Ep 27 Untethered Airway and Tongue Tie Center

In this episode Katie and Dr Meggie Graham discuss how tongue tie and breastfeeding challenges should be supported by a team for better functional results.  They talk about how to make a team, how this approach supports families better, optimal timing of release and why the Untethered Initiative.

Podcast guest: Dr Meggie Graham graduated from Marquette University School of Dentistry in 2009. Dr. Graham owns Lake Park Dental and Untethered Airway Health & Tongue Tie Center. Both are located on Milwaukee’s Eastside near UWM & serves the entire Milwaukee area. She and her team offer a relaxed atmosphere where comprehensive, holistic health is top priority. She is very involved in continuing education, community outreach, and expanding public awareness of airway health. She is an affiliate of The Breathe Institue, a Liason for AAPMD, and member of the Spear Faculty Club.

Podcast host: Katie Oshita, RN, BSN, IBCLC has over 22 years of experience working in Maternal-Infant Medicine. Katie is a telehealth lactation consultant believing that clients anywhere in the world deserve the best care possible for their needs. Being an expert on TOTs, Katie helps families everywhere navigate breastfeeding struggles, especially tongue tie and gut/allergy related issues. Email katie@cuddlesandmilk.com or www.cuddlesandmilk.com

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Disclaimer, this content is meant for information only and not as a diagnosis or medical treatment for any condition. If you or a loved one needs help, please seek out a qualified medical professional for assistance. Welcome to the podcast. I'm your host, Katie Osha, BSN, RN, IVCLC, and infant feeding specialist. Quench your thirst for knowledge and travel with me across the nation to discover, learn, collaborate, and better serve clients from all over the globe. Let's ride and thrive together. On the podcast today, we have Dr. Maggie Graham, who graduated from our Kette University School of Dentistry in 2009. Dr. Graham owns Lake Park Dental and Untethered Airway Health and Tung Tai Center. Both are located on Milwaukee's East Side near UWM and serves the entire Milwaukee area. She and her team offer a relaxed atmosphere where comprehensive holistic health is a top priority. Dr. Graham is very involved in continuing education, community outreach, and expanding public awareness for airway health. She is an affiliate of the Breathe Institute, liaison for AAPMD, and a member of the Spear Faculty Club. Please welcome Dr. Mikey Graham. I am thrilled to be in the space that you have a beautiful office, I think. This is an tether room and lake dentistry right now. Lake Park Dental. Yeah, when we looked at that little um map of the neighborhoods, Lake Park is adjacent to us. Yeah, it's it's a beautiful office, very welcoming. I love the color scheme and it's just thank you. One of the things that um I gave pushback to the architect when we were designing it was they said, you know, it's gonna be loud. You're not you don't have drop ceilings, you don't have carpet, you really should do that. And I was like, no, that really gets in the way of the aesthetic in their defense, it's loud. But I do like how it looks. Thank you. Yeah, I get it. Um that's where the you know noise canceling things come in and stuff like that. But yeah, the aesthetics of it, I mean, a drop ceiling, you would lose this. Is just a funky, fun old building. Isn't it? You don't want to lose that. No, no, I even loved I my dad was a contractor, so I noticed little things like I love all of your you know, reclaimed wood around the window. Thank you for noticing. Those are just beautiful. Oh, yeah. I mean, I can tell that those are definitely really thought about. Yes, you know, it's it's a beautiful office, but the history of the building is cool, and I just think that there's so many new buildings that are beautiful and impressive, but to be able to rehab and recycle an old building and give it a new story is fun. So thank you for noticing. I appreciate that. I do love restorations. I think there's so much more character in it than a new build. Yeah, for sure. When when you leave here, when you go next door, this used to be a parking structure, so you could see the remaining unoccupied parking structure, and we just kind of took what we wanted and put up walls. Wow, this is awesome. But I think what's even more impressive looking at this is this that you're doing here with Untethered. So I kind of got here on a really special day to see this untethered initiative. The timing couldn't have been better, right? I'm really thankful for that. But describe to me how that how did this initiative start and what does that look like for you? Sure. So, you know, I've been working with a collaborative interdisciplinary team over the last several years and realize just the outcomes and the success stories from the parents are dependent on having multiple viewpoints on babies, especially. So we treat infants, we treat kids, we treat adults, but specifically this initiative is for babies. And, you know, recognizing that if we could recreate this model so that the communication was more fluid between the providers, wouldn't that be great? So there's two objectives of the initiative. One is because it's a learning and a training module for us to train our colleagues, we're doing the services as a pay what you can or pay nothing if you can't. So there is the access to care because of noticing the tongue ties and airway and things like that that are not well understood or common across all platforms of medicine, become a really privileged problem to treat. And so it's hard to know that you have access to helping and then somebody might not have the means. So, you know, we dabbled in trying to bill insurance and that got us nowhere. So now this is just another avenue of the families agree to being exposed to a lot of providers and a lot of cross-talk and educational talk, but they get the advantage of not having to pay anything and also getting the advantage of having multiple people weighing in and helping. So it's an access to care and a training objective. And you know, it's brand new. We're kind of making it up as we go, but so far it's been, I think, pretty positive and well received. Access to care is so huge. And I would say that there's a lot of this, you're right, this airway stuff that is not covered or accessible. Totally. I mean, I may mention earlier, I don't know if you've heard me say it, but I have a 10-year-old who just did oral expansion and you know, that pallet