individualized, which is also why I think some people have a hard time when they find a provider who only does like one type of appliance. So like in those situations or just in general, I guess, how does a family kind of figure out, aside from working with you, obviously. But like, how do they figure out, like what is the best fit for them? Provider wise, appliance wise? Like, I know we've talked about how it all needs to be very individualized. So how do they like, do you have any suggestions on how people figure out their best fit?

Yeah, I do think again, kind of going back to that, that, you know, autonomy component. I, I've heard you say before, there's like mom intuition and, and there's a certain degree of that and I think it's just sort of pairing that intuition and that's something that I really had to learn more in the biological dental practice. I think we start out from dental school and we, we should be including patients in those treatment decisions from the beginning. That is something that we learn as a foundational concept. The American Dental association does say that patients should be involved in these treatment decisions. But it's easy to kind of as a provider sit back and say, I'm the professional and you know, pass the wisdom out, here's what you should do. And again, I think that comes from the intentions are good. The intentions are like, here's what you should do because it's what I think is best with my professional expertise and not to disregard that at all. But we need to find that middle ground of the professional expertise meeting what the parents preferences are. So part of that again, we've, we've sort of talked about what are the motivations, what are the primary symptoms. Because I Think, yes, I can tell you to go start with the tongue tie or start with the expander or start with the therapy. But at the end of the day, kind of knowing if you're like just sitting there as a parent, one of the primary examples, I guess that comes to top of mind of like, scratch that we need to backtrack and figure out something different is like when sleep is a hot mess, when your child is getting no sleep and looking for that quick win. Like maybe we need to go chat with a sleep consultant first and get some quick wins there while we're addressing some of the dental issues or while we're addressing some of the functional issues. And sometimes there's a wait list to get into the dental offices. So sometimes it's just figuring out what are the options available and who can we go see. And I know again you said apart from what I offer, which is to sort of sort through all of that, but I think, you know, geographically relying on a lot of the amazing directories and figuring out what's available near you is an important step. I know you have one of those amazing directories, so thank you for that. And then also, yeah, looking into different resources and trying to educate yourself on what, what is resonating. And that's where I think there's been so much sort of. I see a lot. I passively watch some of the Facebook groups and people come out saying like, this is what you should do and you should absolutely do this first. And I just, it doesn't sit well with me because these people are saying, I know it comes from a good place because they know they have the tool set to help somebody. But without knowing what's going on for each family, it's hard, It's a really hard thing to sit with. So, yeah, I think you just have to figure out what is the first thing that you want to see and then figure out from there where we go with selecting a treatment that feels like it will address that.

