How Cleft Lips and Palates Work

Jerry is literally sitting right here. So do you have a problem with that, with misusing that word like so 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 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, 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, 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. 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 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 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 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

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. 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 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 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 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 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, 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 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 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, 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 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 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 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 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, 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 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 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 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 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 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, 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, 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 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 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 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

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 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 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. 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 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 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 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. 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

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 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 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 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 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 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

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 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 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 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

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 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.

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 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 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 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

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 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 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, 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 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 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, 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 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 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, 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 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 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 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, 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, 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 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 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. 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 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 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 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 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 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 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 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

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 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.

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 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 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 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 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 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 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

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 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. 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 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

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

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 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 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 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 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,

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. 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? 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 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 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? 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

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