May 25, 2021 • 40 mins
Cleft lips and palates are common birth defects, but for the kids who have them (and their parents), its no small matter: Years of surgeries, therapy, and possibly lifelong health issues, not to mention the teasing that comes along with looking different.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff you Should Know, a production of I
Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark,
There's Charles W Chuck Bryant, and Jerry is literally right there,
and I'm Chuck. I want to start something. I'm going
to get I actually have a jar at my studio
(00:24):
at home kind of. But it's a use of the
word literally jar. I'm trying to break myself of that,
except when it really truly makes sense, when it literally
makes sense to use that word, like in this instance,
Jerry is literally sitting right here. So do you have
a problem with that, with misusing that word like so
(00:45):
many Yeah, no, not necessarily. It's overused. That's what bothers me.
What about Gimmy and she donating to the jar at all?
Or she just like this literally the dumbest idea. I
don't think she has an opinion on this one. Okay, Yeah,
she's just spend some money. Well, I keep the jar
at home. I'll get money out of it when I
(01:06):
need to. It's more just the ritual of like punishing myself,
calling out that's good, I'm doing something stupid. Once a Catholic,
always a Catholic. So um, oh yeah, this is stuff
you should know. And uh, we are talking Chuck today.
How are you doing, by the way, I'm great. Good,
we're in the same room. It's still a little weird,
(01:27):
getting used to it still. Yeah. I went to a
baseball game last night, Oh my god. And that was weird.
I mean it was great. Uh. And once we get
on our seats, we were actually i mean they're fully
just selling seats, but where we bought seats there just
happened to be no one kind of around us, which
was good. But yeah, I went to a Braves game.
But you know, they're supposed to be policing and saying,
(01:49):
you know, unless you're in your seats, eating and drinking,
you should be wearing a mash. And so we the
four of us, wore masks, you know, in and out
in the bathrooms and the food lines and all that stuff.
But no, buddy else was well, I mean Atlanta there's
a lot of jerks, yeah, and Atlanta. Yeah, it just
it is what it is. We took care of ourselves
and it's fine. Yeah, it was fun. Um, well, that's good.
(02:13):
I'm glad. Juddie good walk off, Homer. Oh yeah, the
bottom of the ninth man. I've only seen like one
of those in my life. It was amazing, great game. Yeah,
it was cool. Who we play? We played the Mets
in our star player Akunya blasted one in the bottom
of the ninth first pitch. It was just great. I
thought Freddie Freeman was our star player there. I mean
they're one and two on any given day. Yeah, I
(02:37):
wouldn't want to be number two, you know what I'm saying.
But yes, no, of course not. That's why I'm number two. No,
that's not true. You meet Jerry all tied for number one.
But anyway, it was a little just's it's just a
little jarring to be among a lot of people again.
And but it also comes back quickly like, oh wait,
I spent the first forty nine years of my life
(02:59):
among people. A took a year off, and I'm back
in this wing. That's good. That's good. I'm hoping to
get back there myself. At any rate. This is still
a little weird. So we're talking today about clefts, and
most people when they think about clefs, they think about
cleft lips. But there's a lot more to that, or
trouble cliffs. Sure, that's a little different. There's an extra
(03:21):
letter in this one that I'm talking about at the end.
How is that spelled? Is that just trouble cleft? No
cl ef Oh, there's no t trouble cliff cliff. I
didn't take piano. That's okay, right, Um, But no, that's
a cleft. This is a cleft. A cleft in this
case is um. It's a it's a division, it's a trench,
it's a void. I guess you could say and that
(03:44):
that that is what we're talking about. It is a
it is a very common, actually fairly common birth defect. Um.
It occurs in the embryonic stage and a child is
born with part of their lip and or part of
their palate the roof of their mouth is another way
to put it right missing, it's just not there, un joined.
(04:07):
And we should probably say right at the beginning, Uh,
this is a birth defect. But it is a visual difference,
is what we call things like this. It is not
a disability, although there are you know, many complications will
go over, but it's a visual difference. And it is
also the term hair lip is not something you should use.
It was used for many, many years, even by doctors
(04:29):
to describe this condition, but it is uh not a
good nice term, so just stop saying it. Yeah, I
don't know anybody who says that. I don't think so
any but you know, some people just may not know. Like, well,
I thought that's what it was called. Uh, And when
doctors use a term, you can sort of understand, you know,
like somebody falling into that trap. But it's not a
term that we use anymore now. And I think that
(04:51):
was a good thing to say. All right, So that's
the c I A is finished. So um, like we're saying,
it is, like you said, it is a birth effect,
but it is just a visible difference. And there's I mean,
that's that's it. I mean, it is tied in with
some syndromes, some genetic syndromes, but plenty of people, I
think in the United States somewhere between one and every
seven um comes with some sort of cleft, either a
(05:12):
cleft lip, a cleft palette, or both UM and there's
that's it. That can be it. That's the only thing
that is different about that child. There's no developmental problems,
there's no and like you said, it's not disability. There's
nothing else that's it. And what's fascinating to me, I
had no idea about this, but I never really thought
(05:33):
about it. Is that the the kid with the cleft
lip or the cleft palette there, their palette or their
lip just never finished forming. Yeah, they never You know,
there's a symmetry generally running down the center of your
nose and the two sides of the lip. You know,
(05:55):
the stuff forms when you're in the in the womb
very early on. It actually for both. I think the
lip is first and then the palette, but you know
they joined together, and in this case they just don't join. Yeah,
you know the little a little bit under your nose,
the bip joining the uh, the bottom of your nose
through top lip. Yeah, it's filtraum okay. And that is
(06:18):
where your lips joined together, your upper lip joins together, right,
and that is where your mustache can part. Yeah, yeah,
you got a little mustache part. I have a mustache
part because mine. But you know, some guys, do you
shave yours in just for looks or is it it
just kind of parts? Naturally? Your hair doesn't quite grow
right there. But you know, if you're like a Burt
(06:39):
Reynolds type or Wilfred Brimley, you can just grow it
over the whole. What's it called filtraum fil traum p
h I l t r U Hiltraum, which would be
a really great nerdy boy's name film. Yeah, yeah, and
his brother Baxter. On the second thought, though, don't name
your son filter so um. When you are in the embryonics,
(07:01):
like you said, very early on, the lip forms in
like the fourth to seventh week, and very frequently a
woman might not even know she's pregnant at that time,
and that lips forming, yes already. Um. I saw a
really cool bbc UM Documentaries sequence basically where they took
three D images of baby in utero and basically turned
(07:24):
it into a flipbook video showing the face forming. Your
nostrils are giant when you're when you're forming, and they're
like on the top of your forehead. They moved down
and each nostrils part of a tissue plate, and then
the bottom jaw and your bottom lip are part of
a third tissue place. So you have three forming and
(07:46):
coming together. And as they form, new cells form new skin,
and they just kind of move into place. If you
have a cleft, flip or a cleft palette. Again, that
that final meeting in the middle just never happened. Yeah,
So when you watch something thing like that, are you
amazed at the miracle of life or are you disgusted
amazed at the miracle? Okay, yeah for sure, because when
(08:07):
you think of nostrils on the top of the head,
it's nothing like that most it did. It's neat, actually
it is. Yeah, for sure. The miracle of life is
what I'm going with. So there are different ways this
can happen. Your your palette on the top of your
mouth is in a couple of sections. The one closer
to the front is the hard palette, and the rear
(08:27):
it's a soft pallet. And if you have a cleft palette,
it can be in the soft part the hard part.
It can split both. Yeah, because if you do don't mouth,
don't do that. The front part is is bony, that's
your hard palate. If you go further back, it's really
kind of tough to do, but you can go, well,
(08:48):
what you gotta stop. You don't like that, No, I
don't think anyone does. Um, I really you think some
people like hearing that. I think it's kind of pleasant.
Anybody who like that shout out. I want to hear you.
I think there's some kind of a pressure point in
your soft pallet too. For is it migraines or something
I remember hearing about, like pressing your thumb into your
soft pallet to do something that wasn't that it was
(09:10):
something else. Well, you can cure an ice cream maybe
multi functional. Anyway, In the very back, you have just
a muscle like your hard palate, bony with some skin
covering it. Further back, it's like muscle with skin covering,
and that's your soft palate. It's like a little rib
cage up there. And you can have this division, this
cleft in either part or both. Right, that's correct, That's
(09:34):
what I said. So, Uh, an incomplete cleft is missing.