Yeah, well, and I just have this like word downloading into my brain, like just flexibility amongst providers. Because, you know, it's making me think back to like, what was it December, maybe 2022 that I did this or 2023? I don't know, I did just it like a one time training inside of our membership. And I called it like airway. It was like airway first or something before, like, you know, all this airway first stuff was coming out. And everyone's always asking me, well, how do you determine like what you recommend to patients, like what journey, like, what should they do first? And I was like, you know, that's something that I even struggled with myself, myself to figure out what I should do first. And honestly, part of it just was what fit my lifestyle at the time, not maybe what was the best practice. You know, what was best practice from a medicine standpoint, it was more like, look in hali handle right now. I did my expansion first, then I did my nose, and I'm like, I feel like I should have done my nose first. And that was totally an afterthought, you know, but that's life. That's how it happens. And so I, I. This was also, like, me sharing. I think it was. I think it was December 2022, because it was after I had, like, my. My ENT. No surgery and everything. And so everyone was like, we want an update? I was like, all right, this is a great way to present this. So in there, I remember speaking about, like, different pathways to the same end goal and how, you know, we have patients who may present very similarly, but maybe they go ent first, maybe they go to body work first, maybe they do myofirst. Maybe they get expanded first. And in a perfect world, airway should trump everything, right? Like, I want your airway to be healthy. What is going to get us a healthy airway first? To that same token, the way we get there can look very different. Because I think everybody, just from a medicine standpoint, everyone's like, well, there's gotta be a step one, a step two, a step three, a step four. And I'm like, yeah, sure, in a textbook. But, like, do we ever really do anything textbook? Like, that's rare that you have, like, a textbook case. Like, no, we're working with humans. There's always deviation from what you learn in a textbook. So, you know, that's where I like, I like to. I love what you're saying because I think it really speaks to that and talks about, like, all just, you know, these nuances, like, we're working with humans and life. You know, if you want people to ultimately do anything, at the end of the day, like you said, you got to meet them, where they're at and figure out what's best for them. So I love that you really highlight that because I think it's just a really great reminder for professionals in this space and parents to even know, hey, we do think this way, and we are here for you, and we want what's best for you. And, you know, I always say, leave your ego at the door. Like, you're not here to be, you know, yes, they want you to be the best provider. That's why they're coming to you. But you know, you give them your expertise, you educate them and then you let them decide. And I, you know, people get their panties in a bundle or they're like, they're not listening to my recommendations, I'm going to fire this patient. And I'm like, hold on a second, like, can you not make any more progress with them? Because maybe that's a reason to say, hey, I can't help you anymore. But if you can still make progress with them, even though they don't want a tongue tie release, even though maybe they're not going through expansion right now, like you can still help them, you know, undo some compensations, gain some function, better their health. Why would you be turning them away? Like, that's, you're doing what you do because, you know, this is, you know, not everybody's going to come and do every single thing that you want them to do or that you think might be best in their case. Right. Like we're all human. And then I try to remind people, like, put yourself in their shoes financially, time wise. You know, life, life is, yeah. Before I, you know, like two year token, same token with like not having kids yet, like before I had kids and I was working with families of young children, I was like, I, I, I can't say that I know, but at the same time, like, I'm gonna try and be very realistic in what I ask families to do outside of therapy because I just, I just don't know, I don't know what they're dealing with. But I also feel like less is more. If we ask them to do maybe a little less, maybe it'll actually get done. Right, let's try that out. And I felt like worked really well for most of my family. So I kind of, you know, even now that I'm a mom with kids, I try to still keep that same thing in mind. Less is more. Like, even with recommend, like recommendations following evaluation, people want to put like five recommendations in of different providers to see. And I'm like, pump the brakes. I'm like, if you're telling them this is a two year treatment plan and here's everything that, you know, maybe verbally share some of that. But also like, if someone came to me and said, you're going to need six different providers to help your child and it's going to cost you $50,000 in two years, I'd be like, you're out of your fricking mind. Now, I can't say I haven't spent that time or money at this point, but nobody came to me and said that I needed to do that from the get go. I kind of was, like, figuring it out as I went along. And so it's all about. I'm like, you're selling. We're all in sales. Like, how are you promoting to these people? Like, what is best for their child? Maybe make like, one recommendation. I screened your kid. I think they need further evaluation for X, Y and Z. Period. Done. End of story. Then you eval and you're like, okay, I evaluate your kid. I think, yes, we should do mayo, but also you might want to see a body worker and a airway centric dentist. Two recommendations, nothing more. You know, it's like, let's not completely overwhelm from the get go, because that's when you lose people. And like, you know, it's just. It's too much. So anyways, I know I'm like, rambling at this point, but I. I love.

Everything you're saying, so I'm eating it up. Important for people to hear. Yeah.

I'm like, take note, therapist, because if you want your clients to come back, you want to, you know, you want to actually help.

On the flip side, though, I've also seen some really incredible treatment plans where someone's, well, this one provider just wanted to start with just an expander, but this provider is telling me I need expander and the frenectomy and this and that and, like, comparing those approaches too. I'm like, well, this office is maybe looking at things possibly more comprehensively. It's hard to know the. That situation too. But, yeah, I think to your point, like, there's a way to verbally provide that information without having the extensive contract that you sign this dotted line before we get started.

