Episode 83: A Dentists Holistic Approach To Treating The Root Cause with Joanna Green, DDS, QOM-D

Hi and welcome to episode 83 of the Untethered podcast. Today we have Dr. Joanna Green joining us. Joanna is a mother of two tongue tied babies and Dr. Joanna Green brings her experience as a mother and a provider to her practice. Working alongside infant and pediatric healthcare specialists, she has developed a comprehensive, compassionate and conservative approach to treating our littlest of patients in a non dental setting. Her journey started with tongue ties but has since evolved into an airway centric practice philosophy. Dr. Green's advanced training in the infant and pediatric laser frenectomy and functional frenuloplasty, pediatric and adult growth appliances including myobrace, Als vivos, orofacial myofunctional disorders. She is trained in OMT and she is a Qom D and Buteyko breathing. Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Hallie Balkan. I'm a certified orofacial myologist, feeding specialist and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, tethered oral tissue and airway space. I challenge you to keep an open mind and join my mission to get this information out to the masses. Let's get started. Joanna, thank you so much for joining me on the podcast today. I'm really excited to sit down with you and chat about all things, you know, tots, myo, airway.

Thank you so much for having me. I'm excited. We've been planning this for a while so it's good to be here with you today.

Yes. So let's jump right on in and talk about how you got into the Totsan Airways space because I know you had your own journey.

Yeah, absolutely. So like many people in my position providers, we have similar stories about our own children and I really believe that's kind of the strongest why that anyone can have. So it all started my first daughter who's now five, she was born a preemie and we had a really difficult time nursing. Just been there, done that, we did everything. So between nursing and bottle feeding it was really a struggle. Then fast forward a couple years later we had our second daughter and she was full term. This literally double the size of her full term baby and she was nursing really well. And then I realized that really, well, was really subjective to what I thought it was. And, like, little things were kind of creeping up after about a month. And so I decided to kind of reach out to local IBCLC in the area. And I actually called them for an appointment, and kind of was talking with one of the IBCLCs, and she's like, yeah, just come in for a comprehensive evaluation. And I'd already done all the Googling, and I'm like. Like, this kind of sounds like a tongue tie. But when I called her and we were discussing it, I'm like, well, I'm just gonna make this very clear. My baby does not have a tongue tie. I am a dentist. Absolutely not. Like, I would know if she had a tongue tie. And so kind of thinking back on that, on that conversation, it's, like, really embarrassing because she's like, okay, well, you know, we're not talking about tongue ties. I'm like, but I'm just. I'm just throwing it out there. I know. I know what a tongue tie is. So fast forward, like a week later, we go in and we had a comprehensive evaluation. And lo and behold, my daughter had a lip and tongue tie, a posterior tongue tie. And I just. I had no idea. And when, after about an hour of being there and doing a functional evaluation, my IBCLC was. I mean, she showed me, and it was kind of like it was right there, and you can't miss it. So after that, my journey kind of went into getting it, the lip and the tongue released. Then after about two and a half weeks or so, we saw drastic improvements, and I kept going back to my ibclc, and she not only was, you know, helping me, but she was also like a friend, someone to confide in, which I think is really important when moms go to these appointments, because it's really not just get help and see you never. It's a support family. And so when I go back there, she's like, listen, Joanna, like, you. You're a mom. You've been through this. Why aren't you doing these procedures? I'm like, oh, I have no idea about this. Remember that conversation that we had on the phone? I didn't even know what a tongue tie looked like in a baby. And she's like, no, I really think that I challenge you to learn more about it and see as a mother how you can provide a really good service to the mothers. Because she's like, I like you. I like what you're about to. So you should learn more about it. I'm like, all right, okay, I'll get back to you when life calms down, which is, you know how that goes with babies, right? Never. So, yeah, a few months later, things calmed down. Nursing was great, and it was just something that really kind of stuck in the back of my mind. I'm like, maybe this is something that I should really look into. And so I did. I took a few courses and learned about it. And then, you know, at the same time we were at my dental practice, we were incorporating airway screening, and so, you know, pediatric airway screening and adult airway screening. And so I was like, well, you know, we're making a lot of changes. Maybe this is the time, right? And fortunate one of my partner at Pike Creek Dental Office, he's super supportive of everything. And so he's like, you should do it. You should do it. Like, we're like, CE junkies. And so took the courses, bought a laser, and I had my first patients. And I quickly became, like, almost like, addicted to it because I. My journey, I basically took everything that I felt could be better in my personal experience with the release. And I had a great experience, but I was like, man, as a mom, I can provide an even better experience for my patients, for my families. And so I designed my own, you know, my own program, my own approach to it, and I was able to kind of fine tune everything the way I wanted it to be and the way I felt mother should be treated and how a mother should, you know, get that peace of mind. And just a lot of time, a lot of these appointments are just counseling. It's education, it's counseling. It's relieving a mom's anxiety that, you know, that they're not crazy, that they're not crazy for doing this to their child. Because what I like to say, it's not. You're not doing this to your baby. You're doing it for your baby, ultimately. And so at the practice, I was able to start incorporating this program. And it was a lot of work. And I had my two main assistants that were there with me through, like, from day one. And it was nerve wracking. And then, you know, you do it more and more, and you start to kind of really fine tune everything. And so that's how it started from in the general practice. And very quickly, as word got out and I made more relationships with IBCLCs and with the hospital and different OBs, and they just really appreciated my mom to mom approach. And so I was getting a lot of babies, which was fantastic because we Loved doing it. And we were getting really kind of fine tuning our process. But we had a lot of crying babies in the office and a lot of moms just sitting with their car seat in the waiting room. And people are like, why is there an infant in the waiting room? And the office is beautiful and it's very open, but at the same time, it would get really noisy. And my partner, he'd be doing a dental procedure, and there's a next door. So it wasn't really good for that calm dental experience that you want for your dental patients. And then also, it wasn't as private as I would like for my mother. So that kind of evolved into moving out of this space. And so from there, we basically, I was talking about getting involved in the airway screening. So like I said earlier, we had already started the whole process of incorporating all this screening protocols. And, you know, in 2017, the ADA released a statement that dentists are in the forefront of screening for pediatric sleep disordered breathing as well, as well as for adults. So we were like, we need to be doing this as every dentist should be doing it, and a lot aren't. I think there's a huge knowledge gap in that. So, I mean, we kind of hit the ground running. And so we felt like this is important. I mean, we are the specialists of the head and neck, and we are able to catch all these red flags. So we've really started implementing a lot of screening tools and seeing exactly what was what our actual patients in our practice were presenting with. And once you learn it from, like, the MYO standpoint, man, like, you cannot unsee it. Oh, no, you can't. No, you can't not unsee it. And it's crazy because you start thinking, you're like, this is every patient. It's every other patient. A lot of you're seeing just so much dysfunction. And then you see a normal patient, you're like, oh, my goodness.