expander, and now we have retainers in, which incidentally, yesterday she lost one of them. Yeah, and the retainers have only been on a little over a month, and we wound up finding it, but immediately I'm like, oh my god, how much is this gonna cost? We need another retainer made and we need it like right now, like we can't go without that that maintaining that shape, and it is expensive. I mean, the panectomy is all the therapies, but it's just and that's not even getting into the orthodontic part of things or the expansion part of things or the skeletal part of things. And I hope that I'm young enough that by the end of my career it is just standard of care, at least that you if you go to 12 different providers, you get the same diagnosis. They might have different tools to combat the issue, but at least you get the same answer because right now no one's getting consistent answers. It's so confusing. So when I, you know, when I dreamt up the initiative and wanted to really figure out a way to provide that access to care component of my business, the nonprofit side of it, I can do the release. I can do this, I can donate my time, I can do the surgery. But the cool part about it is to see my community and my my colleagues in different fields step up and say, Yeah, I want to help this problem too, and donate their services and their expertise and their time, because it really, I feel extremely strongly about the way in which these problems are approached. I think a lot of really well-meaning providers do a clip and go. I use that phrase a lot, and I think it's well-meaning, but the outcomes just aren't the same if you're not looking at things structurally, functionally, emotionally. And so to have access to feeding therapists and body workers and lactation consultants all willing to kind of jump in and donate makes it possible because on my own it's a clip and go, and that's not very helpful. Yeah, and that's that is something that I see a lot. But and I don't, you know, at first I was my mindset was well, they should all wait and we should, you know, that the dentist shouldn't be doing it so fast, everything else. And as I've done this more and I see from different perspectives, which is really what I wanted from this podcast, but personally for myself, is I wanted to start to see stuff through other lenses, I can see how well-meaning it is and how they're really just trying to help. None of these providers out here doing all these mental releases, even whether it's a clip and go or even a laser phonectomy of a well-trained provider, they're not doing it with the intent of harm. They're trying to help the diet as much as possible. And you've got, you know, a lot of times you do have that mom in pain or that baby not gaining, and they're just frantic for that release. I still feel myself even, you know, we had a family today where the mom came in and she was, she's crying in the waiting room. You know, she's she's just emotionally spent, she's tired, she's postpartum, the baby's not feeding. And I have this instant anxiety of wanting to help and having to rein myself in and saying, you know, me treating surgically in this moment is not going to help. She needs a lot of other steps first, and that's hard because I think we all want to be there to support and help. But I have to recognize that sometimes not treating is better. It is helpful. And I think she'll get there, but I think that she'll get there and have a better result, they'll have a better result. I hope that they have a better result now that they have a little bit more structure and support. So it's hard. They want, I mean, who wouldn't want an instant gratification? Totally. We want a metic bullet. Right. I want the pain gone. I mean, if you're in pain and you go to the doctor, you want the pain gone. You don't want them to say, well, it'll get better in a month. Like, of course, we want that. But I think you know, the biggest thing is for the other providers, especially, but also parents understand that we're not sitting there, like you said, we're not just gonna sit there and wait for this magic thing to happen and do the release. You guys have feeding therapies, you have lactation in here, you know. There wouldn't be body workers, there's so much happening. There wouldn't be controversy or confusion about tethered old tissues if it was magical. It would be easy, it'd be well accepted, it'd be an easy quick fix. But the part that I'm learning on this journey is even though I'm the structuralist and my role in it is to release the tethered old tissue, there's so much I don't understand. You know, the way the baby's carried a utero, the birth journey, cesarean versus getting stuck versus normal vaginal delivery, the trauma of the mom, you know, the history of previous births and nursing journeys, reflexes and neurology, like there's so many components to it that have to be considered, you know, and I didn't dream that that was that this was that complicated. Right. And some of these parents come in with, I mean, I wouldn't hesitate to call it really PTSD from whether it's from their birth trauma or whether it was a really poor experience with tethered world tissues with their first, that's pretty common too. Yeah, they're just they're already their anxiety level and their stress levels are already so high because they're reliving all of that and the months and the work and the pain and everything else. So even though this baby's only a few days old, they're just already still. And babies sense that babies can feel their mom's stress and their dad's stress. And um, and I see that trauma coming from like totally opposite ends. One is horrific outcomes surgically or not good support and breast aversion or feeding aversion and poor weight gain. And then the other side of it, too, is and I do believe that there's traumatic experience for the moms there where they know that there's a problem and there's severe restriction, and they just keep being told, no, there's no problem. You're crazy, there's no problem. Maybe they're not being that derogatory, but being told being told there is no problem. And so they're starting to second guess themselves, and then yet they're trying to follow their instinct, and so they're lost, they don't have solid footing, and they're wondering, Am I even on the right page here? So gosh, it's so confusing for these people. One of the worst things about it is those ones that really destroy mom's nipples, the most painful, the craft bleeding, all of this, those tend to be posterior ties, right? So those tend to be harder to see. Sure. And