Yeah, well, and also, like, know your parent. Like, know the family. Family. If the family's. If the person is sitting there asking you, okay, like, and then what? And then what? And then what? Put that in writing. Like, put your 12, you know, step treatment plan in writing because that parent needs it. If you have a parent sitting there looking at you like deer in the headlights, like, read the room. Be like. And, you know, it's. I always tell people, like, you can say, like, you know, these are the initial steps. This is the initial phase of the treatment plan. For additional phases, you know, contact us or something, because it just tells them there is more without completely, like, overwhelming them. And you Know, like, to your point, like, we just. I just signed two agreements, two contracts for my girls for further expansion. And there was discussion of, like, they've had expansion already. This may just be a phase one kind of thing in our office. Maybe we don't need phase two because this might be enough because this is not, you know, one of my kids. This is her third round of expansion. She had an elf. She had a high racks with forward growth, you know, upper and lower. And now they're going into another expansion treat. You know, I like, they need a little bit more, and we want to bring the palate down a little. We want to bring the jaw forward a little bit more. One of my kiddos. And so, you know, but the younger one has only been expanded once, and that was to get her out of airway crisis. That was our initial goal with knowing she's going to need more because she did this between 4 and 5. So it's like, I went in knowing this wasn't like the end all, be all, but this was step one. We're going to need a step two. I didn't know what step two was going to be, but I also didn't need to know what it was at that time. I just knew. I was like. I just like that. I was primed for it. Absolutely. Like, okay, now's the time for step two. She's six. She's seven. Just turned seven. I'm like, let's do step two now and get her, you know, over the hump and get this airway completely healthy again. So, yeah, I mean, it's. It's. It can be so overwhelming. And everyone asks me, they're like, well, did you take them for bot. Did you take Lily for body work when she had her out? And I was like, no, it was pandemic, and everybody was shut down. And like, you know, in a perfect world, I would have loved to, but I didn't. So, like, I'm also a prime example of somebody who maybe would have.

The conditions weren't.

Yeah, life takes over and kind of directs you sometimes, and that's okay, you know. But anyways, all right, let's talk a bit about different global trends. So now that you're over there in Portugal, right? I know there's differences, and I. I get people messaging me online, too, who are like, hey, do you know anybody in this country, in that country? And I'm like, I wish I did. I really don't have a big pulse on, like, other countries. Maybe a couple people here and there, but I know, there's differences and the approaches and all that. So anything you want to share on that topic between us and, like, Europe, go for it.

Yeah, no, I think it's really fun. It's been a fun part of my journey to sort of get a little bit of a perspective shift. I think that one of the things that jumps out to me is I think that in the US we have that mindset of, like, if by the time we're taking action, we want it to be quick often. And I think a lot of the treatments and philosophies over here in Europe tend to be a little more gradual and a little more slow, which I think is interesting. And again, I think product of the environment to a certain extent. I know recently I was listening to you, you had Dr. Wolf on talking about Nuvola, which is based out of Italy, which I think is a really interesting system. There are other treatment options that I've come across in large part. There's a dentist named Dr. Pedro Planas that I had never heard of before, and he influenced a very different philosophy of treatment. He was based in Spain, and I've come across a few different schools of thought that have embraced his teachings and philosophies. So one is sort of similar in concept to when you had the provider on talking about Nugol, they mentioned the Freedom Appliance that's working to unwind some of the cranial strain patterns. So there's an entire book that I read called Dentosophy that's, like, kind of meant to it. It's very superficial. It doesn't go into a lot of detail about the treatment plan itself. But I've had the chance to meet with some providers who are offering this type of treatment. And that's something that's available more readily again in Spain and some in the UK and some providers in France and Italy. But they're looking at these sort of different. What looks like it would be almost like a myobrace, but it has more of a cranial component. And I think that's really interesting because that's one of the things when X rays in general are kind of less commonplace around here, and especially CBCT is being less commonplace around here.

Okay.

One of the really interesting things that I've seen is, is some providers, when they're treating patients, they actually have, like, a podiatrist that they work with, and they scan the feet. And I've heard you say before so many times, I, like, hear your voice saying, from the tip of the tongue to the tip of the Toes. They take, like, foot scans to measure how treatment is going. And I think that's incredible. Wow. And then kind of going back to, like, the. The Pedro Plana system and philosophy. There's other systems. I'm enrolled this year in a training program here in Lisbon that's all functional jaw orthopedics. And that's most similar, I think, in theory, to some of the Bioblock and some of those types of treatments. But it's a system based out of. Of Brazil, and it has 23 different appliances in this one system that's all focused on, like, repositioning how the lower jaw relates to the upper jaw. So again, it's all very slow movement, which I think is a departure and perhaps why this isn't maybe as commonplace in the US Yet. And that's one of the benefits that the Nuvola system has over some of these other approaches is that with the clear aligner therapy sort of bridging the gap, that allows for it to fall in kind of the middle between. It's a little more force. As I was kind of breaking down the systems, it's a little more force, it's a little more precise than some of these systems on their own, perhaps. But that's one of the nuances that I think has been really fascinating, is just kind of getting this global perspective.