Yay.

And I'm like, guess what? I have great news. You have perfect muscles and perfect everything. Like, you know, you get so excited, you're like, wow.

Like, what did you do?

Like, can you tell me your secrets? Like, you know, you start, like, trying to figure out, like, what. When you have a child with perfect development, I'm like, I want to interview the mother because I want to know exactly what they did. Because you really. Unfortunately, we don't see it very often now, so we see a lot of dysfunction, as you know. And so it is our. It is. It is our duty to screen and to Be able to identify history and clinically like the symptoms and signs of different issues that children may be deficient in growth or have like sleep related breathing disorders.

So are you guys using like a specific screener? Did you create your own like for anybody who's listening that might be like, hey, you know what, I really want to implement this and my practice and you know, like I do screens during my myofunctional evaluations. We screen for, for sleep and airway to the extent that we can and you know, then we'll refer out if we think there are greater concerns. So yeah. Are you guys using like any specific tool that you like or did you create your own?

Yeah, great question. So my partner, Dr. Ryan Robinson, he is like triple board certified in lots of things and he's, he's board certified in craniofacial pain, dental sleep medicine and craniofacial dental sleep. So with those certifications he's had a ton of training and basically to answer your question, we made our own.

Awesome.

So we've had, with all the training that he's had and that I've had, we kind of, we take what we think is really relevant. And like I said, he's a CE junkie obviously to have those certifications. And so we really made our own. And really, I mean they're simple. We want them to be simple for our hygienists to be able to quickly screen. We also have screening tools for our, for our parents. So a very common scenario in the dental office is that the family comes in, the mom is basically given a questionnaire and is asked, okay, look at these specific questions. And they consist of behavioral, different, like functional things. So we call it our private eye. And so we send. So a lot of moms when they have no idea anything is going on and we, you know, we've screened and we see signs clinically and you know, it may not be appropriate to bombard them with. You need all this stuff, you know, they're like, no, I'm not sure. Okay, here's this private eye. Take it home and look for, look like, read through this and see your child is doing any of these things. Gather information, let's talk about it again. We can talk about it again at six months or you can come back, give us a call, we can see you sooner, like if you are concerned about it. And so we would use the privatized screening for the parents. The parents would also, they fill out like a whole kind of like a checklist if they, if they notice xyz going on. And then the hygienists do an actual clinical exam and, you know, some questions. So we're able to quickly screen. That way we don't bombard the parents with these questions. At every cleaning appointment, we kind of have a baseline, and then we pull it up, and we're like, you know, do any. Has anything changed? Do any of these, you know, appear to have gotten worse or better? And so from there, we're able to make a referral. So this is at the general practice, and that's kind of how we started. And all these forms are, like, constantly evolving. And so for adults as well, same thing. There's. We have the kind of clinical things that we're looking for. We know that sleep apnea has a ton of red flags in the mouth. Like, you really. You start to see it in the mouth first. And so, you know, we ask the questions. Not, do you snore? We ask, have you ever been told you snore? Because if you're sleeping, you don't snore. Right. And there's such a high correlation with airway collapse when people snore, of course. And then the second, I think, most common one really, is the grinding. So nighttime breathtism, Very high correlation with, you know, sleep apnea and such. So we definitely ask our patients a lot of questions. And when people are kind of, like, turned, they're like, I'm just here for the dentist. We really say, well, just like we're giving you an oral cancer screening, we are ethically, this is our job. We are bound to take a look at you from not just your tooth. Okay? Like, we're not just looking at a little tooth and the gums around it. We're looking at your body or your airway, because it really is. You get to see these manifestations first in the mouth. So we just kind of present it to them that way. We care about your health. This is what we're seeing. Take it or leave it. This is how we can go from here.

I think that is fantastic, because I know, like, most people think, you know, and a lot of registered dental hygienists that I have come into contact with through the myo stuff that I do, and everything online have said, you know, we don't just clean teeth. Right? And that's kind of what I think a lot of the general public thinks. You go to the dentist and you get your teeth cleaned. If there's issues, they help, you know, fix those issues. And what I don't think people realize is that Dentists actually have a much larger role in our full body health. I'm hoping that that's getting through in the podcast because I can't count anymore how many times I've said I think that dentists, especially pediatric dentists, will be like the pediatricians of the future. Like, I keep joking that like 10 years down the road, like you guys are going to replace the pediatricians because you're actually looking at the types of health issues that matter. And I mean, I don't mean to put our peds down at all, but you know, they should be doing airway screenings in a pediatrician's office.

We now at our new office at the pain and sleep therapy center, we actually have one team member on our staff that is dedicated. Like her time is spent educating offices and going around to pediatricians. We give presentations to different, different dental offices and teaching hygienists how to screen and how like simple screening tools to help them figure out who needs maybe just a more comprehensive evaluation. So we do a lot of education in the community, which is super important. We even go to schools and teach. We have one hygienist, she's amazing with children and her big thing is doing puppet shows at schools. And she's been doing it for 40 years and it's mind blowing how, how much the children love it. And so we're hoping that soon we can incorporate some kind of screenings at schools. Like, why isn't that being done the most? Right?