those are really the ones that they're told, no, this is all in your head. Yeah, we've got a baby that's gaining, you just need tough it up, yeah. Tough it up, just deal with it to your first time. Or or go to a formula, go to bottles, and just you know, abandon this journey that you feel so strongly about. Or here's here's a nipple shield. Not to say that nipple shields aren't great. We're so lucky to have so many solutions, acute solutions. But I think so when we kind of dismiss or quickly offer band-aid solutions, we're missing a bigger picture. Well, one of the things with one of the babies today was he was really struggling with bottles. Parents were talking about, you know, 50, 60 minute bottle beats, and watching him, he was gumming it, his mouth was open a lot of the time, he's sucking in tons of air. A formula bottle is not a fix for tethered oral tissues. It is not going to change the structure that we're dealing with or the lack of function. So I think that's what's really frustrating to me, too, is when a pediatrician does say, well, just you know, switch to a bottle. It's like that's not gonna fix what we're dealing with here. You know, and I have a different perspective too, because I am and first and always will be a general dentist. I started with adults and I still treat adults, and understanding that if tethered oral tissue is not caught in a nursing scenario or a speech scenario, so often families are told that it's not a problem. And what I have found is that those dysfunctional things that cause feeding issues and cause speech issues are sometimes compensated for and missed, but then it changes the way the whole skeleton grows and how the patients breathe and how their teeth come in and causes all other issues that we're not even having that discussion when we're talking to a diet or uh breastfeeding family, but like that's in the back of my head too. It's like I really want to optimize this function because I just know of all this other stuff that could be avoidable if we can change that growth pattern early on. Absolutely. I mean, I I'm living that right now with my kids at 10 and 13 going through their 10 releases this year and their myofunctional therapy and oral expansion and all of that, and that's still earlier than me. Sure, that I discovered this last year that I've had a 10 tech because it never occurred to me to even think about it and to look. And I think it was funny. I was at Richard Baxter's, and have you seen his forms? Like his little intake ones are pretty common. And I was looking at the child one going, huh? Me, me, me. Like I filled out all the baby stuff from what my mom said, and then I fill out all the chip kid stuff, and I'm like, oh my god. And it explains so much about my childhood. And I'm on, you know, my slow journey because I was actually going to have my 10 released with my girls, which was super blessing that I didn't, because that wasn't a good plan. Like, yeah, I don't know that I should do something at the same time. Sure, you want to be the mom, you want to be the caretaker, not the patient. But I tried, you know, I had my first myofunctional therapy appointment or myofascial, and my body just did not handle it well, which is amazing to me because I'm like, it's a super gentle, super gentle thing, right? Myofascial was so I mean, it's like this, I describe it as a non-moving massage, like it's so gentle, and I have nerve issues, and my body just went into a massive painkiller.

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And I was like, okay, okay.

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So I talked to my team and said, What are we doing about this? And everybody agreed that this was a sign that my body was already. For sure. There's so many that even though you're not an infant, there's still so many things to consider. Oh, yeah. And they were like, Okay, we need to we need to address my health first and then get here when my body is not in a stress state. But there's things like that to think about, and I do hear in general, most providers, most structuralists are doing the if you're an adult, a teen or an adult, you have to have myofunctional therapy before you go. Oh, when like I'm not hearing that at all that they're not doing it, it's the babies where that timing is is. I still I still hear it in adult circles um or in big kid circles. And I just think it's people that you know recognize a structural issue but don't have the education quite yet to know that there is a functional component. But you're right, I don't hear it as frequently as I hear it amongst the baby demographic. It's amazing though, you know, listening to what you said about your your personal struggles, but how well we compensate and kind of get over it and deal with it. And so one of the things that I tell families all the time is, you know, there's a lot of tongue-tied adults walking around and they're okay. But could they have had an easier journey? Could they have avoided interventions? Could they have fewer ailments and problems now? Probably, yeah. So I would have loved to avoid a speech therapy all through elementary school. Well, and I think about how many of my patients, adults and teenagers, and have had orthodontic treatment multiple times, once, twice, three, four times, to make the teeth straight. But if you're missing the structural component, who cares if you have straight teeth if the if the body's not in harmony? Um, I won't stay straight. No, and that's where the myofunctional therapy component comes in to support that orthodontic need, right? If you're dysfunctionally compensating or you know, you're dysfunctionally functioning, you're gonna have a higher chance of needing structural change like orthodontics. If you don't address that dysfunction, you need to rely on those retainers 100% and your chance of relapse is really high. So if you don't address the why behind needing the ortho in the first place, you know, you're still missing something huge. Yes. So I think that myofunctional therapy is part of in infancy with feeding or with child in children and adults is part of the treatment plan no matter what, always. And then if the myofunctional therapy is not possible, if you can't realize the objectives of the therapy because of the tethered oral tissue, then you release the tissue. But you've got to be able to function or at least try. Yeah. So I'm right there with you. And I I see the the difficulty, you know, and I see how hard it can be, especially for providers who are trying to do the right thing, trying to support these families, but maybe don't