It's a little notch and it's missing from the middle
of the upper left. A complete cleft is all the
way through into the nose. And then with the lip,
it's it's always the upper lip, but it's usually off
to one side or the other, I think because of
that symmetry and how it forms. Yes, uh, And it's
(09:56):
always the upper lip because it only affects the two
top plates of flesh that are forming that from your
upper lip in your face and those forehead nostrils that
come back down to your nostril area. That's right. God,
it's just like old times. Cherry's literally dropping food out
of her mouth onto the table. Is amazing. No, but
it's so funny. I don't know. I think there might
(10:18):
be a little all day and she chooses to eat
when she's in here. I think we should take a break.
I think so too. All right, that's a good opening, Uh, salvo,
So we'll be back after this. I think I might
(10:52):
have missed you salvo did I don't think so? Was
that right? Yeah? I associate that with like a timpani
or and in going off. Yeah, all right, I think you.
I think you used it correctly. A cleft that you
got wrong. Yeah, back to clefts. They are developmental defects,
like we said, very early, and what causes them, you know,
(11:16):
genetics can play a part. I think if you're a
parent you have with a cleft either a palette or lip,
you have it like a two to eight percent chance
that your kid may if you have a biological child,
and then that goes up if you have siblings and
or if you have your parents and it's sort of
passed down. I think that number can go up to like, yeah,
(11:37):
it can if you if your parent has a sibling
that has a cleft as well, the chance of your
your kid having ACT is definitely increased. And then um,
it can keep going up depending on whether or not
your parent has a genetic syndrome that they're passing along. Um.
I think there's something like three hundred to four hundred
different genetic syndromes are associated with cleft lip or cleft
(12:02):
palette um and together we should say they're both called
orofacial clefts. Oh yeah, we didn't say that to me.
And I've also known and I've also seen it abbreviated
as c l slash p lips slash pallet um. That
seems to be kind of like the shorthand for it,
because doctors don't like the right full words and their
handwriting is just terrible. Um. And then I've also seen
(12:24):
them called affectionately as cleft eas. Oh that's nice. So
and you know, we'll talk about the uh, you know,
acceptance of facial differences if you have a cleft or
have friends or family members, and that's a big, big
part of it. And I think something like cleft E's
might be a way of embracing that s. So there
are some other things that could be risk factors and
(12:46):
increase the risk of all kinds of birth effects, certainly
including clefts. And one of them is if you're smoking
and drinking booze while you're pregnant. UM. One of the
reasons alcohol effects UM, any kind of birth effect, is
because it disrupts the absorption of UH follic acid. And
that's another reason you might if you don't have enough
(13:08):
fallic acid. That's why pregnant women take extra It's a
natural form of B nine. It's a vitamin. And yeah,
I think. And then late nineties the FDA said you've
got to start putting extra folic acid in like all
kinds of common foods. Remember that store your recyclables starting, yeah,
and and just like put it in bread and pasta
(13:29):
and grains and cereals and things that people eat a
lot of. UH. It's naturally found in sunflower seeds and
fruits and beans and peanuts and stuff like that. So
you want the follic acid, I think if you're pregnant,
they recommend you take at least UH six hundred milligrams
per day. And and if you're just a regular non
(13:51):
pregnant humans a day, yeah, if you UM are in
your reproductive stage or age. Right, but you you need
folic acid anyway, right, why not just as a person? Sure? Yeah,
I get a lot of bread, I get a lot
of folic acid. Uh So smoking and drinking is one,
Diabetes is another. Right, Yeah, that's a really big risk factor.
(14:12):
Diabetes and obesity both seem to be correlated to increased
risk of clefts. I'm not sure what the incidences for
women with diabetes, but it is an increased risk UM.
And then there's also a couple of epilepsy medications that
increase your risk. UM. The thing about all this is
there is no UM definitive understanding your explanation of why
(14:37):
clefts form of what it is that causes some children's
um lips just not to join together or their palettes
that not fuse together at that last final stage. UM.
It seems to be multi factorial is what they call it,
where there's just a bunch of different factors. UM. And
also in addition to genetics, like your parents having one
(14:58):
of your parents having a sibling with one UM depending
on your race, actually your your risk is increased. Apparently,
it's far more common among Asian people, UM and Native Americans.
I think it's the highest among Native Americans, something like
three points six out of every uh thousand births. I
(15:20):
believe um to two among Asian people. It's the lowest
among African Americans. I think Chinese babies are more commonly diagnosed.
Is a diagnosis or just what do you even call that? No,
you're diagnosed, But I mean it's like very easy diagnosis.
It's like, okay, you're a child has a cleft flip. Right.
(15:42):
But what's what's interesting, Chuck, is with the cleft palette.
You can have a cleft palette, but it not be visible.
It can actually be hidden. That's called the submucosis cleft palette.
And they might they you might never be diagnosed with
it because there may be no problem with that or
that arise from it, like with other cluts, like we'll
(16:03):
talk about. Yeah, but um, that's kind of rare from
what I understand, right, And the palette is less visible
anyway as opposed to the lip. Uh. And you know,
if you see any kind of photo image of cleft palette,
is usually the doctor taking a picture of someone with
their mouth wide open, kind of tilting their head back
so you can get a good angle on it. Um
(16:23):
health problems that are associated with clefts are uh, they
can be numerous. It's it's not you know, it seems
like everything is something that can be overcome. But they
are challenges, nonetheless, and they are challenges that especially can
just make a kid when they're growing up field not
so great about themselves. So that that's a big, big
(16:45):
part of overcoming these challenges. But to be sure, there
are some physical things that happen, like it can interfere
with how your teeth are forming and growing in Uh.
Sometimes you might have to get bone graphs on the
upper portion of your gums, especially if you have a
cleft lip. Yeah, cleft lips, it seems like it's usually
where the teeth problems come from. Uh. And then one
(17:07):
of the first things you know, if you're nursing your baby,
then if your baby has a cleft lip or and
or a cleft pallet, they may have trouble latching on
and getting a good like a good suck is what
they call it. Yes, And if you luckily, there are
different um methods for improving that. There are certain types
(17:28):
of bottles which can help with that. So again that's
a problem that can be overcome pretty routinely. It's the
easiest to overcome and to nurse a child with a
cleft lip because you can set the baby up and
as usual chuck them in the air um, and you
(17:48):
can just after they latch on, you just kind of
put your finger over their cleft flip oh and just
like close the gap. Basically, it's it's easy as pie.
With a cleft palette, it can be much more difficult
because we use our palette to create suction, use your
tongue and your palate, your soft pallet in particular to
create suction. So there's specialized bottles for feeding babies with
(18:11):
cleft pallets. Uh. And in particular, if the baby is
just not able to latch on for breastfeeding, they still say, well,
just pump your breast milk and feed your baby the
bottle milk because unfortunately, because of that gap in their
their palette, uh, there there's basically a passage into their
nose and sometimes their ears, so breast milk can get
(18:33):
in there, and they found it's far less irritating breast
milk is than um formula when it does get in
the little baby's ears and nose. That's right. And because
of that same gap there, I think throughout you know,
we'll talk about the surgeries, but throughout childhood, babies and
children with cleft palets and lips have higher incidences of
(18:54):
ear infections, UM, sometimes chronic Sometimes they might have trouble
hearing and learning how to talk. But again, these are
all early challenges that it's such a common birth defect
that they really really know a lot about how to
overcome this stuff. That's exactly right. Fortunately, especially in the
developed world, there's a lot of services available that are
(19:17):
pretty routine. Yeah, and if you're fortunate enough to live
in a country with socialized medicine, you get it all
for free. And if you're not, you're gonna be dropping
some money on surgery. I think the statistic is two
hundred thousand dollar average for medical procedures over the course
of your life. Uh. And I don't know if that's
(19:37):
figuring in insurance. If that's a two d thousand dollars
sort of total and you pay a portion of that
if you're insured, I get that that's out of pocket.
Oh you think so. I think so interesting. So do
you want to talk specifically about some of the treatments
for class. Yeah. So, Um, the diagnosis of cleft often
happens um through ultrasounds. Uh, so you will know your
(20:02):
baby is going to be born with a cleft lip
especially is how you know. But a cleft palates probably
diagnosed after birth, but shortly after birth, usually upon the
first examination by the doctor and they'll say, okay, well
your your child has a cleft pallet. Um, don't panic.