Yeah. So like when we go into the private schools that we go into, we are doing speech and we call them speech language screenings and we call them OT screenings. But in that we're having a snack and we're watching how they're chewing and we're watching how, you know, what happens to the tongue and is their mouth open the whole time. So we're actually screening for OMDs airway issues like any, you know, and so, and it's a 15 minute screen comprehensive of like speech, language, myo air. It doesn't have to take long. Right. And so this is the thing that really like, like you're saying like we really need more education. We need to be getting into like in with these kids when they're younger. And you know, I know our pediatricians are amazing and I know that they have so much on their plate, but it's like, why not add just one more little checklist screening you send home. I'm already filling out five every time I have to bring my kid in for like, you know, the next like checkup. Like, let's add one more because really, to me, the airway screen is going to be the most important one, you know, along with the general developmental screen over some of the other things that I fill out. So it's one of those things that I've honest. And the other thing you mentioned too, that I thought was really amazing was your approach to basically telling families, hey, whether it's an adult or a child, like, ethically, like, we need to be looking at this. This is part of what we do. This is within our, you know, this is part of our scope. And like, we can't honestly proceed forward without kind of checking all the boxes and making sure that we're really. How do we know what the next best treatment may be for you if we don't know, you know, the whole picture? So I love that. And I love that. You know, the one thing I'll say about, like, moms is I always say moms are, you know, I would say moms are the best therapists, Moms are the best reporters, except when it comes to sleep. And, you know, and it's honestly because I've had so many kiddos on my caseload where parents are like, oh, they're great sleepers. They don't have any sleep issues. And then they kind of write off the conversation. But what nobody's realizing is we need to be looking at that child when they're sleeping. Can we hear them breathing? Is it audible at all? They don't have to be snoring. Is their mouth open when they're sleeping? Is something in their mouth when they're sleeping? There's just so many. Do they wet the bed? Like you said, we look at other behaviors, like, what are daytime behaviors? Like, what are these indicators that maybe something larger is going on? And I think that when we start to open up that conversation more for parents and they start to realize the connections and how we can actually improve the quality of life in general just by looking at something that seems so simple from a parent standpoint. But for us, it's so complex and so involved. But because sleep affects everything, so airway affects everything.

Yeah. So, and that's a great point because so many moms will say moms and dads, I should say. So my child sleeps great. They sleep 12 hours. Yeah. Now, the amount of time they sleep does not mean that they're sleeping well. I can tell you my 3 year old is a prime example of that. She had large tonsils and adenoids and she would sleep a good stretch of time. But when she was sleeping, she was sweating, she was moving around. You know, she would, she was mouth breathing, she wasn't sleeping well. She was sleeping a long time to get that amount of sleep that she needed. And so. Yeah, and so as you know, I'm a mother of three, so I get it. Been there, done that. It's just important to kind of sometimes to take a step back because you get lost in the day to day and you just, everything becomes normal. Like the, you know, the little things that, like, for us that we're looking for, you may not notice it because it's been going on forever. So, you know, it's common, but it's not normal for that to happen. Right?

Not normal. I love that.

So it's nice. So at the practice, you know, just educating the parents, like what to look for, because, you know, even with the pediatricians, we, our goal is not to be super aggressive, you know, turn people off and be like, hey, like more of an educational approach. But like, goodness, wouldn't it be life changing if they had a screening that they would just be. All we're asking for is to say, hey, like I see, like, oh, like your, your child is breathing through their mouth, like pretty much all the time. Other than, you know, pretty much all the time. Or this, this, that or the other. Here, let me send you to someone who's a specialist in that to just kind of. I'm not really sure, you know, if this is an issue, but let me just send you to someone who is and can make that determination. That's really all we're asking for from, from any provider, whether that's a pediatrician, a pcp. Just being like, I'm seeing, I'm noticing these things. Let me kind of send you to the person that can just check it out a little bit further. So I think that we're, you know, I think over time we'll slowly make our mark on the pediatric community that way.

That is the goal. And if we can, we can make it through, like to the ents, you know, I know there's like a, a good number of ENTs that are in this space that get it, but that's another profession where I feel like we're constantly trying to educate. You know, because my, my own daughter Lily had very large tonsils. They weren't kissing, but they were large. And they weren't just large, they were inflamed. And you could see like the veins running through them. They were like hard, solid balls in the back of her mouth. And she was not always Mouth breathing. She had very flushed lips. So, like, they sat together most of the time. And so because of that, the ENT was like, nope, she's fine. But she was a kid who was like, chronically catching everything and, you know, upper respiratory. And I'm like, if the kid is also getting sick a lot, you know, then. But it wasn't sick in the terms that we weren't having to go and get antibiotics all the time. It was like colds. So because it was undocumented, it was kind of like, oh, that's not a big deal. And I'm like, it was just this whole, like, run around that we got. And that's part of, like, my passion behind it. And I know sometimes I have a very strong opinion towards certain professions, and it's not meant to come off as, you know, being hate toward any one profession. But, you know, I feel like I just envision. I always have this, like, larger vision. Like you, like, probably like you do in a sense, where it's like, if we could just bring everybody together, we could all come together. And we're not asking you to, like, you know, like you said, it can be very simple. It doesn't need to be complex. Like a couple questions. Something that you note on your forum that maybe you ask the parent about a bit more. And then if you kind of feel like there's something maybe going on here, like you said, you refer out to that stuff. Like, that's how I envision the future going.

Yeah.

That is the ultimate dream vision.

And I think it's important to note that we're not looking at a child and saying, oh, they have large tonsils. We're looking at large tonsils. Behavioral issues. We know that ADD and ADHD have the same symptoms as sleep disorder. Breathing. So. So we're looking at the big picture. Are they mouth breathing all the time? Are they chronically sick? How does their mouth look? How are their jaws? How's their palate? How's their tongue function? What's their history? How are they eating? I mean, there's just so many things that. What we ended up doing at the practice, the dental practice, was doing these screenings. And then we would have a whole checklist that we would actually. The parents would fill out on the front set. On the front. And it would, you know, kind of different things that they're seeing. Right? Like, yes, no, not sure. On the back, the hygienist would fill out what. What they're seeing. Like, different, you know, intraoral. Right. Like, so we would talk about like the palate, the teeth, malocclusion mall and patty score, tonsil grade. And then also, like, development developmental things on for the face, you know, so long face, maxillary deficient. So different things that, as the professionals, they would kind of, you know, working with the dentist, we would kind of check off, and then we would give that. Give them that paper to take to their primary care or to their ENT and be like, yes, there's large tonsils, but look at all the other stuff that's going on. So please take into consideration all the other things that are being affected in this child's development and life before you just say they'll grow out of it.

And that's our approach, too. We have our little referral pad checklist that has all the things on it so we can check off all the symptoms, because, like you said, it's one piece of the puzzle. And yes, large tonsils on their own are not necessarily a concern. It's all those other symptoms that surround it.

So that's so important.

So I'm glad you brought that up. So I'm like, everybody kind of knows Lily's story, so I didn't really go into all the details, but, yeah, if you followed this pod, my podcast, for any length of time, you know, like, Lily had a whole slew of symptoms and still has some things that we're working through. But, yeah, so it's definitely important to. I think the other thing we've also been educating on is when you send a child to an ent, it helps to use instead of being that slp, Right. Because a lot of speech pathologists refer and go, please look at the tonsils and add noise. They're probably sick of getting that. So we said, you know, send them and use the term upper airway resistance. Because if you say, I'm concerned about upper airway resistance, like, that's going to open up a very different conversation than saying, I think this kid has large tonsils. And so, you know, if we just start the conversation differently and you're sending that referral pattern, you're sending, you know, that checklist of symptoms to be like, hey, you know, what are you seeing? This is what I'm seeing. I think it's a much gentler approach to having a productive conversation. So, yeah, I absolutely love that.