have a team, right? Not everyone has totally a Jordan around or a Molly, but I I would say to people they're there. We just have to start building a team. I think that people need to really start to value and respect everyone's scope. And there are people around, and they may not have what you need yet either. So there have been times where I've worked with a chiropractor and said, you know, how much are you comfortable with and what is your training? And then we share information. Would you consider this? And yes, or sharing studies or talking about classes and ways of expanding that knowledge to grow your team where everyone starts to get, I mean, we're all learning and it's talk storming. You I have a lot of people that shadow or you know want to hear about the journey that I've taken and kind of where I started to where we are right now and where we're planning to go. But, you know, a lot of it's luck, right? I'm in a community that has amazing providers, but a lot of it is exactly that it's rolling up sleeves and having lunch and having coffee and shadowing each other and collaborating and communicating and sharing how you each see a patient differently to establish those relationships. Because even though our community is so fortunate to have rock stars like Jordan and Molly, they're out there. You just need to find them and create those relationships so that you can start to build that because otherwise you're all just working independently and not harmoniously at all. And that doesn't help the patient. It does not. And I think that it's so important too for people to realize that there's there's that credential that we all have, you know, various credentials, but then there's education experience. And so I will, you know, frequently hear, well, the you know, the other lactation told me that the baby doesn't have a tentai, right? Or the nutrition said this, or the SLP. And I'm like, well, everyone has the same training. And I think that's what's so hard for parents, and that's across the board with any single profession, right? And that's what I'm saying. Mechanics have different training and different specialties, you know, carpenters and doctors and ENTs and dentists who all have different training, and just because you have that title doesn't mean you have that same level of experience or expertise. So I think that the one of the most damaging things a provider can say is no, it's not a problem. I have so much more respect for providers that will say, I don't know. I'm not sure. I'm not familiar with that, or I've never heard of that, because you have to recognize you're limited in your ability to diagnose and help by what you know. And if you don't know it, it doesn't mean it doesn't exist, you just don't know it yet. So I agree with that too. Yeah, I think referring out when you don't know is so much more beneficial. I think there is way too much of saying no, there's no time tie. And sometimes, you know, I'm hearing from clients, sometimes they're assessing the baby in the car seat, or you know, they're not putting their hands in the mouth at all. They're just looking, and I'm like, okay, that's not a that's not a very good assessment there, right? Like it's not a comprehensive assessment, right? Would if you went to the orthopedist because your knee hurt and you just sat there the whole time and they didn't touch your knee and they didn't ask you to walk and they didn't ask you to do anything, are they gonna have the best assessment? Right. It's a great analogy. Yeah. I mean, all of these things, we need to just change the way we all work together and how how the communication happens and everything, but it's it's challenging. There's so many barriers, there's so many challenges. It's the communication aspect and aligning philosophically and from a treatment standpoint. It's the academic understanding of the science behind what you're doing. It's the hand skills to assess a baby, to feel the baby, to treat the baby. Like there's so many barriers that really have to come into alignment. And I think that that is part of what's missing in the respect of this of this field is understanding just how not simple it is. I'm sure there's a more articulate way of saying that, but it is really complex. Our bodies are really complex, and there's no part that functions by itself, which is part of why halopathic medicine is the way that it is now because it's so suctional, right? Versus working with an ND or functional med where they're looking at your whole body, because even take something like a thyroid, and you see an endocrinologist for that, but it's like your fiber is going to affect all your hormones, it might be affecting your mood, it might be affecting your gut, it might be affecting so many other parts, and yet they're looking at one tiny piece. Right. And then even getting broader than that, because this is my wheelhouse. So if your sleep cycles are disrupted, how that impacts the thyroid too. Like all of these things are interwoven, and your body doesn't read a textbook, your body's just doing what your body does, and it's us having the misunderstanding and lacking the knowledge to kind of piece those things together. Right. Actually, sleep's a big one. When parents will ask me, Well, what happens if we don't do this? I don't want to overwhelm and scare them, right? I mean, nobody wants to hear a scare tactic. No, right. That's not beneficial because people are going to shut down, and that's not my goal to scare new parents. But what I, you know, and I'll say usually what I'll say is that it interferes with sleep because we're not getting that. Time up on the palate, and if we're not having quality sleep and quality air ray, that's gonna affect us in a lot of different ways. And I can't know how it's gonna affect your baby or this specific person, but you affect sleep and you pretty much affect everything in our body. Like I think if we we're really gonna oversimplify everything, if people had ideal sleep architecture and ideal breathing, those two things would impact so many of the other fires that we're putting out. Right. I mean, how many adults are walking around sleep-deprived, and you know, how much does it affect their mood and their diet, and then their diet affects everything. I mean, there's so much that can be changed. That's the triple effect, yeah. Yeah, totally. I know, and these babies are lucky to be seen though now and get that dealt with as opposed to as an adult. Oh, for sure, right? Of course, absolutely. And there's no, you know, we talk about risk management and there's no magic bullet. But