There's a lot of stuff in place. We know exactly
what to do, we know exactly when to do it.
(20:23):
But it's gonna be really tough for you and your
family because your baby, before your baby turns one year old,
and as actually as early as maybe three months old, uh,
they might be they will undergo a surgery, like a
major surgery where they are given general anesthesia and um,
basically it's a form of cosmetic surgery to to repair
(20:46):
is what they call it, um their cleft lip or
the cleft palette or both. And it's it's basically the
first in a very long line of surgeries that will
take up their first eighteen years pretty easily. Yeah, it's
called the first one is called kylo plasty uh c
h e I l o plasty, and this is uh
(21:06):
it can be a few surgeries. Like I said about
the teeth, it can include bone graphs. And I think
the cleft palate surgery is a little bit later. That's
only for cleft lip and cleft pallet though, is still
before they're eighteen months old. And you know, even though
it's routine, it is like you said, it's it's stressful
for a parent too to see that little baby go
under general anesthesia and go under the knife. Yeah, and
(21:28):
when they come out, I mean, you know, they're in pain,
they're not very happy, they're pretty uncomfortable. It's no fun. Fortunately, um,
they've actually come up with a procedure called nasoalveolar molding
or any um, thank god uh where this reduces the
number of follow up surgeries because they don't always get
(21:50):
it on the first surgery. They might just kind of
be like, well, this is the first step, and we're
gonna let this heal and kind of fuse a little
more closer together, and then we're gonna try it again
and again, and we'll finally get there after a couple
of surgeries. Are a few Uh an a yum kind
of does that follow up surgery ahead of time by
molding the little baby's astoundingly malleable features ahead of time
(22:14):
before the surgery. Yeah, it almost sounded like braces for
your faces. That's right. Uh. It's a clear plastic retainer
inside the mouth, and like you said, it helps mold
it as they grow, and then like braces, they adjust
it as they grow and maybe like tighten it down.
I think for cleff lips um they add a little
(22:37):
if it's a small one, they add a little plastic
post that's up in the nose to lift that up
because it can also affect the shape of your nose
early on too. I'm not sure if we mentioned that.
So it's all sort of tied in together developmentally, and
it sounds like this nam retainer device sort of just limits,
like you said, what's going to happen in the future. Yeah,
(22:58):
And it just brings a head cliff closer together so
that when they actually do go in to do the surgery,
there's far less trauma and it's it's far more successful
bringing it together. Um. The palette surgery is called the palettoplasty,
and it actually because the especially if it's going through
the bony part of your hard pallet. Um. They may
(23:22):
use bone graphs to kind of fuse that, or they
may just basically cut the gums along the roof of
your mouth from the mouth and bring it together and
just basically cover it up. And for all intents and purposes, Um,
the palette has been fixed. There's not milk going in
their ear canal any longer rub their nose. Um, they're
(23:44):
going to be able to speak clearly because they'll have
that soft palette, which we use to basically make almost
every sound we make phonetically. We use our soft palette
to close the airway. I'm doing it right now, literally,
right now, I'm doing literally. Um. So if you could
just kind of cover that cleft palette with gum tissue,
(24:05):
I mean, you've fixed a lot of the issues that
arise from having a cleft pallet. Yeah. I mean, in
addition to that speech surgery, there may be speech therapy
that your kid might undergo early on. Um, they're rhino plastic.
Sometimes because I did mention the nose, sometimes the rhino
plastic comes into play. Uh. And then there's also worth
(24:29):
man or though Nathnick Nathic ornatic. That g's gotta be silent,
don't you think? I don't know? Man, all right, you
take a stab or thug natic? Yeah, I think that
was it, really yeah, I think so. All right, Well,
this is jaw alignment surgery, and this is uh, this
(24:50):
is something that happens later on because your jaw has
to stop growing. This is sort of similar, I think
to my issues with my crossbite, and it's all sort
of the Donic related in a way as well. Um,
and that that ridge that's at the like right behind
your teeth, that your adult teeth actually grow out of
that And if you have a cliff lip in particular,
(25:12):
like you were saying, um, you might need a bone graph.
That's another surgery that you were talking about implants, so
that like for your front teeth in particular. Um, So
that's a that's a pretty decent amount of surgeries and
that's not necessarily one and done for any of them.
Especially I think rhinoplastic can be uh can take multiple
(25:33):
surgeries to kind of get the nose back where you
wanted to. But again, like this is the doctors who
handle this stuff at children's hospitals around the country and
basically everywhere and the um the global North just know
exactly what they're doing and what to do and when
to do it, and it's the The outcome is usually
(25:54):
very good. The prognosis of a baby born with a
cleft lip um is you know, is pretty good. Yeah,
it's great. Um, there can be scarring obviously, especially that
first surgery. They're sort of a signature scar from a
cleft lips surgical procedure, and kids can be very self
conscious about that stuff. But I think you know, they
(26:15):
encourage parents to try and uh just be open about
that stuff and get them to to own that as
a as a facial difference and as a visible difference,
and and to really drive home to the kid like
this is not going to you know, you can still
be an athlete, you can still it doesn't affect any
kind of uh learning or anything like that in school. So, uh,
(26:37):
it's really up to the parents and then through the
help of like friends and family hopefully to to get
that kid on the right track. And that that's a
huge one to supposedly like parents who are given, especially
with an ultrasound a diagnosis of a child with a
cleft lip um, can they can take the news pretty hard. Yeah. Um,
I was reading Uh, I don't remember I read it,
(26:57):
but it was basically like a first person account of
having a child with a cleft lip. And the woman
was saying, she was really worried that she's gonna have
trouble bonding with her baby. Remember our cute episode in
the kinder kindIn Schema. Um, she was basically worried about that. Uh.
And then she said the moment she saw her baby,
she just fell totally in love and it was like
(27:19):
it was just like having any other baby. It was
her baby, so of course she loved it no matter
whether she had a cleft lip or not. But that
is that is a common concern among parents when their
first you know, getting their feet wet with this. Um.
But I was reading some studies and they found that
there are basically no bonding issues that that differentiate parents
(27:45):
and children of kids with cleft palates or lips um
from from kids without cleft lips. That that they basically
the outcome is the same. One of the things that
you do have to be careful with though, is it's
very easy for you to become an overprotective parent because
you're dealing with a baby that you're sending off for surgery.
(28:08):
You don't want any harm to come to it. You've
now seen your baby with like a heart monitor, like
i V tube sticking out of them, and that's just
not a sight you want to see. It can really
make you even more protective of your baby than before.
And then when they come home and they're being teased
because of their facial difference, which they cannot help and
they had. They're not guilty of anything. They don't deserve
(28:30):
any of that kind of bullying or teasing. I'm sure
it makes you want to go kill those little kids
who are doing that. UM, so you got you kind
of have to. It's a definite crucible for uh, for
parents that that you have. It's an additional challenge that
you would have to to take on. But parents do
it all the time and their kids turn out totally
(28:50):
normal all the time. All right, Well, take another break,
are another break, and we'll come back and finish up
right after this. See alright, so we should talk about
(29:23):
some of the great things that are going on around
the world, but we first have to talk about some
of the not so great things. Um. We've been talking
to this about this from the perspective of someone in
the United States, where it is very common and very
treatable and outcomes are great. Unfortunately, in developing countries there
are a lot more challenges. Of course. Uh. There is
(29:44):
a lot of stigma attached to this anywhere, but especially
in developing countries. You might come into a situation where
um uh, like a father might blame the mother and
say you were to blame because you didn't do whatever right,
that my child looks like this, and there can be
a lot of shame involved. I think there was a
(30:04):
study in Kenya where mothers of babies were blamed by
their husband and extended families for that. And they interviewed
some of these women and some had contemplated taking the
baby's life or their own life or both. Uh. And
that is just unspeakable, uh, unspeakably tragic, of course. Uh.
Their access to medical care is different. Obviously. The further
(30:29):
they are away from good care and the more expensive
it is, the harder it becomes to overcome these challenges.
But there is great news because there are some great organizations.