Yeah. So basically from there, we had such. Once we learned about and we were seeing it, we're like, this is perfect. We need to. Between the babies and all the children that we're seeing that need myofunctional Therapy that would benefit from it. That's where the pain and sleep therapy center kind of was born. From a non dental specialty practice. It's airway focused integrative care for children, infants, children and adults. And so really what we focus on is finding the root cause. We want to improve everyone's quality of life. Like that's our mission. Improve quality of life by finding the root cause. And you can't ask for more than that because as an adult you can treat a patient or you can like make their symptoms better, but as a child you can cure them. You can, you know, basically redirect their growth. And how amazing is that to have some early intervention so that they are not just being, you know, treated as a OSA patient in the future with a sleep appliance or a cpap. We want to help our children to develop really good habits and kind of redirect them to grow properly. So yeah, so the center is, I mean it's fantastic because we offer like a lot of different services. We have a, so myofunctional therapist, that is her background is as a registered dental hygienist. We have an slp and she's also a certified lactation counselor, kind of like a bottle feeding specialist for the babies as well. And she is also myofunctional therapist. And you know, we have Dr. Ryan Robinson, as I told you earlier, he's like triple board certified. So he's seeing a lot of the adults. We do functional frenul plasties. We do. And then I personally do the, all the laser infant frenectomies. And our pediatric clinic is, I mean it's amazing. We have our CT so we're able to do the 3D imaging and you would not, I mean you would believe it. But for everyone else out there, the amount of families that come in to see me for their babies, the amount of people that come in and I treat their infants and then they bring their other children and then the mom is like, well, well, you know, this guy right here and she's like giving him the side eye. She's like, I can't, I have to sleep in a different room. Like, can, can I bring him back for his snoring? And so it's really, I mean it's really amazing how we can have this kind of multi generational family approach to treating the families. And I mean for me personally getting, when I see them as infants, that is my like, man, that is my passion. And I love having that space to, to really talk to the parents. In this, you know, non dental environment. So there's no. So it's a very private, private rooms and it's quiet and you know, a lot of it is just education and, and making them understand like where, you know, what the research shows why we're doing this. So like I said earlier, a lot of moms are like, well if this is just for breastfeeding, then I'm going to bottle feed. And you know, it's, I take a lot of time to talk about, you know, you've come to me as a referral from an ibclc, someone who's all they do all day long is watch babies feed. And so their job truly is to rule out positioning, latch, supply mom to baby, fit the dyad. Right. And so then we can focus on function. And when the function is impeded, it's all about function as you know. Right. So that's why you're here today to talk about function for me to have a second look at it to see if I agree that function, function is impaired because of a physical structure. And then really just talking about how a physical structure, the tongue tie or a lip tie, how that can affect tongue posture. Because we know all the research, so much research shows how really tongue posture and how that will influence the growth of the jaw. So it can be a learned behavior. We have the mouth breathers because they have huge tonsils and adenoids, chronic congestion, allergies, or we have physical restriction, right. That causes that. And so really it's that just spending a lot of time educating them, making them feel like this is, like I said, you're not doing this to your baby, you're doing it for your baby. And we have done everything from a conservative approach to assess and to treat your baby comprehensively, compassionately.

Right.

Like we're not there just to be doing that just for fun, right people. I've definitely overheard a mom before that was like, what kind of person could do this for a living? I mean it makes you kind of.

Like you giggle a little bit. At the same time you're like, I actually think that like we're doing this to like harm children.

I'm like, well let me tell you. But if I can do a procedure that takes like 10 seconds, you can change the way your baby functions. And I can keep them from being a three year old that is eating with their fingers, gagging, is a mouth breather and is going to turn into a sleep apnea patient when they are 40 years old or a TMD.

And then, you know, maybe they Also have, like others, their sleep is awful, and so school is hard and they really struggle and they can't attend and they're sitting backwards at circle time and they're not making friends. I mean, it's like, I see it evolve and evolve and evolve, and nobody has any idea that these things can change when the child is sleeping adequately and breathing adequately. And I know there's been research studies out there, too, about how children who have obstructive sleep apnea, young children actually have IQs that have been shown to be 10 points lower than their same age, typically developing peers, because of the damage that it does to the brain over a certain amount of time. And it's not, and it's thought to be irreversible. So, you know, it's one of those things where I'm like, I don't care what any parent thinks about me. If I can help a child get on track, like, you can think whatever you want about me.

I listened to. So the podcast that you had with Dr. David McIntosh. Ent. Yeah, man. His analogies about the. Yeah, they're very strong.

Yeah, they're intense, and it really gives you a good visual.

But truly, I mean, you have to sleep, you have to get oxygen into your body. And so when a child is snoring, it is never normal. And when they're grinding their teeth, usually it is a airway issue. And so, you know, I don't know if anyone's going to dress up as Dr. Green, the frenectomy specialist for Halloween.

Right.

Because I'm like this evil villain. Hopeful. Hopefully not. Hopefully not. But I like to think that, you know, we can provide compassionate care and make the moms and the dads feel strong and just good about their decision and support them through that process. That is my goal, is to make it a good experience and provide all the information before the appointment, after the appointment to make us have good outcomes afterwards. And so I think that my kind of track record has shown that my parents, my parents are very happy and they like to sing our praises. And so that's kind of like the best compliment when we have moms referring their friends or family to see me because. And they've had. They've gotten good care, and that's what it's all about.