if we can, again, back to really simplifying the functional aspect of it, if we can optimize the breastfeeding function or the feeding function or the swallow function or the oral rest posture, that's gonna change the way these little moldable babies grow, which is gonna set them up for better breathing, which is gonna set them up for better sleep. So it just becomes this journey, the cycle. Absolutely. And I think that you know, that the earlier we start it, the better. But I also see there's definitely some knee-jerk reactions that I'm getting to from providers or parents doing the, especially parents in the second, they'll do the well, my first one had a tin ties, so we're gonna make the appointment and go on the way home from the hospital. Yep, absolutely. And I'm like, I hear you, I hear how difficult that first journey must have been. Great that you know it's a problem this time, but that doesn't mean that jumping in and treating without assessing the other stuff is gonna be helpful. But it's hard, especially if they didn't have a team approach the first time, sure, right? And so they're like, Well, you know, and sometimes it worked, sometimes it sometimes it helps, and sometimes it helps with the sheep complaint of let's say pain, but it might not be optimized function, which isn't helping with the growth, right? You know, and so it gives a false sense of it worked really well, totally. And then sometimes I'll be trying to explain all of this to her client, like, but it worked last time, and I just went in and had that done, and it's fine. Well, you were lucky, you're lucky, and these are two different babies, two different babies with two different journeys and completely different subsets of parts that need to be considered, right? I think one of the interesting dilemmas, too, that I hear a lot about is the the ENT world versus dentistry and how we're going to get everybody kind of on that same page. You would think ENTs would be all over this, right? I mean, we're all airway, they're like they specialize in this tiny bit of the face, but not the mouth. The mouth is annexed from the rest of the body. If you think about the shared anatomy, of course, the roof of the mouth is the floor of the nose, but the mouth is the center of the cranial facial respiratory complex, and yet the mouth is annexed from the rest of the body, it's not part of the body, you know, and it's it's the start of our GI system, it's a part of everything, but it's not we don't look at that in GI either. You know, and the if you really get into the politics and the history of the separation of dentistry and medicine, it's it's fascinating to see how you know there's different insurance for the mouth versus the rest of the body. So it's surprising because of the proximity of the anatomy and the shared real estate, but it's not surprising knowing just how how separated the mouth is. You know, I've talked to extremely educated physicians and ENTs, pediatricians, and they don't know how many teeth are in the mouth. They don't know what a normal bite looks like, they don't know normal tongue posture, and that's not because they're uneducated, it's because it's not part of the curriculum, it's not part of their scope. So there's just got to be better communication, right? You know, and there's not even good communication amongst dentists and then between dentists and orthodontists. So the communication piece of it is universal. I think dentistry in general, and I'm sure this would matter to you, but I think that it has not been considered as you know, this preventative health plan that it should have been. And it's it's like it got pushed to the side and was like, yeah, if you want a nice smile or white teeth, you can go to the dentist and everything, but it's just not prioritized in the same way that you know getting your physicals and everything else is, and I'm like, it really should be like the dentist, it should be seeing humans all regularly and throughout this lifespan to really you can pick up so much. But even dentists aren't trained that way. So even the dentist, the traditional dental curriculum is very technical and talking about teeth and gum and bone, and that's about it. And to consider that the mouth is the beginning of the digestive tract, that's mind-blowing for a lot of dentists to think about that. That's part of the gut, it's not part of the normal curriculum, and to think about you know, the systemic risk factors of paradontal disease and things like that. It's not even part of the physician's curriculum, and it's hard for the dentist to see that and then they don't communicate, and it's just it's just a missed opportunity. I hope that that changes too over time. There's some pretty phenomenal out, you know, well-spoken, popular functional medicine or functional dentists that are kind of helping bridge that gap. But I think until it gets into the academic level and the norm, it's a hard thing to change once you're already out practicing in what you think you learned in dental school is gospel. Yeah, I think it's so interesting too. And we come back to this a lot in the talks world that it's not in the curriculum. Yeah, it's not in dental, it's not in medical school, it's not in nursing school, it's not in lactation, it's not in most SLP programs. Like it's completely not there. And I'm hoping again that as all of this starts to happen and we start to see this change, it will get there. But I think the thing that needs to help, you know, getting to the academic level is a pipe dream. I think that there's a chance and a hope, but really I think what's going to happen is families sharing their stories. And, you know, in addition to providers collaborating and connecting and communicating, I think those two things have the best chance of changing that scope a little bit. But I think that it's such a massive ship and to turn it is hard. But I think these moms and these babies and these personal journeys and stories have the most impact, at least for creating a public demand and educating the moms or the families. So I wanted to ask you because I see you educating and teaching another dentist here today and trying to help him learn for his practice and for his patients and everything else. Do you think that you can achieve the same release or really closely if you were doing the same technique with scissors? So that's a great question. Because I think that you can do a lot of damage with the scissors, and I think you can do a lot of damage with the laser. And I think that you can get a really good release with the scissors, and I