One's called Smile Train, one's called Operations Smile and what
they do instead of sending in doctors, they try and
go in and train up doctors in these places to
(30:50):
deal with this better, to teach them how to perform
these surgeries, and to help educate the public at large
about facial differences and that it's it's okay. Yeah, I
was looking at Charity Navigator. You ever go on there, man,
they're great. Um, it turns out Operations Smile has like
a seventy, which is fine, but Smile Train is a
(31:13):
Charity Navigator. No. No, they've been around for a while now.
That's amazing. Both of them have, like, um, they're spending
tens and tens of millions of dollars a year on
providing like these services for children around the world. So
seventy five or a hundred, hats off to both of
them for that. That's great. I think Operations Smile has
(31:34):
thirty one medical centers in sixteen countries and they have
these international medical missions every year, like over a hundred
of them that they where, Like I said, they just
go in they teach the doctors instead of bringing in doctors,
and I think the whole teacher person to fish thing
all right comes into play. Teach a person to fix
a cleft flip and they'll be doing it again and again.
(31:56):
That's the old thing. So uh, there are actually like
since it's I think one out of every seven fifty
berths in the United States alone, that might even be
like a European statistic too. Um, there's a lot of
famous people who have cleft flips because, like you said,
if you have a cleft lip or a cleft palette,
it doesn't prevent you from doing anything. Um, so you
(32:19):
could excel at say acting as maybe Mike Hamer if
you wanted to Stacy Kea. Yeah, is that you're talking about? Yeah,
Stacy Keach has that cleft palette or I guess cleft
lips surgery scar forward surgeries. Actually that Stacy Keach had
uh cheech marin sure. I guess he can still smoke
(32:40):
downs a weed. I was gonna say, he's got the
suction thing down maybe, So who else? Uh? Joaquin Phoenix
actually is widely considered to have a um like a
cleft scar. It has what looks like that cleft scar
like he had a cleft lip repair, a chilly a
kilo plastic um, but he doesn't. He has a microform
(33:04):
cleft that was It's it's looked like that since birth. Um.
And apparently Wendy Williams, the talk show host, got just
jumped all over last year because she was talking about
how cute she thought it was and then was like
basically pulling her Yeah, she didn't do it right at all.
She was ultimately trying to give him a compliment, but
(33:25):
she did not do it in the right way. Definitely
suffered for it. Um. And then Peyton Manning is another one. Yeah,
I think his was a palette, right, he had I
think a lip too. No, I guess it says palette.
I thought he had a cliff flip because I feel
like I've seen him he has a scar, like his
(33:45):
lip looks turned up a little bit. But maybe it
was just a cliff palette. So he had a couple
of surgeries, and he had I think he had braces
for like eleven years, from like age four. Yeah, man,
that's to four to fifteen having races. I mean I
had braces twice and that was bad. That's the Jolly
Rancher years. And Peyton Manning missed out on those. I
(34:06):
can assure you he did. Did you like the individual
candies or the sticks? The sticks? That was just too much, man,
it was over the top was it for me? I
kind of liked him because the more you uh licked
on him and sucked on him that you can make
him into a knife basically right, like a poop knife.
But it was very sharp. What was your flavor? I
(34:28):
was always green apple? Same here. I love those watermelon
are good too. It's okay, it's old fast. Don't come
at me with grape. I don't. I don't like the grape.
I don't. I had no problem with grapes. What about
the blue? I think blue raspberry one have been remember
that maybe? But boy, those green apple, yeah, they're good.
I haven't had one of those in forty years. I
think I still have. I haven't either. I still have
(34:49):
some stuff to my mole. Wow, Dennison never just couldn't
even get it out. They try, they try, and they fail,
every single one of them. So Peyton man Ing uh, he,
like I said, has done a lot with his money
over the years, in addition to throwing lots of touchdowns,
a lot of philanthropy, and I think even the St.
(35:09):
Vincent's Childrens Hospital in Indiana they renamed that Peyton Manning
Children's Hospital at St. Vincent because they have the leading
or one of the leading pediatric cranio facial centers in
the country, and he has shoveled a lot of money
their way. UM. There's also one other thing we're talking about,
how other kids and other countries don't have access to
(35:30):
a lot of the services UM. And apparently a lot
of people have said, I want to adopt a child
from a developing country, and I am going to just
basically go ahead and go right onto the canonization track
and adopt a child from a developing country who has
what's called an unrepaired cleft and like, you know this
(35:51):
going into it, Yes, you sign up for it. There's
actually a group by the way called Rainbow Kids UM
that connects people to adoptive parents to children with developmental
UM or other kinds of special needs UM and that
includes kids with cleff lips, cleff pallets, that kind of thing,
which I think is pretty great. That is great, and
then you know that's one of the stressors of the
(36:13):
many stressors of adopting a kid period. I can say
from experience and that you are oftentimes dealing with a
birth mother that may not have practiced great prenatal care.
Add access to it, UM, smoking and drugs and alcohol
could play a part. And you you sign up for this,
and you they ask you these questions beforehand. They're like,
what would you do if you are in the birth
(36:35):
room and the baby comes out with a cleff flip
or a cleft pallet? Like, what's your real They ask that. Yeah,
I mean it's just called your tolerance list, Like what
if this happens? What if this happens? What if you
go in there and the baby comes out that's an
unexpected race? And you're like, okay, well could that happen? Yeah,
They're like, well sure again, so how are you gonna
(36:56):
And then they you know, they tap on their on
the clipboard and look you and they're like what would
you do? So you just got to fill out all
this stuff, and uh, it's really interesting and it makes
you do two things. That makes you really take a
hard look at what matters and also take a hard
look at your own family and genetics, and eventually probably
end up saying like, hey, we're no prize either, so
(37:19):
let's just do this. That's fantastic. Yeah, it's real, it's
really do an adoption podcast. When I agree, I agree.
Jerry could even maybe say a few words. She just
thumbed up and then shook her head. She did. She's
a little sleep now. She just finished the lunch. We'll see. Uh,
so you got anything else? I got nothing else? Okay, Well,
if you want to know more about cleft lips and
(37:39):
cliff palettes and cranio facial clefts, then you can go
do some more research online. Since I say good, do
more research online, it's time for listener. Ma, I'm gonna
call this. Uh. I inadvertently said something and I didn't
even know what it meant. I don't think we did this,
(38:00):
and yet did we about Netflix and Chill? I don't so,
I said, Netflix and Chill have heard. It's an expression.
There's a been and Jerry's flavor that I love. What's it? Oh?
I can't even remember. It's just really good. It's got
a lot of good, delicious, crunchy sweet things going on.
It's one of my favorite flavors. I'll check it out.
(38:22):
But let me just read this welcome back stuff you
should know. Team listening to your appendix episode had a
good laugh During the podcast, Chuck said our immune system
is not good at Netflix and Chill and I really
started laughing. Did you know what this meant? Yes, why
didn't you say something when I said it? I don't know.
I must have been thinking of my next joke or something,
because I don't know how I missed that. Did you know, Jerry?
(38:43):
Do you know what that? Man? I'm an idiot. I
can listen if I snorted. Last week, my thirty year
old daughter was visiting. I said to her, let's Netflix
and Chill and she promptly told me, mom, that is
code for having sex. What who knew? Obviously? Stuff you
should know. Oh did not get the slang Dakota memo either,
and we should say Chuck did not. I'm absolving you
(39:05):
and Jerry, but thanks for making me laugh. And that's
from Rosie. And Rosie said that I could read this
and her daughter would get a good laugh about it.
But I feel like a rube. I had no idea that,
And it makes sense now, like I could see some
kid being like, what did you guys do last night? Well?
Just you know Netflix and Chill, when in fact they
were doing you know, unspeakable things. But now I know
(39:26):
Netflix and Chill. Yeah, I don't know how I let
that one passed. Maybe it was purposeful, that's right. Um, Well,
thanks for that one. Who was that again, Rosie? Rosie
appreciate that. Um, and I'll bet that was a really
great conversation you have with your mom. I'm glad we're
clearing this up though, because there's probably a lot of
people that were like, what is is Chuck that dumb? Right?