That's very fascinating. And so cool. Now is. So is Dr. Planis like. Of Planis tracks. Did he invent the plan? Yes, yes.

Hear a little bit about the girls.

Had those.

Yeah, yeah. And so those. For people who don't know about those, the idea behind those, they're like little composite, like. Like white filling material that's added onto the teeth that changes the function of how somebody is chewing and how they posture their mouth. And that can be enough on its own. You don't even need a full appliance in their mouth. You can just start with something like this to change how they function. And as a result, it changes the muscle patterns, and as a result, that changes the growth. So I think all that's really incredible and not very commonplace from what I was understanding more in the U.S. yeah.

So it's interesting because Dr. Barahol, that I took my girls to in North Miami when we moved here, she. So she uses a variety. A variety of things. She'll use an alf. She's, you know, she'll also do hyrax with, like, a forward growth component. Component that she customizes. So my older one was a good, you know, age. Basically, if you're going Based on age to go into it had the alf. We had great expansion but I was like, we know we need more. So she put her in upper and lower with like a forward growth component. And she may have, I think she put, yeah, she put planus troxan, both kids teeth. And part of what she explained to me was she was like this is to really change the bite pattern and to help develop those masseters and to help, you know, I was just like, oh, okay. My younger one, she wanted to start her in a myo brace and then because she was four and I think she was like three and a half when we started talking. When I finally started it, she was, had just turned four and this kid had had croup for nine times as a three year old. They were constantly putting her on meds. I was also like switching into the homeopathic world. It's like, you know, in the beginning of the pandemic I was like, we've got to get this kid off steroids. It is destroying her gut and her entire immune system. And I was like, I know she's basically an airway crisis. And you know, we did, we did CBCT and it confirmed it. Okay. Like we, we kind of knew that. So when I told her about her, her history, she was like, oh no, no, no. Like I wanna, she's like, we gotta, I would rather do some rapid than slow on her just because you know, we know there's research that says like kids who are in airway crisis like rapidly probably a good option. Right? So we put her in the rapid. It went beautifully. But she also as a kid who was grinding her teeth down like crazy, which my older one never did. And I mean I was over here like, does she have parasites? Is it an airway thing? Is it everything? Is it like all the things combined like what is happening? And so she put the planus tracks on which I feel like that was something that gave me the most peace of mind out of the entire treatment plan because I was like, if she's grinding, she's grinding the planus track and I know that she's not destroying her teeth. Plus she supposedly is changing her bite for the better right now. Plus we're, you know, we're building up the jaw and the muscles in between them and everything. And so I feel like that was a saving grace for her. Those planus tracks. So they were like my most favorite thing of the entire treatment plan. And we've gone back where she's built them back up, you know, over the past Several years. And again, it just gives me peace of mind when my kid gets sick and she's, like, grinding away at night. And I'm like. Because we had switched to using the myobrace more like a placeholder for both kids after. And Mia, my younger one, was, like, fantastic with wearing it. And all night, every night, until it, like, broke. And, like, within days of, like, the yellow, the white thing kind of poking through and me, like, poking it back through, it started to get moldy. And I was like, okay, now we have a whole host of other issues.

This.

I was like, got a new one. I bought a new one, full price, and then never, never used it. So that was a waste of money. And my older one couldn't keep it in her mouth. Like, she was coughing, gagging, choking it out every night. And I was like, this is not good for her nervous system or anything, you know? So I was like, okay, we're probably going to go into another round of expansion because I'm sure we're going to lose some if we're not using the MYO brace. But I would rather do that than have her wear something that she's. Her body's literally gagging out two hours into sleep. Something is not working for her. So it's just been so fascinating to me, like, have now had exposure to all these appliances for my kids. Myself. Like, I had a DNA Vivos appliance for a couple years and then went into Invisalign. I need more expansion. My midline is off. And so that's a whole other conversation to have with Dr. Koval, who we're seeing here in Boca now, because she works with adults, too. But, man, I will tell you, it was just. It's so fascinating, so very fascinating to see all these different appliances to have now had experience with some of them. But fascinating, too, to hear about, like, how things. I mean, everything's different in Europe, so it doesn't. Yeah. But, oh, so cool, because it never occurred to me that, like, Planus tracks were from somebody with a lot, you know, with that name. Yeah, that makes sense. And I'm over here, like, writing his name, and I'm like, yeah, I just.