Well, and you're a mom who's been through it. You're a provider who cares about the work you do. I mean, and it shows. And people, you know, I think when people get to know you as a practitioner and they experience it for themselves, Obviously, they're gonna come to realize, like, you're not. People don't get into this for the money. They don't get into this because it's the latest fad. Like, it's not. It's not those things, right? It's really, truly. Because we see a bigger picture. We see a quality of life changes that are going to happen. And it's not just short term, it's the entire. It's like, like you said, like, this goes into adulthood. If you can prevent a child from turning into an adult who has obstructive sleep apnea. You know, obviously there's no guarantees in life, but, like, if we know the connection and we can do what we can do now, why not do it? It's such a minimal procedure. And, you know, the one thing you said that stood out to me was like that, you know, a mom who kind of says, well, if I have to put my baby through this procedure, I'll just stop breastfeeding and I'll bottle feed. If that's her goal, fine. But what I want parents to realize is you still, a baby who has trouble breastfeeding is most likely going to be dysfunctional on the bottle as well. And so, you know, they might be able to feed. Maybe it'll even seem easier on the bottle for some kids. But we get a lot of kiddos who won't even transition to a bottle. So, you know, and I just actually recorded a podcast episode this week with another practitioner talking about, you know, actually typically developing babies and how actually normal for breastfeeding babies who have zero feeding issues to refuse that transition to the bottle. And we talked about how you can actually go about doing that, because we get parents sometimes who are like, frantic around, like, I have to go back to work, my baby won't take a bottle. And a lot of people will pathologize those babies. And sometimes there's actually nothing wrong. It's just the baby has a preference and they're having a hard time making that transition. Now, those are not typically the babies that we're seeing, right? Like, we're usually seeing the babies who are dysfunctional on both breast and. Or bottle, or maybe they're taking one and not the other, but that doesn't mean that it's functional. And so, you know, I love how you. You're very much so. Like, I am. Like, my whole goal is, let's get to the root of the problem. Let's stop slapping band aids on things. Let's figure out what is causing this and deal with that because that's going to also improve other things usually. So I love that, that whole mission, you know, because it's all about getting down to the root.

Absolutely. And the most important thing that we can tell parents and educate them on is growth and development. And the research that we have, we have really strong research about the importance of basically tongue posture for growth and development of the palate, how that ties into the nose, how that ties into airway development. We have really strong research on nasal breathing and the importance of that. And I mean that as a foundation for myofunctional therapy. Like that is our first and foremost goal is to close the mouth. And I mean there's a ton of research on it and there's good research on it. So I think that that is, that's a huge thing that we, you know, we screen for. We take the time to discuss with parents that even so even for like my babies, when I do my two week post op with them, I talk about things to look out for because I never say this procedure is going to cure everything. You'll never have any issues. The fact that you're in my office right now, you are at a higher risk for, you know, throughout childhood that you are already here. So we can, let's take care of this physical restriction. Let's improve function, this healthy range. I don't talk about it from a yes or a no perspective, but we want to have a healthy range of motion and we know form follows function. And so hopefully we can really instill good habits and that will translate into through childhood. Right. And to have good growth and development. But you need to be on the, on the lookout for X, Y and Z. I'm always here for you, like hopefully I'll never see you again. But if you notice your kid doing, having eating issues or this or that, like we need to, you know, put our heads together again. So I think that's, that's important that you know, we kind of make that a point that it's not a failed procedure. Right. Like if, you know, sometimes you get those babies where you release the structure and they're like have minimal improvements. Well, this is a whole body thing and that's why we work as a multidisciplinary practice. We, I work with IBCLCs that are, that know when even before they see me to send them for bodywork. I mean I think body work, whether that's cranial sacral therapy, chiropractic osteopathy, all those things are such great adjuncts to conservative treatment. Or at least getting the baby in this optimal timing. And I think that's another huge point, is that this procedure should never be like a frenectomy, should never be an emergency procedure. If it is an emergency procedure, it is the wrong thing to do. We need to make sure the babies have a feeding plan, are healthy enough to be able to actually eat, that they have an established feeding source, whether it's bottle or breast, and that the parents are in a healthy state of mind as well. Because as we know, like post frenectomy, it's difficult to do the active home care. So we need to make sure that everyone's like, kind of in this optimal range. And so, you know, I think Michelle Emanuel, she talks a lot about optimal timing of release, and I totally agree with that because that's really when you have the best outcomes for the babies. Oh, yeah.

And I've seen it firsthand. I've seen it when parents call me and they say, I just left, we just had the procedure. I'm like, what? Why is this the first time you're calling me? I mean, obviously I want to step in and help. But, you know, one, oftentimes when that's the case, baby has not actually been prepped optimally. Two, I have no baseline. Right. I really don't know the baseline. So I don't even know, like, what we were starting with to even know where to go. And I can see what you know, and baby's not going to be the same post op as they were pre op. But yeah, I mean, you make such a great point because it is super important to prep a baby. The timeline is going to depend on that baby and that baby's needs and the providers on the team that are working with the baby. Everybody should be signing off and saying that, yes, baby is fully ready. But after the fact, it is so important to already know, literally when you leave that office, what is your active care plan afterwards to make sure baby heals properly? Because that's going to be separate from the feeding plan. That's two different things. And I think that everybody kind of looks at it as well. I did all the lifts under the baby's tongue and I was really good about doing the exercises they gave me. And I'm like, did you work with an IVC or a feeding specialist? Like, did anybody, you know, did anybody habilitate the baby's tongue and oral structures?

And they go, they never had normal function. So you're not rehabilitating them, you're habilitating them. You are actually teaching them what normal should be. Right? Yeah.

I mean, I try to educate on that because we develop our swallow in utero by 12 weeks and this baby has never known anything else. Like this baby went from literally like conception to swallowing this way with a tongue that was tethered down to the floor of the mouth that couldn't reach the palate. And so this is the first time. So like you said, like you pointed out, I mentioned habilitate. Like we're not rehabbing, we are habilitating. First time we're doing this with this baby. They have never had this function before. So I also don't always see it as a failed procedure. I see it as well, we didn't have the proper care surrounding the procedure.

So.

So the procedure itself may have been a beautiful release, but if we were not habilitating the muscles and the oral anatomy and helping this baby learn how to use that tongue to suck, swallow and breathe and create that sequence, that healthy suck, swallow, breathe pattern that they need based on whatever age they are, that's where we're really failing our little babies. And so that's. Yeah, I mean, it's so, so important too. Optimal timing, but also the follow up.

It's just a very complex, complex issue. And I think that frenectomies, especially for providers that are doing them, and I can speak from a dental perspective, it's very much like a hot topic right now. And so I can't stress enough about learning the right way and learning the team approach to things because it shouldn't be a procedure that is, you know, just anyone calls and they walk into your office and they just get it done. No, no, no, no. Because that's really what gives the frenectomy a bad name. And that's when the pediatricians, when they get this mom that calls, my baby isn't peeing, I can't feed them, they're screeching. And then they call the pediatrician. Do you know what the pediatrician says? Well, tongue ties, you know, tongue ties.

Are a fad you shouldn't have released.

Why did you do that? Why don't you go to the emergency room then? Like, let me show you.

Right.

Well.