(39:49):
Or maybe they thought like you had just gotten bone
dry and your sense of humor and timing and delivery. Um. Well,
if you want to get in touch with this, like
Rosie did, we want to hear from you, you can
email to us directly at stuff podcast at i heeart
radio dot com. Stuff you Should Know is a production
(40:09):
of I Heart Radio. For more podcasts my heart Radio,
visit the iHeart Radio app, Apple Podcasts, or wherever you
listen to your favorite shows. H
Welcome to Stuff you Should Know, a production of I
Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark,
There's Charles W Chuck Bryant, and Jerry is literally right there,
and I'm Chuck. I want to start something. I'm going
to get I actually have a jar at my studio
(00:24):
at home kind of. But it's a use of the
word literally jar. I'm trying to break myself of that,
except when it really truly makes sense, when it literally
makes sense to use that word, like in this instance,
Jerry is literally sitting right here. So do you have
a problem with that, with misusing that word like so
(00:45):
many Yeah, no, not necessarily. It's overused. That's what bothers me.
What about Gimmy and she donating to the jar at all?
Or she just like this literally the dumbest idea. I
don't think she has an opinion on this one. Okay, Yeah,
she's just spend some money. Well, I keep the jar
at home. I'll get money out of it when I
(01:06):
need to. It's more just the ritual of like punishing myself,
calling out that's good, I'm doing something stupid. Once a Catholic,
always a Catholic. So um, oh yeah, this is stuff
you should know. And uh, we are talking Chuck today.
How are you doing, by the way, I'm great. Good,
we're in the same room. It's still a little weird,
(01:27):
getting used to it still. Yeah. I went to a
baseball game last night, Oh my god. And that was weird.
I mean it was great. Uh. And once we get
on our seats, we were actually i mean they're fully
just selling seats, but where we bought seats there just
happened to be no one kind of around us, which
was good. But yeah, I went to a Braves game.
But you know, they're supposed to be policing and saying,
(01:49):
you know, unless you're in your seats, eating and drinking,
you should be wearing a mash. And so we the
four of us, wore masks, you know, in and out
in the bathrooms and the food lines and all that stuff.
But no, buddy else was well, I mean Atlanta there's
a lot of jerks, yeah, and Atlanta. Yeah, it just
it is what it is. We took care of ourselves
and it's fine. Yeah, it was fun. Um, well, that's good.
(02:13):
I'm glad. Juddie good walk off, Homer. Oh yeah, the
bottom of the ninth man. I've only seen like one
of those in my life. It was amazing, great game. Yeah,
it was cool. Who we play? We played the Mets
in our star player Akunya blasted one in the bottom
of the ninth first pitch. It was just great. I
thought Freddie Freeman was our star player there. I mean
they're one and two on any given day. Yeah, I
(02:37):
wouldn't want to be number two, you know what I'm saying.
But yes, no, of course not. That's why I'm number two. No,
that's not true. You meet Jerry all tied for number one.
But anyway, it was a little just's it's just a
little jarring to be among a lot of people again.
And but it also comes back quickly like, oh wait,
I spent the first forty nine years of my life
(02:59):
among people. A took a year off, and I'm back
in this wing. That's good. That's good. I'm hoping to
get back there myself. At any rate. This is still
a little weird. So we're talking today about clefts, and
most people when they think about clefs, they think about
cleft lips. But there's a lot more to that, or
trouble cliffs. Sure, that's a little different. There's an extra
(03:21):
letter in this one that I'm talking about at the end.
How is that spelled? Is that just trouble cleft? No
cl ef Oh, there's no t trouble cliff cliff. I
didn't take piano. That's okay, right, Um, But no, that's
a cleft. This is a cleft. A cleft in this
case is um. It's a it's a division, it's a trench,
it's a void. I guess you could say and that
(03:44):
that that is what we're talking about. It is a
it is a very common, actually fairly common birth defect. Um.
It occurs in the embryonic stage and a child is
born with part of their lip and or part of
their palate the roof of their mouth is another way
to put it right missing, it's just not there, un joined.
(04:07):
And we should probably say right at the beginning, Uh,
this is a birth defect. But it is a visual difference,
is what we call things like this. It is not
a disability, although there are you know, many complications will
go over, but it's a visual difference. And it is
also the term hair lip is not something you should use.
It was used for many, many years, even by doctors
(04:29):
to describe this condition, but it is uh not a
good nice term, so just stop saying it. Yeah, I
don't know anybody who says that. I don't think so
any but you know, some people just may not know. Like, well,
I thought that's what it was called. Uh, And when
doctors use a term, you can sort of understand, you know,
like somebody falling into that trap. But it's not a
term that we use anymore now. And I think that
(04:51):
was a good thing to say. All right, So that's
the c I A is finished. So um, like we're saying,
it is, like you said, it is a birth effect,
but it is just a visible difference. And there's I mean,
that's that's it. I mean, it is tied in with
some syndromes, some genetic syndromes, but plenty of people, I
think in the United States somewhere between one and every
seven um comes with some sort of cleft, either a
(05:12):
cleft lip, a cleft palette, or both UM and there's
that's it. That can be it. That's the only thing
that is different about that child. There's no developmental problems,
there's no and like you said, it's not disability. There's
nothing else that's it. And what's fascinating to me, I
had no idea about this, but I never really thought
(05:33):
about it. Is that the the kid with the cleft
lip or the cleft palette there, their palette or their
lip just never finished forming. Yeah, they never You know,
there's a symmetry generally running down the center of your
nose and the two sides of the lip. You know,
(05:55):
the stuff forms when you're in the in the womb
very early on. It actually for both. I think the
lip is first and then the palette, but you know
they joined together, and in this case they just don't join. Yeah,
you know the little a little bit under your nose,
the bip joining the uh, the bottom of your nose
through top lip. Yeah, it's filtraum okay. And that is
(06:18):
where your lips joined together, your upper lip joins together, right,
and that is where your mustache can part. Yeah, yeah,
you got a little mustache part. I have a mustache
part because mine. But you know, some guys, do you
shave yours in just for looks or is it it
just kind of parts? Naturally? Your hair doesn't quite grow
right there. But you know, if you're like a Burt
(06:39):
Reynolds type or Wilfred Brimley, you can just grow it
over the whole. What's it called filtraum fil traum p
h I l t r U Hiltraum, which would be
a really great nerdy boy's name film. Yeah, yeah, and
his brother Baxter. On the second thought, though, don't name
your son filter so um. When you are in the embryonics,
(07:01):
like you said, very early on, the lip forms in
like the fourth to seventh week, and very frequently a
woman might not even know she's pregnant at that time,
and that lips forming, yes already. Um. I saw a
really cool bbc UM Documentaries sequence basically where they took
three D images of baby in utero and basically turned
(07:24):
it into a flipbook video showing the face forming. Your
nostrils are giant when you're when you're forming, and they're
like on the top of your forehead. They moved down
and each nostrils part of a tissue plate, and then
the bottom jaw and your bottom lip are part of
a third tissue place. So you have three forming and
(07:46):
coming together. And as they form, new cells form new skin,
and they just kind of move into place. If you
have a cleft, flip or a cleft palette. Again, that
that final meeting in the middle just never happened. Yeah,
So when you watch something thing like that, are you
amazed at the miracle of life or are you disgusted
amazed at the miracle? Okay, yeah for sure, because when
(08:07):
you think of nostrils on the top of the head,
it's nothing like that most it did. It's neat, actually
it is. Yeah, for sure. The miracle of life is
what I'm going with. So there are different ways this
can happen. Your your palette on the top of your
mouth is in a couple of sections. The one closer
to the front is the hard palette, and the rear
(08:27):
it's a soft pallet. And if you have a cleft palette,
it can be in the soft part the hard part.
It can split both. Yeah, because if you do don't mouth,
don't do that. The front part is is bony, that's
your hard palate. If you go further back, it's really
kind of tough to do, but you can go, well,
(08:48):
what you gotta stop. You don't like that, No, I
don't think anyone does. Um, I really you think some
people like hearing that. I think it's kind of pleasant.
Anybody who like that shout out. I want to hear you.
I think there's some kind of a pressure point in
your soft pallet too. For is it migraines or something
I remember hearing about, like pressing your thumb into your
soft pallet to do something that wasn't that it was
(09:10):
something else. Well, you can cure an ice cream maybe
multi functional. Anyway, In the very back, you have just
a muscle like your hard palate, bony with some skin
covering it. Further back, it's like muscle with skin covering,
and that's your soft palate. It's like a little rib
cage up there. And you can have this division, this
cleft in either part or both. Right, that's correct, That's
(09:34):
what I said. So, Uh, an incomplete cleft is missing.