think you can get a really good release with the laser. You know, I flippantly said once in the right hands, you could probably do a release with a nail clipper. That's a terrible thing to be to say because it's a terrible thing to be quoted on. But what my point was is that I think it's more the understanding of the anatomy, the handset, the hand skills of the surgeon or the provider, the structuralist. I think that has the most impact, even more so than the tool used. Now, in my hands, in my experience, I like the CO2 laser because I think, in addition to my hand skills and my experience and my education, I think the laser takes it to the next level. It's very precise, it has low risk, but it doesn't mean that I think that there are providers out there that are doing poor releases with the scissors. It's just that I think that it's easier with the CO2, in addition to having it, that skill set. I know it's a loaded topic, but I think it's again like everything else, it's not black and white. I definitely, I mean, I agree. If I if I was having it done with my kids, I want a laser, and I'm not saying that I don't think it I do, I do think it does a better release. Definitely the hands are the most important, but there are so many places in this country that are medical deserts that you don't have specialists around for anything, and sometimes for many, many hours drive. Right. And so when I think about how we can change this, I don't think it's necessarily possible for every state or city to have someone doing laser releases, you know. And you know, to drop off a laser in every single office isn't gonna help the problem. Right. Now you've got lasers in the office, but you still don't know how to use them. So I think that it really has to be back to the basics of the anatomy and what you're releasing, and then if you have access to the best tool, even better. But I think that I think that the anatomy understanding and what you're trying to release is would trump the the instrument. So I guess it's a long-winded way of saying if I had to make a decision of who was going to release a family member, I would want somebody with amazing experience and understanding over the tool. Right. And I think that should be in general for any proprietor. I mean in the right hands, you know, I was labored delivery next for 15 years. In the right hand, I'd rather have four steps in a vacuum in the right hands. But you're sharing four steps in someone's hand who doesn't know what they're doing and totally very dangerous. So again, it does come back to that. I just I've been surprised as I've been traveling and expanding my clients to more nationwide and doing telehealth at how many places they really don't have access to to quality specialists. I mean, to the point of even my clients that come from the outer San Francisco Bay Area, they're not that far from San Francisco and stuff like that. And they can get in for a release, but to have functional therapy, to have body work, to have any of that. And then there's places that you can't even, you know, I've had clients in Montana and they're like, there's no one. We're working three hours from the pediatrician's office. And then it circles back to what I said at the beginning of our conversation, just that it's really becoming a privileged thing to treat, you know, that it's inaccessible to a lot of families, not necessarily only financially, but even just from a geography. Absolutely. And, you know, I I met with one auntie who was pretty passionate about the access for care. And she felt that it was really very, very important to make sure that those releases are getting done in the disadvantaged areas. Oh, those children are not, they're not accessing, a lot of them are not able to get speech therapy at school or to get orthodontier or to get all of these other things that they might need if they don't get the release. They're on a they're in a medical desert and an access to care desert just based on their circumstances. So if we talk about how a tongue tie makes somebody more at risk for needing orthodontic care or a higher risk for having cavities or periodontal disease, if you can assess and address the functional issue and the structural issue early, you're not solving all the problems. Diet and home care is still a big deal that needs to be addressed, but you're setting them up to be in a lower risk category. So I agree. I couldn't agree with that statement more. Yeah, it's a it's a pretty big deal. And I think we need to get people on board to understanding that this isn't about breastfeeding, even this isn't about this tiny under the tongue. This is about airway and oral development and health. Like this is about so much more than just one piece of it. 100%, you know, this is a very big puzzle. You know, and there's a there's a lot of there's a lot of talk about well, it's a quick, it's a quick way to make money, it's a money grab, which of which of course I take offense to, but but I get it, right? I think that there's there's a lot of bandwagons we can jump on, and there's a lot of ways that we could make our businesses more profitable. And the thing that sticks with me is I would have a much more lucrative practice if I just shut up and cut teeth, you know. But really, I think the best medicine is to get people out of the way of meeting those interventions. Great that we have the means to fix problems, but if we could prevent them in the first place, that's better medicine. There's not a lot of medicine, there's not a lot of money in prevention. And so I think that that's something to be considered and talked about. Is it's usually the people that are doing these kinds of services are spending tons of time without pay because it's a passion project and they believe so strongly in the way that care should be provided and accessed. Absolutely. I mean, I think when you talk to people in this space, like us who are really passionate and love all of this stuff, we're also taking a ton of classes, way more than we need for our licensing stuff. We're doing meetings and collaboration and training and talking about. Time with family and donating, donating left and right, not necessarily only care, but also education and intellectual property and just trying to spread what I think is goodness, you know. I tell families when whenever I hear the, you know, well, the dentist just want to make money thing, I tell them that first of all, that's just rather offensive. But that they need to understand prevent your dentistry and dentistry in general can be a lucrative field, but I don't know anyone getting