And that's, that's the whole reason why I think there is this bad, bad blood, if you will, between some professions. Because if you do not treat it holistically, it, you know, look, are there cases where you release a tongue and all of a sudden that baby kind of figures out how to feed themselves? You know? Sure. Anything is possible but that's going to be more rare than it is common. And I would. It's like. That's like playing Russian roulette. Like, I'm not going to. We don't do that with a baby who needs to eat. They have two goals. They need to be able to breathe and they need to be able to eat. And we're messing with both of those. If we release a tongue that cannot properly fill the palate, because what else can happen? Well, babies sleep on their backs these days, and if their tongue is not habilitated or ready for that release, that tongue can also fall into the airway, block the airway, and cause sleep issues that maybe weren't there if the tongue was being maybe held down a certain way, you know, and tethered down and out of the airway initially. So, you know, I've seen issues, too, where we actually had larger airway issues that then the feedings, you know, should have gone okay, because we had habilitated the tongue. But then all of a sudden, you know, maybe the tongue wasn't completely functioning properly. And we were just dealing with where the tongue was actually resting in the mouth immediately following the release when there was some inflammation. This is a new tongue. Baby has to learn the neural anatomy. So, you know, it is complex. And I really. I get very passionate about this and very frustrated because there are a lot of people on social media who talk about these things, and it's very out of scope. And there's a lot of misinformation on social media platforms with professions that really don't have the credentials to be feeding babies. And so it's, you know, I think moms latch onto anything that's gonna help. And look, I'm the mom who's been there. I didn't know about this with my first child, and I would have latched onto anything. I had 13 months of painful breastfeeding, and I was just so determined to keep her at breast that when the lactations consultant told me that she was fine, there was no tongue tie, and the pediatrician confirmed that I believed them, you know, and just dealt with it. But, you know, it was one of those things where, you know, even in the past five years, it's just exploded on, like, Instagram and Facebook. And, you know, I just put out a post last night where I was like, you have got to heed the advice that, you know, you need to look at who the professional is that you're listening to. You need to know their specialty, and you really need to be careful. What you read on Instagram, like, this is not medical advice that you should be applying to your child. You need to be finding that specialist in your area who does this work and is working from that team approach. Because as you pointed out, it's really that holistic team approach that's so important. And we really need to caution parents from. Like you said, you really don't want to go to a provider who's just going to fit you in today when you've had no other pre work done to prep your baby for this release. So that's my big PSA of the day.

I hear you. Right there with you.

Yeah. But you've also been on the other side of it too, right? So I know your husband just had his tug released, so you actually can see. So even in your own family, you can see, like, from infant to adulthood, the effects of a tethered tub.

Yes.

Yeah.

So my husband. And this was not my doing at all. Okay.

I did not, like, poke and fraud.

Him until you did it. Yeah. So he's tongue tied. And he is like a case study. And. Sorry, Kyle, case study in, like, poor oral development. Had all the braces, all the headgear as a child growing up in, like, the early 90s. All the headgear. And so, you know, his parents made huge sacrifices to have ortho and this and that. And then now we know better. We know that he had retractive orthodontics, so they pushed everything back. So in addition to his, you know, basically his development, he also had a tongue tie. And. And that's all he's ever known, of course. And, you know, now in this space, right. Like, that. This is what I do. It's what my partner does. He's like, you know, I'm having this issue, that issue. And then one day he's like, I'm going to do myofunctional therapy and I'm going to get my tongue release. And I'm like, the sky is parted and the angels were seeing. I'm like, okay, so. And I just left it at that. And so, you know, he's working with Lauren, one of our myofunctional therapists. And, you know, he. He trained for, I mean, literally three. He did all the. All the myofunctional therapy for about three. I would say probably three months. A lot of it. And so he had the release. He had a functional frenulplasty. So my partner and I are trained by Dr. Zagi, the ENT out in California, out of Stanford. And, yeah, he had the release done yesterday, and it was a guided release with a craniosacral therapist who he's also been working with. And he's been singing her praises because he's like. Even before this, he was like, he would go for his sessions, and he's like, I feel like a different person when I leave there. He's like, my. Like, my head just feels like it's on, like, a different body.

And so.

Yeah, right. And he's like, not one that would ever say things like that. He's, you know. So then fast forward to yesterday. He had the release done, and he came home. And so, of course, a functional release is done using scissors, but really it's a dissection technique. So it's all about, you know, the cave and the actual function of the tongue during the release. Dr. Robinson uses the kind of these basically Q tips or such to kind of pull back the fibers. So it's very little, like, actually cutting versus kind of teasing things apart. And his cave. So the cave is like the tongue suction to the palate as, you know, doubled afterwards. I mean, he had a huge improvement. Yeah, he had a huge improvement. And then. So anyways, he got home last night, and he has some sutures in there, had a smoothie. And today he was at work, and. And he's speaking normally, and he says he's not in that much, like, discomfort. He took, like, a couple, you know, Tylenol. But so I had a chance to kind of ask him about it. I was like, so, what was your experience like during? And he's like, it kind of felt like I was on nitrous on laughing gas. He's like, I had a couple, like, minutes there during the procedure. He's like, I just felt, like, just weird. Like, he's like, I could feel it, like, washing through my body, like, something like dropping or like, the. The laughing gas kind of, like, floaty. And it really just goes to show how everything is. How it. How it is connected to the rest of your body. We talk about fascia being like a spider web that kind of covers everything, and it connects in the midline and how everything releases after that. And so he. Today, he's like, yeah, I feel like my, like, shoulder area and his, like, chest area feels a lot just kind of looser. And he's like, I don't know if it's just because I didn't have a long day of work yesterday or because of the release, but he's like, it definitely feels a lot different. And he's like, I'm not that sore. And so, yeah, so it's so far so good.