It's a little notch and it's missing from the middle
of the upper left. A complete cleft is all the
way through into the nose. And then with the lip,
it's it's always the upper lip, but it's usually off
to one side or the other, I think because of
that symmetry and how it forms. Yes, uh, And it's
(09:56):
always the upper lip because it only affects the two
top plates of flesh that are forming that from your
upper lip in your face and those forehead nostrils that
come back down to your nostril area. That's right. God,
it's just like old times. Cherry's literally dropping food out
of her mouth onto the table. Is amazing. No, but
it's so funny. I don't know. I think there might
(10:18):
be a little all day and she chooses to eat
when she's in here. I think we should take a break.
I think so too. All right, that's a good opening, Uh, salvo,
So we'll be back after this. I think I might
(10:52):
have missed you salvo did I don't think so? Was
that right? Yeah? I associate that with like a timpani
or and in going off. Yeah, all right, I think you.
I think you used it correctly. A cleft that you
got wrong. Yeah, back to clefts. They are developmental defects,
like we said, very early, and what causes them, you know,
(11:16):
genetics can play a part. I think if you're a
parent you have with a cleft either a palette or lip,
you have it like a two to eight percent chance
that your kid may if you have a biological child,
and then that goes up if you have siblings and
or if you have your parents and it's sort of
passed down. I think that number can go up to like, yeah,
(11:37):
it can if you if your parent has a sibling
that has a cleft as well, the chance of your
your kid having ACT is definitely increased. And then um,
it can keep going up depending on whether or not
your parent has a genetic syndrome that they're passing along. Um.
I think there's something like three hundred to four hundred
different genetic syndromes are associated with cleft lip or cleft
(12:02):
palette um and together we should say they're both called
orofacial clefts. Oh yeah, we didn't say that to me.
And I've also known and I've also seen it abbreviated
as c l slash p lips slash pallet um. That
seems to be kind of like the shorthand for it,
because doctors don't like the right full words and their
handwriting is just terrible. Um. And then I've also seen
(12:24):
them called affectionately as cleft eas. Oh that's nice. So
and you know, we'll talk about the uh, you know,
acceptance of facial differences if you have a cleft or
have friends or family members, and that's a big, big
part of it. And I think something like cleft E's
might be a way of embracing that s. So there
are some other things that could be risk factors and
(12:46):
increase the risk of all kinds of birth effects, certainly
including clefts. And one of them is if you're smoking
and drinking booze while you're pregnant. UM. One of the
reasons alcohol effects UM, any kind of birth effect, is
because it disrupts the absorption of UH follic acid. And
that's another reason you might if you don't have enough
(13:08):
fallic acid. That's why pregnant women take extra It's a
natural form of B nine. It's a vitamin. And yeah,
I think. And then late nineties the FDA said you've
got to start putting extra folic acid in like all
kinds of common foods. Remember that store your recyclables starting, yeah,
and and just like put it in bread and pasta
(13:29):
and grains and cereals and things that people eat a
lot of. UH. It's naturally found in sunflower seeds and
fruits and beans and peanuts and stuff like that. So
you want the follic acid, I think if you're pregnant,
they recommend you take at least UH six hundred milligrams
per day. And and if you're just a regular non
(13:51):
pregnant humans a day, yeah, if you UM are in
your reproductive stage or age. Right, but you you need
folic acid anyway, right, why not just as a person? Sure? Yeah,
I get a lot of bread, I get a lot
of folic acid. Uh So smoking and drinking is one,
Diabetes is another. Right, Yeah, that's a really big risk factor.
(14:12):
Diabetes and obesity both seem to be correlated to increased
risk of clefts. I'm not sure what the incidences for
women with diabetes, but it is an increased risk UM.
And then there's also a couple of epilepsy medications that
increase your risk. UM. The thing about all this is
there is no UM definitive understanding your explanation of why
(14:37):
clefts form of what it is that causes some children's
um lips just not to join together or their palettes
that not fuse together at that last final stage. UM.
It seems to be multi factorial is what they call it,
where there's just a bunch of different factors. UM. And
also in addition to genetics, like your parents having one
(14:58):
of your parents having a sibling with one UM depending
on your race, actually your your risk is increased. Apparently,
it's far more common among Asian people, UM and Native Americans.
I think it's the highest among Native Americans, something like
three points six out of every uh thousand births. I
(15:20):
believe um to two among Asian people. It's the lowest
among African Americans. I think Chinese babies are more commonly diagnosed.
Is a diagnosis or just what do you even call that? No,
you're diagnosed, But I mean it's like very easy diagnosis.
It's like, okay, you're a child has a cleft flip. Right.
(15:42):
But what's what's interesting, Chuck, is with the cleft palette.
You can have a cleft palette, but it not be visible.
It can actually be hidden. That's called the submucosis cleft palette.
And they might they you might never be diagnosed with
it because there may be no problem with that or
that arise from it, like with other cluts, like we'll
(16:03):
talk about. Yeah, but um, that's kind of rare from
what I understand, right, And the palette is less visible
anyway as opposed to the lip. Uh. And you know,
if you see any kind of photo image of cleft palette,
is usually the doctor taking a picture of someone with
their mouth wide open, kind of tilting their head back
so you can get a good angle on it. Um
(16:23):
health problems that are associated with clefts are uh, they
can be numerous. It's it's not you know, it seems
like everything is something that can be overcome. But they
are challenges, nonetheless, and they are challenges that especially can
just make a kid when they're growing up field not
so great about themselves. So that that's a big, big
(16:45):
part of overcoming these challenges. But to be sure, there
are some physical things that happen, like it can interfere
with how your teeth are forming and growing in Uh.
Sometimes you might have to get bone graphs on the
upper portion of your gums, especially if you have a
cleft lip. Yeah, cleft lips, it seems like it's usually
where the teeth problems come from. Uh. And then one
(17:07):
of the first things you know, if you're nursing your baby,
then if your baby has a cleft lip or and
or a cleft pallet, they may have trouble latching on
and getting a good like a good suck is what
they call it. Yes, And if you luckily, there are
different um methods for improving that. There are certain types
(17:28):
of bottles which can help with that. So again that's
a problem that can be overcome pretty routinely. It's the
easiest to overcome and to nurse a child with a
cleft lip because you can set the baby up and
as usual chuck them in the air um, and you
(17:48):
can just after they latch on, you just kind of
put your finger over their cleft flip oh and just
like close the gap. Basically, it's it's easy as pie.
With a cleft palette, it can be much more difficult
because we use our palette to create suction, use your
tongue and your palate, your soft pallet in particular to
create suction. So there's specialized bottles for feeding babies with
(18:11):
cleft pallets. Uh. And in particular, if the baby is
just not able to latch on for breastfeeding, they still say, well,
just pump your breast milk and feed your baby the
bottle milk because unfortunately, because of that gap in their
their palette, uh, there there's basically a passage into their
nose and sometimes their ears, so breast milk can get
(18:33):
in there, and they found it's far less irritating breast
milk is than um formula when it does get in
the little baby's ears and nose. That's right. And because
of that same gap there, I think throughout you know,
we'll talk about the surgeries, but throughout childhood, babies and
children with cleft palets and lips have higher incidences of
(18:54):
ear infections, UM, sometimes chronic Sometimes they might have trouble
hearing and learning how to talk. But again, these are
all early challenges that it's such a common birth defect
that they really really know a lot about how to
overcome this stuff. That's exactly right. Fortunately, especially in the
developed world, there's a lot of services available that are
(19:17):
pretty routine. Yeah, and if you're fortunate enough to live
in a country with socialized medicine, you get it all
for free. And if you're not, you're gonna be dropping
some money on surgery. I think the statistic is two
hundred thousand dollar average for medical procedures over the course
of your life. Uh. And I don't know if that's
(19:37):
figuring in insurance. If that's a two d thousand dollars
sort of total and you pay a portion of that
if you're insured, I get that that's out of pocket.
Oh you think so. I think so interesting. So do
you want to talk specifically about some of the treatments
for class. Yeah. So, Um, the diagnosis of cleft often
happens um through ultrasounds. Uh, so you will know your
(20:02):
baby is going to be born with a cleft lip
especially is how you know. But a cleft palates probably
diagnosed after birth, but shortly after birth, usually upon the
first examination by the doctor and they'll say, okay, well
your your child has a cleft pallet. Um, don't panic.