into this top space for the money because you know what? It's way more happy. It's a lot easier, there's a lot easier ways to make money. A lot of easier ways. If you're a dentist, there's a lot of easier ways to make a really good amount of money and is not with a lot less risk and a lot less time. And you know, maybe there are a couple bad seats out there that are just it's a bandwagon I'm gonna hop on and it's it's trendy, but I don't think that people think like that. I have I have the benefit of the doubt for most humans, and I think that that goes for providers as well. And yeah, it's an uncomfortable thing to talk about and discuss, but I think it's important to address it. I think it's it's really unfortunate because when I hear that comment and when someone says that they were told that, I tell them that that's really telling and shows where the other provider is coming from, where that they're attacking personally this profession and trying to undermine the confidence in it instead of looking at this as a I don't really understand. Or they don't understand the complexity of it. If you think about everything we've already talked about and the complexity of the issue, the amount of time and expense to gain that knowledge, the return on investment for that is probably never ever gonna be there fully, right? Right. And then again, like I said, it would be better for me to not fix the problem and fix the later problems, but of course, that's that's not how I'm gonna practice. Yeah, I I worked with one, I recorded with one dentist out in Florida, and he's like, Yeah, my life would be way easier if I just like drilling and filling. He's like, I could sit and drill and fill all day. It's like, but it's not what I want to do. No, he's like, I want to help parents understand that while they think that you know they're not giving their kid candy to help prevent cavities, they don't think about the goldfish, like it's eating 247 or things like that. You know, he's like, I'm all about prevention because I don't want to just sit here and fill cavities. It's prevent, it's it's avoidable. Yeah, yeah, because that's the thing. Once you look at a problem and you realize that it's avoidable, you can't unsee that. And you're like, No, you can't unsee it. We could change the course, we could change your your life course to not have all of these steps or start to diminish risk, start to chip away at those big risk factors and starting to control that a little bit more and putting more power back into the families and the patients themselves. Yeah, I would say that's a huge thing right now, right? Like you talked about, I mean the parents advocating for themselves is so huge. And I feel a little bad that there's so much on them to do that, right? That that we need that medicine right now for them to advocate for themselves. I mean, there isn't more, you know, um, an easier path for them, but I also see how strong they are and how amazing. And there was a publication last, I think it was last summer, and Ts put out about how this vulnerable population is being misled, right? And um, I heard quite a few aunties say this, you know, it was very misogynistic. And it's like, you know what, you meet a mom and your baby, and you tell me that they're not that's a mom there, there like she's so protective, and and parent new parents rather overwhelmed and they may not understand all of this, but they're very protective of their baby, and they know what that child needs, and they're just trying to there's instinct here, sure. Absolutely, and they understand when something is wrong, and it's really unfortunate that too often they're going into care, you know, frequently at the pediatrician, but even other providers sometimes, and getting told that there's nothing wrong when they're saying there's something wrong. I spent a long time angry about that, that they're being told there's nothing wrong when there was something wrong, but I just realized that's just they don't know. And the other thing that Jordan has helped me see is you know, we see, and her more than me, and the pediatricians more than me, see the worst of the worst. So pick up a laser in an unskilled hand or without an interdisciplinary team, and there's a lot of damage that can be done. Now, the pediatrician or the feeding specialist sees these babies with sometimes irreverable harm done. And it's a tough thing to kind of now diagnose another baby with the same problem without having that support ready and a good community ready to refer to. So I think it's muddy all the way around. It is. I just think that it's it's unfortunately something that happens more to women in care than men. And I think to be dismissed, you may be dismissed. Yeah, and I think it's really important that when you go in, you know. I will say to patients all the time, I'm like, your pediatrician does not have to agree with my assessment. We each have our own training and everything else. That's okay. So, but if they're dismissing you and your concerns and not hearing that you think there's a problem, that's not okay. That's not okay, right? Like they don't have to have the answers, they might not know, but they need to be listening to you and say, I hear you. Yeah, I hear you. There's something going on. How can we figure that out? Who needs to be brought in? Where's another expert? Like something, and then having the confidence and you know, just the self-esteem to say, I don't know. I don't know, but you're right, I hear you. This is this is abnormal, and it sounds like it's a struggle. Let's figure it out. Yeah, because it's very upsetting to me that it is, and it's it's fairly universal in healthcare that women get dismissed too often. I mean, we've all read the stats on how women's heart attacks aren't seen as often as men's because we don't present quote unquote classically, but that whole classically designed presentation is based on men. Yes, right, and so we're just dismissed too often. It can make it even more complicated and even more complex to talk about now throwing race in addition to gender and talk about being dismissed even further. And this becomes exponentially harder to get get answers and get help and get care when when the statistics and the history shows that women of color, especially, are dismissed even further than white women. Like it can get really complicated and bogged down, but but I think it's things that we need to talk about and recognize and help empower at least the patient until medicine catches up. Yeah, hopefully it will. I'm a big fan of advocates and I will tell people, you