Think it's interesting because I really hadn't heard his name or come across his name when I was looking at things that were based out of the US and here. Multiple systems. Yeah, multiple systems are like, oh, Dr. Pedro, plan us. And the way, you know, the way that it just. They're really looking at the way that. That the jaw moves in a different way. And I love that.

Yeah. And that's part of why I loved, like, the whole concept of the ALF appliance in the beginning. Because the whole, like, not locking your body up and allowing the sutures to move, and now all the fluids can move and everything. Everything can integrate the way it's supposed to. And da, da, da. And I was like. And I actually think it was really helpful for my oldest when she had it, because she was kind of like a sensory kid. Like, I was like, I don't know how she's gonna do with something in her mouth. And I think that appliance really just helped her kind of like. Like, her whole nervous system just, like, was like, we're good. Yeah, she had it put in. I was like, this is pretty cool. It's up there because her tongue's not yet. So I like this for us. So, yeah, I do feel like different appliances definitely serve different purposes too, which is kind of cool when you get into the nitty gritty of it. But anyways, so I think those are.

Great examples to highlight, you know, again, why certain appliances are maybe right for certain kids at different times. And, yeah, I love that you shared from your personal experience. You've learned so much about that, too.

Yeah, well, that's why I tell everybody. I'm like, this is totally, like, my personal experience. Yours could be totally different. But also, if a provider's recommending something to me, like, I want to know why. I want to know what their reasoning is behind it. If you give me a reason, I will probably sign that contract and give you my credit card right there. But if you can't tell me why we're even doing this, like, I'm going to go get another opinion. And I did take Lily to another, like, very highly regarded orthodontist, actually two in Boca. And before we started with Dr. Bear Hill, I was trying to keep us in Boca, where we live. And one of them was just very old school, very well renowned, like, you know, people love him. And I was just like, not. Not the treatment plan I was looking for. So not for me. Went to the second one, super airway centric for, like, US Standards type of, you know, eval. CBCT in office. Pulled it up on the screen, went over everything, talked about all the things, and then that author proceeded to basically shit on every single person in the airway space that I knew all, you know, oh, I've taken all those courses and this, that and the other, and was basically like, just, let's just do a normal expander. Embraces And I was like, super airway centric evaluation. 0 airway centric on the treatment plan. And said in front of my kid, like, you're gonna fatigue her. You don't need, you know, let's wait a year. I think we should pull those lower central incisors. When his dental colleague was like, nope, don't pull those. Like, you know, our dentist like, don't pull those, they will come out. He was like, her tongue will push the teeth forward, you know, after they come out. I was like, well, we don't really want the tongue to do that. But I don't disagree with you based on where her tongue currently, because I don't like that this is the advice. Oh, but we're gonna roll with it. It's fine. And that is exactly what happened. So he wasn't wrong. But the ortho was like, her face is so beautiful. You don't want to mess that up. And he said that in front of my kid. And I was like, I don't care if you're the most airway centric provider to say something like that in front of a six year old. Yeah, like, we're done. Thank you so much. Bye bye. And he knew I was mad. Like, he called me a couple hours later to like be like, hey, just want to make sure we're okay and do you have any questions? And I'm like, you know, I'm not okay. Okay. You know, not happy because I was.

Oh my gosh.

Yeah, it was just. Yeah.

Anyways, no, I think that again, I think it's really helpful for people to hear about these types of stories because again, that's where somebody, you know, they can be regarded as like the person to go see. But if you don't feel like you're going to have trust in that provider, that your communication with that provider is going to be on point, that's going to negatively catch up, up at some point in the treatment. So it's amazing that you listen to your gut and you're like, this is not what we're doing.

Yeah. And I've told people that. I'm like, that's why as even just like a mom of a provider and a business owner in this space, whether online education or in the private practice itself. Like, I like to go to providers and have a personal experience with them before I ever refer somebody. Because the way you treat me, regardless of whether you know what I know or I don't know, is going to tell me a whole lot about how you're going to Treat my patients, I refer to you or just moms off the Internet. And I'm not referring to you just because you have a skill set. I want to know that you're going to treat patients right and you're going to respect their decisions and they're going to have a good experience regardless of what they choose to do. And I think that's such a lost art these days. I'm like, it's such a dance between art and science that like, if we cannot put our egos aside and remember that everybody in front of us is a human too and we're all on our own journeys, like, you probably have no business in medicine, but that's a whole nother conversation for another day. Agreed. Oh, okay. So now how can they work with you? Like, what is the best way for them to find you? Tell us all the things.