There's a lot of stuff in place. We know exactly
what to do, we know exactly when to do it.
(20:23):
But it's gonna be really tough for you and your
family because your baby, before your baby turns one year old,
and as actually as early as maybe three months old, uh,
they might be they will undergo a surgery, like a
major surgery where they are given general anesthesia and um,
basically it's a form of cosmetic surgery to to repair
(20:46):
is what they call it, um their cleft lip or
the cleft palette or both. And it's it's basically the
first in a very long line of surgeries that will
take up their first eighteen years pretty easily. Yeah, it's
called the first one is called kylo plasty uh c
h e I l o plasty, and this is uh
(21:06):
it can be a few surgeries. Like I said about
the teeth, it can include bone graphs. And I think
the cleft palate surgery is a little bit later. That's
only for cleft lip and cleft pallet though, is still
before they're eighteen months old. And you know, even though
it's routine, it is like you said, it's it's stressful
for a parent too to see that little baby go
under general anesthesia and go under the knife. Yeah, and
(21:28):
when they come out, I mean, you know, they're in pain,
they're not very happy, they're pretty uncomfortable. It's no fun. Fortunately, um,
they've actually come up with a procedure called nasoalveolar molding
or any um, thank god uh where this reduces the
number of follow up surgeries because they don't always get
(21:50):
it on the first surgery. They might just kind of
be like, well, this is the first step, and we're
gonna let this heal and kind of fuse a little
more closer together, and then we're gonna try it again
and again, and we'll finally get there after a couple
of surgeries. Are a few Uh an a yum kind
of does that follow up surgery ahead of time by
molding the little baby's astoundingly malleable features ahead of time
(22:14):
before the surgery. Yeah, it almost sounded like braces for
your faces. That's right. Uh. It's a clear plastic retainer
inside the mouth, and like you said, it helps mold
it as they grow, and then like braces, they adjust
it as they grow and maybe like tighten it down.
I think for cleff lips um they add a little
(22:37):
if it's a small one, they add a little plastic
post that's up in the nose to lift that up
because it can also affect the shape of your nose
early on too. I'm not sure if we mentioned that.
So it's all sort of tied in together developmentally, and
it sounds like this nam retainer device sort of just limits,
like you said, what's going to happen in the future. Yeah,
(22:58):
And it just brings a head cliff closer together so
that when they actually do go in to do the surgery,
there's far less trauma and it's it's far more successful
bringing it together. Um. The palette surgery is called the palettoplasty,
and it actually because the especially if it's going through
the bony part of your hard pallet. Um. They may
(23:22):
use bone graphs to kind of fuse that, or they
may just basically cut the gums along the roof of
your mouth from the mouth and bring it together and
just basically cover it up. And for all intents and purposes, Um,
the palette has been fixed. There's not milk going in
their ear canal any longer rub their nose. Um, they're
(23:44):
going to be able to speak clearly because they'll have
that soft palette, which we use to basically make almost
every sound we make phonetically. We use our soft palette
to close the airway. I'm doing it right now, literally,
right now, I'm doing literally. Um. So if you could
just kind of cover that cleft palette with gum tissue,
(24:05):
I mean, you've fixed a lot of the issues that
arise from having a cleft pallet. Yeah. I mean, in
addition to that speech surgery, there may be speech therapy
that your kid might undergo early on. Um, they're rhino plastic.
Sometimes because I did mention the nose, sometimes the rhino
plastic comes into play. Uh. And then there's also worth
(24:29):
man or though Nathnick Nathic ornatic. That g's gotta be silent,
don't you think? I don't know? Man, all right, you
take a stab or thug natic? Yeah, I think that
was it, really yeah, I think so. All right, Well,
this is jaw alignment surgery, and this is uh, this
(24:50):
is something that happens later on because your jaw has
to stop growing. This is sort of similar, I think
to my issues with my crossbite, and it's all sort
of the Donic related in a way as well. Um,
and that that ridge that's at the like right behind
your teeth, that your adult teeth actually grow out of
that And if you have a cliff lip in particular,
(25:12):
like you were saying, um, you might need a bone graph.
That's another surgery that you were talking about implants, so
that like for your front teeth in particular. Um, So
that's a that's a pretty decent amount of surgeries and
that's not necessarily one and done for any of them.
Especially I think rhinoplastic can be uh can take multiple
(25:33):
surgeries to kind of get the nose back where you
wanted to. But again, like this is the doctors who
handle this stuff at children's hospitals around the country and
basically everywhere and the um the global North just know
exactly what they're doing and what to do and when
to do it, and it's the The outcome is usually
(25:54):
very good. The prognosis of a baby born with a
cleft lip um is you know, is pretty good. Yeah,
it's great. Um, there can be scarring obviously, especially that
first surgery. They're sort of a signature scar from a
cleft lips surgical procedure, and kids can be very self
conscious about that stuff. But I think you know, they
(26:15):
encourage parents to try and uh just be open about
that stuff and get them to to own that as
a as a facial difference and as a visible difference,
and and to really drive home to the kid like
this is not going to you know, you can still
be an athlete, you can still it doesn't affect any
kind of uh learning or anything like that in school. So, uh,
(26:37):
it's really up to the parents and then through the
help of like friends and family hopefully to to get
that kid on the right track. And that that's a
huge one to supposedly like parents who are given, especially
with an ultrasound a diagnosis of a child with a
cleft lip um, can they can take the news pretty hard. Yeah. Um,
I was reading Uh, I don't remember I read it,
(26:57):
but it was basically like a first person account of
having a child with a cleft lip. And the woman
was saying, she was really worried that she's gonna have
trouble bonding with her baby. Remember our cute episode in
the kinder kindIn Schema. Um, she was basically worried about that. Uh.
And then she said the moment she saw her baby,
she just fell totally in love and it was like
(27:19):
it was just like having any other baby. It was
her baby, so of course she loved it no matter
whether she had a cleft lip or not. But that
is that is a common concern among parents when their
first you know, getting their feet wet with this. Um.
But I was reading some studies and they found that
there are basically no bonding issues that that differentiate parents
(27:45):
and children of kids with cleft palates or lips um
from from kids without cleft lips. That that they basically
the outcome is the same. One of the things that
you do have to be careful with though, is it's
very easy for you to become an overprotective parent because
you're dealing with a baby that you're sending off for surgery.
(28:08):
You don't want any harm to come to it. You've
now seen your baby with like a heart monitor, like
i V tube sticking out of them, and that's just
not a sight you want to see. It can really
make you even more protective of your baby than before.
And then when they come home and they're being teased
because of their facial difference, which they cannot help and
they had. They're not guilty of anything. They don't deserve
(28:30):
any of that kind of bullying or teasing. I'm sure
it makes you want to go kill those little kids
who are doing that. UM, so you got you kind
of have to. It's a definite crucible for uh, for
parents that that you have. It's an additional challenge that
you would have to to take on. But parents do
it all the time and their kids turn out totally
(28:50):
normal all the time. All right, Well, take another break,
are another break, and we'll come back and finish up
right after this. See alright, so we should talk about
(29:23):
some of the great things that are going on around
the world, but we first have to talk about some
of the not so great things. Um. We've been talking
to this about this from the perspective of someone in
the United States, where it is very common and very
treatable and outcomes are great. Unfortunately, in developing countries there
are a lot more challenges. Of course. Uh. There is
(29:44):
a lot of stigma attached to this anywhere, but especially
in developing countries. You might come into a situation where
um uh, like a father might blame the mother and
say you were to blame because you didn't do whatever right,
that my child looks like this, and there can be
a lot of shame involved. I think there was a
(30:04):
study in Kenya where mothers of babies were blamed by
their husband and extended families for that. And they interviewed
some of these women and some had contemplated taking the
baby's life or their own life or both. Uh. And
that is just unspeakable, uh, unspeakably tragic, of course. Uh.
Their access to medical care is different. Obviously. The further
(30:29):
they are away from good care and the more expensive
it is, the harder it becomes to overcome these challenges.
But there is great news because there are some great organizations.
One's called Smile Train, one's called Operations Smile and what
they do instead of sending in doctors, they try and
go in and train up doctors in these places to
(30:50):
deal with this better, to teach them how to perform
these surgeries, and to help educate the public at large
about facial differences and that it's it's okay. Yeah, I
was looking at Charity Navigator. You ever go on there, man,
they're great. Um, it turns out Operations Smile has like
a seventy, which is fine, but Smile Train is a
(31:13):
Charity Navigator. No. No, they've been around for a while now.