know, especially if I'm working with like a penetra plan, I'm a big fan of two legs. I'm just I'm a big fan of having an advocate. And I think that if you, you know, if you're in the hospital, I think everyone should have an advocate. I just think in an ideal system we would have to do. Absolutely, you know. I talk about that a lot too with my patients that will come to see me for consults. I might not have all of the skill set to help their problems. They might need an ENT, they might need surgical orthodontic treatment, they might need functional therapy that I don't have access to or have the skill set to help. But I'm happy to be their quarterback or their advocate and help them kind of decipher it all. It I think you need to have somebody that can speak the language and go to bat for you and help you find that team because you're gonna be met with so much resistance. The chances are you're gonna be met with resistance or at least differing opinions. Absolutely. And I think that having, you know, and sometimes that advocate can be a partner, totally, it can be a friend, it can be anybody, it can be another provider, but having somebody who, you know, sometimes calls that time out or says we don't understand or let's recruit or all of those things. I think having an advocate is such a big deal. And you know, I think in this multidisciplinary, you've got a lot of people, and that's one thing that I kind of saw. I think Molly was bringing a bit up today of like checking in with the family. How are you doing? What are you doing? What do you think is a plan? What do you understand of what we do? Yes, yes, absolutely, especially in this demographic, the postpartum demographic, because mom's healing, dad's sleep deprived, there might be other kids at home. There's so many things, and we're talking about a baby's structural difficulties, like it's back to this very specific demographic. It's a tough, tough thing to navigate. So advocacy is even more important at that stage. Absolutely. It's why I love I'm I absolutely love staying climbed prenatally. And if I can do a prenatal lactation visit, that's the best thing ever because they're not in that super high stress, exhausted pain state to actually hear and absorb. But once you get them in here and have the baby and all of this is already kind of crumbling. Well, that's why we that's why we've been as a group collectively trying to slow the process down and not being so quick to treat, not withholding treatment that's necessary, but making sure that they have that confidence and skill set pre-operatively. Now you're adding in a recovering baby, and that just I think amplifies the stress level for sure. Well, I love that I saw that in practice today. Cool. You know, that you guys had a couple of babies today that were just not ready. And, you know, one of them was definitely gonna need more work than the other, and talking the parents through what does this look like? What do the next couple of days or the next couple of weeks look like, and how is that going to affect feeding and what are we gonna do to get there? And then a couple of babies that weren't ready today. And I think there was actually a baby that was ready, but the family wasn't ready. You know, I think that if we were only to assess the baby's reflexes and the tethered tissue and even the body, the body component, I think the baby was ready, but we just had so many red flags that the family wasn't ready. And to try to set them up for success was like, okay, let's slow this down a little bit and make sure that they have a lot of confidence in what's coming before we just throw them into now having having to help this baby heal. And I think that that's overlooked a lot too. It's that emotional and that overwhelming. Oh, I would totally overlook it if I didn't have the support of my team. I would have overlooked that. I'm ready to help. I see the structure, you know. So they want the help. I mean, that's they're very much here because they they know there's a problem and they want that support. The trust that we the families give us is just blows me away every day. I just I think it's such a gift, and um, I don't take that trust lightly. So I I make put a lot of pressure on myself and I know my team does as well to make sure that what we're what we're advising, we truly believe in it because that trust is huge. Absolutely. I know I feel the same thing with clients. It's like they're trusting us to they're trusting me to walk this journey with them, to support them and to respect my advice and listen, and and that's a big deal, right? Right, it's huge. That's a big deal. I'm affecting this baby and this breastfeeding diet. I mean, I don't take that lightly. And then you go back down to all the things that come sequentially afterwards, you know, that impact is huge. It is, and it's amazing when we can make that impact and make it a good, a good system for them and make everything actually come together. Well, there's so many things we can't control, but like if we can manage the things that we can control, you know, I think that that's where that trust is earned. Absolutely. I mean, this is this has been amazing. I I think the timing of your your visit to be here to land on today was so cool. Yeah, really cool. Absolutely amazing. I mean, I don't I haven't seen it. There might be somebody else doing something similar, but I have not seen it yet. I've seen a couple of team approaches that are not quite getting the same at all. But this this is definitely well, I mean it's pretty it's pretty unique and pretty special to have, you know, we had six providers all donating their time today on what should be an off day or at least another patient day. So that's pretty unique to be able to make that happen. So I do think that there's a lot of luck and generosity of the other people that are making it possible. So I can see why it's a hard thing to replicate, but it gives me hope that it's something that could be replicated. That's pretty amazing. So I'm gonna keep following along and watching what you guys are doing here. Thank you. And I can't wait to keep hearing your experience with other providers so we can pick up pearls and tidbits and tweaks so that we can keep getting better too. So thank you so much for allowing me to be here today. Thank you for being here and thank you for your trust and your time. When you change the way you look at things, the things you look at change you. I hope that you enjoyed the podcast today and learned something new. If you know someone who would benefit from this podcast, please share.