And I know, like, we were talking about it beforehand, and I think that the difference. Sometimes, obviously there's differences in, and how people heal and how people respond to different procedures, but I also think you brought up a really good point that there's a big difference in those who are prepared for procedures. And if you're actually prepared and all the surrounding muscles are as relaxed as we can possibly get them, and you're as functional as we can possibly get you up until the point of the release. Right. We know obviously there's still going to be tension. We know there's still going to be a tongue tie in place. But if we can get everything else as fully functional as possible before we send somebody for a release, what I've seen is that I've seen it happen without that and I've seen it happen with that. And the results following a functional release and a person going in, you know, going in, truly prepared for that release there. It's like, groundbreaking. It's like, phenomenal. It's amazing to see that instant, you know, relief. And I've had a lot of adults say, like, oh, my gosh, it was like a ton of brick off my shoulders. Like, I. I've never thought I'd be able to get rid of my neck pain, my back pain. For me, I actually have been working with a PT who trains through the Postural Restoration Institute. And he does what he calls, he calls it modern counter strain technique. And so he uses a variety of things. I was working with him a lot, and he's actually in the dentist's office who has done my other dental work, my growth appliances, I should say, not my dental work. And so it was just amazing because, like, we had been working before I got pregnant with my second daughter on, like, opening up my chest, opening up my airway. Like, I was always so tense through my chest and my diaphragm and, like, I'm an slp. Like, I'm supposed to be deep breathing through your diaphragm and this, that and the other. And, like. And I go to see him and he tells me that basically, like, I'm all torqued, like, everything is out of alignment. You're no wonder you're so tight. Like, this is here and that's there. And what was also interesting was that, like, before the release, I had to keep going back to him. And we were able to achieve it as good as we were going to get. It before I got pregnant and then throughout pregnancy. But then I had my tongue released after my second child was born. And I have not had to go back to see him that much. And he's like, your body's actually holding now. So I still had to do that post op work. But now it's like the body has the capability of holding and maintaining the results longer and longer and longer before I have to go back and see him. And really we haven't even been working on that. When I see him now, it's because of the growth up here and in my face that he's really been working on, you know, supporting that growth. And the other thing I'll add before we start to wrap up today is when I was doing my growth appliance, he. I noticed that I would hit a ball and like I was in a DNA appliance. So I couldn't, I really couldn't crank it anymore because if I cranked it, I could not get it back in my mouth. It was extremely painful, like to try and, you know, it just wouldn't fit. And this was about a year into my treatment. I was in that appliance for two years. When I would go and see him, I would see him and then I could crank it again. And it was just incredible because he was basically just resetting everything and then I could crank it. But it was really incredible to see the impact of the bodywork. And that's when people say, well, what is body work and how do we know it's effective? And I'm like, look, I don't know. Like, I don't know all the details. All I know is this is what I've seen in my own children, this is what I've seen in myself. This is what I've seen in my patients, you know, And I really think that goes, that goes to show that it has a very important role, you know, on the, you know, they have a very important role as a team member of, you know, what we're talking about here.

So. Right. Yeah. And so I also do growth appliances for children, like the Alpha appliance and the Vivos. You know, all these things, they are, you are changing, you are changing a very important structure.

Okay.

And so you really need to incorporate bodywork. And so like when we do like the ALF growth appliances, we have our patients. You know, of course, myofunctional therapy is like the foundation. The appliance is helping with that. And then the bodywork, that really kind of is the icing on the cake to help those changes happen. And so it's such an important part, whether it's for a child or for, well, really an infant, a child, or an adult, we can always benefit from it because we have so many factors that are, you know, whether it's environmental or if it's basically something that you have been born with, you know, hereditary. So we want to kind of balance the system out, especially when you're making changes. We want to restore function and harmony is, I guess, the end result, really.

Yeah, no, absolutely. And I think the one thing that we don't talk about enough on the podcast is, like, the nervous system. And, like, there's just. There's so much going on throughout your entire body. And, you know, I see a lot of people move into. They're much calmer after release, when they've had the body work. They're much just everything just everything changes for the better, really. And it's just been very. It's been very fascinating to me. I've had adult patients whose anxiety went away after having a release and who. But they were also getting the body work, and, you know, they were functioning. They were doing the myo. The body work. They were prepped for the release. You know, maybe they also had a growth appliance. Like, they really are full on doing, like, everything they need to do to support their body as a whole. And that's why I always say, like, we are tied from the tip of our tongue down to our toes because everything is interconnected. And I don't really mean that as far as, like, a tongue tie goes, but just how all of our systems interact. But I feel like the general medical community tries to treat everything in, like, a silo, and that's just not how we operate. So, you know, I really love when I get to have conversations with practitioners like yourself and people who come on the podcast, because I think that we really look at things holistically and in a way that, like, you can't tease these things apart. You need to be treated together.

So we even just on that kind of point, we even do breathing therapy. So Buteyko breathing, if you're familiar with that, like, that's been a game changer for so many of our adult OSA patients. Like, who knew that over breathing was a thing? And it certainly is. And when you kind of learn more about it, you're like, wow, that. That makes total sense. And so it's kind of incorporating, you know, it's the whole body. It's a lot of different systems incorporating as much therapy as we can to. It's just not one thing that will fix all of it. Right.

Yep. Yeah. And you have to figure out what that specific patient needs. We've had Patrick McEwen on the podcast talking about Buteyko, and he's actually going to be doing a webinar for me for my group in December. And so, I mean, he's. He's great. And his website has tons of resources. They even have. I think he's got, like, free stuff for kids, like kid, you know, assessment, treatment type of stuff, like, right on website that any practitioner can kind of dive into if they want to get started with understanding more about that. So very, very good point. Because, you know, we talk about airway, and everyone kind of goes, well, how do I help that? Well, we need to know how someone's breathing first. So that's tough one. But, no, this has been awesome. Anything else that we didn't cover that you want to.

Yeah, we did cover a lot. I don't think so. I think. Oh, you know, I wanted to tell the story of my son. I did his release. Yeah. So just a fun fact that, you know, when you are a frenectomy provider and then your kid is born with a tongue tie, you often. Maybe you're wondering who gets to do that. And I'll tell you who gets to do that. The mom. Yeah. So my son, Dalton, he was. When he was 12 days old, I finally. I mean, I would have done it earlier, but he was born during COVID And so he is a prime example, actually, of, you know, I preach and preach and preach about optimal time, timing of release. Well, then you have a baby that's born literally in April during the shutdown of everything. And I'm like, you know, talking with the IBCLCs I work with, and, like, everyone was just shut down. And I'm like, well, I know, you know, from doing this for, like, going on four years now, like, I know not. I was like, he obviously has a tongue tie, but I would really like to see my ibclc. I would really like to get body work done. I want to do, like. I was, like, prepared to do, like, all of it, you know, like, just drink it. All right. Yeah.

Yeah.

Let me just drive from what. You know, because I understand the importance of it. Well, everything was shut down, so then I ended up just doing the release, which was, like, the worst thing that a mother can do for their. On their own baby. But, you know, you kind of go in from mother mode to provider mode, and you just do it and then it's quick, so it's over and done with. But the kind of. The habilitation after that, even at 12 days old, would have been so much easier had we had incorporated, you know, trips to the, you know, CST or chiropractic. So, you know, that's just a little fun fact. But he's doing great. But it just took a little bit longer for him to. To really get nursing down pat and like, you know, just in a comfortable and just efficient manner. But he's. He's doing great now. So just kind of goes to show I lived, you know, well, that's also.

