Released-At Last
Photos: L to R: 1. Kimberly White measuring Ashlyns progress days before the release 2. Ashlyn feeling good prior to the release, thumbs up for the group of friends praying for her 3. Laser release 4. Dr. Thomas showing her how to stretch the tongue at home 5. Incision one hour post-release 6. Fascia release massage therapy. PS If you notice she’s wearing a Twenty One Pilots hoodie, just know that it’s actually mine. Yes, I’m that cool (but only that cool).
This is part three of a three part series on our adventure with an adult tongue tie release. See the prior two blog posts for the full story.
Ashlyn was given a couple of names of Speech Language Pathologists to see for a few weeks prior to her release appointment with Dr. Thomas. She chose Kimberly White in Denton. I went with her to her first appointment and was beyond impressed. I don’t really have a grasp on all Kimberly does, but I want to be her when I grow up. She offices out of her beautiful home, just off Lillian Millar/Loop 288. She has a team made up of women with degrees in the field who work under Kimberly’s license (I hope I have that right). There are children in and out of her home, each of them seeing one of Kimberly’s assistants. Andrea works in the office and is a lovely asset to this well oiled machine.
There is a thermometer and temp chart near the door. No one ever took our temperatures. Because of the nature of the work, masks would be silly. Kimberly ends up with her (gloved) hands in her clients’ mouths so six feet of distance is pointless. Ashlyn fits right in.
We were given a list of foods of various textures to bring and as we chat through the intake with Kimberly, she has Ashlyn try a bite of food, chew it up until just before she’d swallow it, then open her mouth and show Kimberly. Of course Ashlyn chewed it a little longer than normal, her work was about to be on display. When she stuck out her tongue, it was covered in food. Kimberly was not surprised but told Ashlyn that an untethered tongue would form the food into a bolus, or ball, then swallow. Ashlyn couldn’t. She continued to explain the other issues Ashlyn had because of her tongue tie: a forward pulling of the head and rolling forward of the shoulders allowed her airway to be open, sleeping with her lips slightly apart allowed her to mouth breathe, which may be the only way to breathe if your tongue isn’t mobile. She feels Ashlyn will sleep better, have better posture, and yes, be able to clear food from her mouth more easily. Constipation is often a result of swallowing nearly whole food because of a tie, but Ashlyn made it clear this is not her issue. She took measurements including the strength of Ashlyn’s lips (weak), how far she could open her mouth (not far), and she documented her posture and tie in photographs. She sent Ash home with a therapy kit, explained the exercises necessary to prepare the mouth for the release and planned to see her weekly via telehealth. She requested Ashlyn see her in person once prior to the release for more measurements. Kimberly also asked Ashlyn to see a fascia release massage therapist once before and once after the release. Yes the bills were stacking up-I’m thankful our health share covers tongue tie releases.
Ashlyn worked hard to be a compliant patient even though it’s hay season and she’s busy in a tractor all day. She made steady progress and after about six weeks, Kimberly said Ash was ready to make the appointment with Dr. Thomas.
Thankfully, the tie release day was much, much better than root canal day.
Ashlyn and I drove over to Dr. Thomas’ new office Monday June 22nd. We waited with several other patients including a little newborn (Dr. Thomas is one of the go-to dentists for revisions in DFW. She was trained by the famous-in-our-world Dr. Cole, who also works in DFW). Ashlyn was called back, Dr. Thomas reviewed Ashlyn’s history and the plan for the day, then she numbed her (it was easy this time, as the tongue is different than teeth). The laser only took a minute or less. Easy peasy. Dr. Thomas had Ashlyn try to touch her tongue to her chin (she could), her nose (she couldn’t, which is of course just fine), sweep her tongue from her back teeth all the way around the line of teeth to the other back teeth, which she could, for the first time in her life. She could open her mouth wider. Success!
Ashlyn said the procedure was not uncomfortable but she was a 5 on the pain scale as the lidocaine wore off. She was to eat foods that were not hot (temp or spice level) and not hard/sharp (like chips) for a while but she could eat normal food soon-it was good exercise for the tongue for her to do so. She was given stretches and exercises to be done every 2 hours, even through the night. She was taught how to massage and stretch her tongue with aloe before we left. She was to drink a milkshake on the way home for cold therapy-what a great prescription. :)
She took two Motrin on the way home, her throat hurt that night and the next day-it’s actually the tongue adjusting to its new position, but it feels like a sore throat. She’s had to adjust to the new things her tongue could do. She said she felt like she could relate to our dog, Sam, who sleeps with his tongue hanging out. Her tongue took up more room now that it wasn’t tied down. She was already off work the next day but felt fine-a little bit of pain was present but not bad. She texted me from work later in the week and said, “I only need to swallow once now.” Apparently it was new to her to be able to clear her mouth with only one swallow (additionally, she always had to wash down her food with a drink, which should be going away, too).
We were warned by others (not Kimberly or Dr. Thomas) about the pain after the release but it has not been severe. She had the fascia massage the day after and while it wasn't comfortable, it probably helped keep the tissue loose. Dr. Thomas said if her pain was high on day 3 or 4, the stretches were not adequate/working. Ashlyn worked hard to do the stretches well and was not in much pain days 3 or 4. Ties can grow back, regardless of the work done by the patient, but Ashlyn was not going to let it be her fault it returned.
I think the success of a release is highly dependent on the patient receiving the extra care of the massage & speech therapists, the patient being instructed in and completing the exercises and stretches and the skill of the provider in knowing how far to go with the laser. Many families don’t get all of this and unknowingly move on to some other treatment (or no further treatment) because they tried a release and it didn't work. It may not have been a good release or good prep/post op care that was the problem. See a solid provider the first time!
She’ll see Kimberly via Telehealth a few more times, then in person about 4-5 weeks post-op to measure everything again. Apparently the exercises and stretching she does in the weeks after the release will add to her mobility, so she’s not even seen the full result of her release as of this writing (6/26/21). Her pain level today is a 4, but only when she’s doing her stretches. Dr. Thomas’ told her to expect that, and that the way to it healing was to push through the pain.
It’s been an insightful adventure. I’ve made new connections with providers that I would feel great sending my clients to (having lunch with Kimberly after Ashlyn’s next appointment). I’ve seen a release first hand and now have a grasp on the prep work and recovery work surrounding a good release. Ashlyn and I have both been guilty of assessing my entire family for ties, randomly asking them to touch their chin with their tongue. We’ve not yet asked them to show us their food before they swallow but I can’t rule that out as a future family activity.