That's amazing. Both of them have, like, um, they're spending
tens and tens of millions of dollars a year on
providing like these services for children around the world. So
seventy five or a hundred, hats off to both of
them for that. That's great. I think Operations Smile has
(31:34):
thirty one medical centers in sixteen countries and they have
these international medical missions every year, like over a hundred
of them that they where, Like I said, they just
go in they teach the doctors instead of bringing in doctors,
and I think the whole teacher person to fish thing
all right comes into play. Teach a person to fix
a cleft flip and they'll be doing it again and again.
(31:56):
That's the old thing. So uh, there are actually like
since it's I think one out of every seven fifty
berths in the United States alone, that might even be
like a European statistic too. Um, there's a lot of
famous people who have cleft flips because, like you said,
if you have a cleft lip or a cleft palette,
it doesn't prevent you from doing anything. Um, so you
(32:19):
could excel at say acting as maybe Mike Hamer if
you wanted to Stacy Kea. Yeah, is that you're talking about? Yeah,
Stacy Keach has that cleft palette or I guess cleft
lips surgery scar forward surgeries. Actually that Stacy Keach had
uh cheech marin sure. I guess he can still smoke
(32:40):
downs a weed. I was gonna say, he's got the
suction thing down maybe, So who else? Uh? Joaquin Phoenix
actually is widely considered to have a um like a
cleft scar. It has what looks like that cleft scar
like he had a cleft lip repair, a chilly a
kilo plastic um, but he doesn't. He has a microform
(33:04):
cleft that was It's it's looked like that since birth. Um.
And apparently Wendy Williams, the talk show host, got just
jumped all over last year because she was talking about
how cute she thought it was and then was like
basically pulling her Yeah, she didn't do it right at all.
She was ultimately trying to give him a compliment, but
(33:25):
she did not do it in the right way. Definitely
suffered for it. Um. And then Peyton Manning is another one. Yeah,
I think his was a palette, right, he had I
think a lip too. No, I guess it says palette.
I thought he had a cliff flip because I feel
like I've seen him he has a scar, like his
(33:45):
lip looks turned up a little bit. But maybe it
was just a cliff palette. So he had a couple
of surgeries, and he had I think he had braces
for like eleven years, from like age four. Yeah, man,
that's to four to fifteen having races. I mean I
had braces twice and that was bad. That's the Jolly
Rancher years. And Peyton Manning missed out on those. I
(34:06):
can assure you he did. Did you like the individual
candies or the sticks? The sticks? That was just too much, man,
it was over the top was it for me? I
kind of liked him because the more you uh licked
on him and sucked on him that you can make
him into a knife basically right, like a poop knife.
But it was very sharp. What was your flavor? I
(34:28):
was always green apple? Same here. I love those watermelon
are good too. It's okay, it's old fast. Don't come
at me with grape. I don't. I don't like the grape.
I don't. I had no problem with grapes. What about
the blue? I think blue raspberry one have been remember
that maybe? But boy, those green apple, yeah, they're good.
I haven't had one of those in forty years. I
think I still have. I haven't either. I still have
(34:49):
some stuff to my mole. Wow, Dennison never just couldn't
even get it out. They try, they try, and they fail,
every single one of them. So Peyton man Ing uh, he,
like I said, has done a lot with his money
over the years, in addition to throwing lots of touchdowns,
a lot of philanthropy, and I think even the St.
(35:09):
Vincent's Childrens Hospital in Indiana they renamed that Peyton Manning
Children's Hospital at St. Vincent because they have the leading
or one of the leading pediatric cranio facial centers in
the country, and he has shoveled a lot of money
their way. UM. There's also one other thing we're talking about,
how other kids and other countries don't have access to
(35:30):
a lot of the services UM. And apparently a lot
of people have said, I want to adopt a child
from a developing country, and I am going to just
basically go ahead and go right onto the canonization track
and adopt a child from a developing country who has
what's called an unrepaired cleft and like, you know this
(35:51):
going into it, Yes, you sign up for it. There's
actually a group by the way called Rainbow Kids UM
that connects people to adoptive parents to children with developmental
UM or other kinds of special needs UM and that
includes kids with cleff lips, cleff pallets, that kind of thing,
which I think is pretty great. That is great, and
then you know that's one of the stressors of the
(36:13):
many stressors of adopting a kid period. I can say
from experience and that you are oftentimes dealing with a
birth mother that may not have practiced great prenatal care.
Add access to it, UM, smoking and drugs and alcohol
could play a part. And you you sign up for this,
and you they ask you these questions beforehand. They're like,
what would you do if you are in the birth
(36:35):
room and the baby comes out with a cleff flip
or a cleft pallet? Like, what's your real They ask that. Yeah,
I mean it's just called your tolerance list, Like what
if this happens? What if this happens? What if you
go in there and the baby comes out that's an
unexpected race? And you're like, okay, well could that happen? Yeah,
They're like, well sure again, so how are you gonna
(36:56):
And then they you know, they tap on their on
the clipboard and look you and they're like what would
you do? So you just got to fill out all
this stuff, and uh, it's really interesting and it makes
you do two things. That makes you really take a
hard look at what matters and also take a hard
look at your own family and genetics, and eventually probably
end up saying like, hey, we're no prize either, so
(37:19):
let's just do this. That's fantastic. Yeah, it's real, it's
really do an adoption podcast. When I agree, I agree.
Jerry could even maybe say a few words. She just
thumbed up and then shook her head. She did. She's
a little sleep now. She just finished the lunch. We'll see. Uh,
so you got anything else? I got nothing else? Okay, Well,
if you want to know more about cleft lips and
(37:39):
cliff palettes and cranio facial clefts, then you can go
do some more research online. Since I say good, do
more research online, it's time for listener. Ma, I'm gonna
call this. Uh. I inadvertently said something and I didn't
even know what it meant. I don't think we did this,
(38:00):
and yet did we about Netflix and Chill? I don't so,
I said, Netflix and Chill have heard. It's an expression.
There's a been and Jerry's flavor that I love. What's it? Oh?
I can't even remember. It's just really good. It's got
a lot of good, delicious, crunchy sweet things going on.
It's one of my favorite flavors. I'll check it out.
(38:22):
But let me just read this welcome back stuff you
should know. Team listening to your appendix episode had a
good laugh During the podcast, Chuck said our immune system
is not good at Netflix and Chill and I really
started laughing. Did you know what this meant? Yes, why
didn't you say something when I said it? I don't know.
I must have been thinking of my next joke or something,
because I don't know how I missed that. Did you know, Jerry?
(38:43):
Do you know what that? Man? I'm an idiot. I
can listen if I snorted. Last week, my thirty year
old daughter was visiting. I said to her, let's Netflix
and Chill and she promptly told me, mom, that is
code for having sex. What who knew? Obviously? Stuff you
should know. Oh did not get the slang Dakota memo either,
and we should say Chuck did not. I'm absolving you
(39:05):
and Jerry, but thanks for making me laugh. And that's
from Rosie. And Rosie said that I could read this
and her daughter would get a good laugh about it.
But I feel like a rube. I had no idea that,
And it makes sense now, like I could see some
kid being like, what did you guys do last night? Well?
Just you know Netflix and Chill, when in fact they
were doing you know, unspeakable things. But now I know
(39:26):
Netflix and Chill. Yeah, I don't know how I let
that one passed. Maybe it was purposeful, that's right. Um, Well,
thanks for that one. Who was that again, Rosie? Rosie
appreciate that. Um, and I'll bet that was a really
great conversation you have with your mom. I'm glad we're
clearing this up though, because there's probably a lot of
people that were like, what is is Chuck that dumb? Right?
(39:49):
Or maybe they thought like you had just gotten bone
dry and your sense of humor and timing and delivery. Um. Well,
if you want to get in touch with this, like
Rosie did, we want to hear from you, you can
email to us directly at stuff podcast at i heeart
radio dot com. Stuff you Should Know is a production
(40:09):
of I Heart Radio. For more podcasts my heart Radio,
visit the iHeart Radio app, Apple Podcasts, or wherever you
listen to your favorite shows. H
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