Yeah, so I do have a website. It's www.horacewellness.com. and from there there's information on there about taking the next steps. For a lot of parents, they do want to do like a initial discovery call just because what I'm offering is pretty niche and not everyone understands whether what I'm offering sounds like what the next step is or not. So you do offer a free discovery call. That's just to kind of get a little more information. But for some families, they're like, I don't even want to spend that time. My time is so valuable that otherwise you can book straight into a consult. So there's typically for most families it's a 60 minute consult to kind of go through all the information. And for a lot of families that is enough to sort of get on unstuck. So I do like to point that out because I know it's like one more thing that I'm committing to this like ongoing thing. But that's not my goal and that's not what what purpose I'm trying to serve. I'm trying to get you unstuck so that you can move forward and continue on this journey. I also have an Instagram account, so Oris Wellness is a resource that you can follow me there and send me messages there. Those are the two biggest places I've dabbled in. Some showing up on YouTube and trying to figure out some of that stuff. So to to be determined as I continue to roll that out. But best way is kind of through my website. You can email me, you can contact me, schedule a call there or catch me on Instagram.

Amazing. And we'll make sure that all of that is in the show notes so that they can find you very easily. Thank you so much. So, so much. Dr. Julia, is there anything that we didn't cover that you want to, like, wrap up with?

No, I think the only other thing I would say is, like, part of what I've been enjoying doing that's been sort of incidental is a lot of the have connected with me have been health providers themselves. And so one of the things that I'm trying to figure out what role I can take is sort of bridging the gap for some of the providers that are in the early stages of being curious about airway health. So, for example, like, a pediatrician that was focusing on anxiety and had no idea about kind of how airway health could come into the equation, I was like, well, I think you might want to consider this. And she's like, oh, I think I might have to revisit some conversations with some of my patients. So just some of the providers that are listening. If you're, like, just getting started in this journey and not really knowing yet, you know, obviously there are many amazing training courses and resources that you've made available and so much with your podcast. But if someone's just looking for that conversation to sort of get more information about, like, how they might fit into this space, I definitely welcome those conversations. That's something I'm. I'm starting to dabble with, is just how I can be a better ally to those who are wanting to dip their toes in this space, too.

I love that because I feel like we need to get more providers, like, into this space. And I think, you know, like, for, you know, parents that are listening, it can be so intimidating, even for providers, because we've spent so much time and energy and honing our skill set that we have now, and it sometimes just feels like, oh, another thing. And we have to do our own due diligence to figure out, like, is this legit? Is this, you know, is this the next. Next thing, you know, is this where I should be going? Because when I know when I jump into anything, these rabbit holes, like, it is a rabbit hole, and I am dedicated, and we are going hard. So, you know, it's like when I dove into the MYO space, I was like, okay, I'm here for it. And literally all of my continuing ed and courses and everything that I've done over the past five, six, seven, eight years now have all been myo, Airway, tots, pediatric feeding. Like, that is my world. And, you know, I had to be make sure. Before I dove into it, that that was where I was headed. And so, you know, not everybody. Right. Is going to be in this space. And that's okay because we need other types of specialists too, in our field. But, yeah, I think just understanding that, like, it's. It's just as overwhelming for us getting into it when we're new as it is for you all as parents, you know, and patients and parents of patients, getting into it for your own child. So, like, we are all in this together. I think we all just want everyone to succeed and have healthier ways.

For sure. For sure. Yes.

Absolutely.

Well, thank you so much for having me here to chat, Ali. It's been so fun. And again, I've. I've been listening to your podcast for a long time, so I'm really grateful for kind of how things have progressed that I feel like I have something to share with your audience at this point. I've learned so much from all the other guests, so thanks for kind of paying it forward.

Yeah, well, it's come full circle, so thank you for joining me and I'm excited for us to get this out there.

Perfect. Thank you.

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@hallie balkan.com or pop over to Hollybulcan on Instagram to get all the latest updates.