Part of it, too. So I know that, like, I get up on a pedestal and, like, preach things right, and I'm like, well, this is the way you do it. But in reality, we understand that maybe it's not always possible, especially in a pandemic, and maybe there aren't the types of practitioners in your area that can fully 100% support what we're saying. So you do the best that you can do. But I think that just, you know, at least having knowledge of what is most optimal and kind of working from that is always the best. It's never to make a parent feel any less or. We're not shaming anybody if you did. I have a lot of moms who actually come to my Instagram page and they'll see my post on pacifiers or they'll see my post on something and they'll go, oh, my gosh, I'm the worst mother ever. I can't believe I did this to my baby. And I'm going, hold up, hold up, hold up. You did the best with the information that you had. I've been there. I've been that mom who didn't know my baby was high, who push through painful breastfeeding, who tried to force a pacifier in my first baby's mouth, but she refused to take it. Past four months, thank goodness. Like, I was the. I mean, I. I did so many things wrong. But also, I'm. I'm sharing. Not just. I'm sharing not just from, like, what's better for oral function and development as a practitioner, but I'm sharing as a mom because, like, I've been there. And if I can spare you some heartache or maybe make a little things easier for you and your child, like, by all means, I'm shedding that mama light on it, but also with the credentials to support that, my specialty, you know, so it's kind of like that's where the passion comes from.

Right? And so, you know, I see patients every day, and they come in at all different ages, whether it's, you know, three or five or 12. And, you know, you say, exactly. You know, you did the best that you could. You had no idea where were your. Like, you didn't have people like us, like, to. To be there and, like, tell you all these things. I mean, I wish every, you know, I wish every situation, the mom would have stumbled across this. This space. Right. Or, you know, that one person. I would have been like, hey, by the way, did you know that that's not really good, or this or that, or that's a red flag. And not. Not everyone has. Has had that opportunity. So we meet you where you're at. And what I always tell parents, I'm like, you know what? Three years old is better than six. And if you're coming in at six, it's better than at 12. If you're coming at 12, hey, it's better than when you're 40 years old. So we meet you where you're at, and we can always kind of figure out what to do. The important thing is that you're here and that we can assess and figure out what to do, because truly, we have a lot of. Lot of different things that we can work, you know, implement a lot of different, you know, kind of ways to treating each patient as an individual and to not feel bad. Because we're all moms, we're all parents. We've been there, done that, and it's just important to have compassion.

Yeah. Yeah. I mean, I even get mamas who are like, my baby's 6 months old. Is it too late? And I'm like, no, no. I mean, it's. Honestly, it's never too late to improve function. Right. Maybe as an adult, it's going to be a lot more challenging because of what we know about adults. And you're fully grown, and so to actually try to, like, make changes in an adult, you're going to hit probably a lot more roadblocks than you will in a child who's still growing. Right. We know it's much easier to mold a child than to change an adult. I'm a perfect example of that. Like, I had braces, I had Invisalign, I had lingual bars upper and lower until I was 30 and asked for them to be removed because they were supposed to apparently fall out by the time I turned 20. And that never happened. And then all my teeth shifted after that. And after they shifted, I went what is going on? And hello, I had a tongue tie and a tongue pressed and I was open mouth breathing when I was sleeping and all the things. And so now I've gone through two years of in vivos appliance and now I just started my invisalign because I, you know, we're trying to now move things into the right spaces that have been created. And so it's been an experience for me. My husband is going into a growth appliance. Lily was in an ALF for a year and she just turned five and had it removed like right after her fifth birthday. And so, I mean, I walk the wall. Like, I'm doing all the things that we preach here on this podcast. Yeah, I was like, because my husband's had some dental work too. So our plan is like to start with one appliance, knowing that as an adult we're probably gonna have to switch the appliance actually that he prefers the ALS to like a Viva client. So we're like, that's fine, we'll start with that. But we know this is not going to get you the full amount of where we need to go. So we're going to have to swap that out at some point to a different appliance once you can tolerate something a little better. But he's like my sensory guy. Like, he is, you know, I joke that he and my 5 year old are the same person. Like, I joke my husband has the nose of a pregnant woman. Like, like, what is that smell? And I'm like, what smell are you talking about? He's like gagging. I don't smell anything. So like, he's like, you know, doesn't like her. How certain things feel. Don't touch his ears, don't touch his nose. Like, he's just. Yeah. And so I'm like, we're gonna have to release that tongue at some point too. But let's, let's see if we can get a little growth first.

Yeah, well, it's, it's very important having tongue space. You cannot release the tongue unless it has somewhere to go. And that's, you know, that's a huge, that's a huge, very important topic versus tongue space topic.

Yes. And absolutely. And that was something that was newer to me in the past year when I really started to. I mean, I knew, but I didn't know, you know. And so now that there's like a name attached to it, I think that, I think Soggy was the first one I heard really speak about tongue tie versus tongue space. And I started going, well, that makes a heck of a lot of sense because, you know, the timing, depending on the case of when you might have a tongue tie release versus when you do a growth appliance versus, you know, like, the age of the patient and all these different factors that play in. Lily had her tongue tie release it too. And now that she's had her. Her palate grown, you know, with the upper and lower, I should say, so both her mandible and her maxilla, we've seen growth with the alf. She had that in for a year. I think that her posterior portion of her tongue cannot elevate to meet her new anatomy based on how things are structured now. And so, you know, she's been, like, gagging and, like, almost choking on water, even out of, like, a straw, like, so thin liquids. And I'm like, what is this? Like, it started, like, halfway through her ALF appliance. And so, you know, here I am, like the feeding therapist and orofacial myologist, and I'm like, what gives? Like, why is my child looking on thin liquids? Like, what? So, yeah, I mean, so there's always something.

And that's so much from our family. Right, Right.

I know. I'm like, that's why it's like, I have, like, I've never even seen that in a patient, but here my own child is struggling with it. Anyways, I know we could talk all day about these things, but it's been awesome. Yeah. This has been so good. Thank you so much for joining us today, Josh.

Yeah, absolutely. Thank you so much.

I appreciate your time. Thanks for listening to this podcast. If you want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others, you know, in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook on on my Facebook page @hallebulckenbiz, on Instagram Halle Balkan. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes, where you can also subscribe to be kept up to date on the latest podcast episodes.