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How Cleft Lips and Palates Work · Stuff You Should Know

0:01
Speaker 1: Welcome to Stuff you Should Know, a production of I
0:04
Speaker 1: Heart Radio. Hey, and welcome to the podcast. I'm Josh Clark,
0:13
Speaker 1: There's Charles W Chuck Bryant, and Jerry is literally right there,
0:18
Speaker 1: and I'm Chuck. I want to start something. I'm going
0:21
Speaker 1: to get I actually have a jar at my studio
0:24
Speaker 1: at home kind of. But it's a use of the
0:28
Speaker 1: word literally jar. I'm trying to break myself of that,
0:32
Speaker 1: except when it really truly makes sense, when it literally
0:35
Speaker 1: makes sense to use that word, like in this instance,
0:39
Speaker 1: Jerry is literally sitting right here. So do you have
0:42
Speaker 1: a problem with that, with misusing that word like so
0:45
Speaker 1: many Yeah, no, not necessarily. It's overused. That's what bothers me.
0:49
Speaker 1: What about Gimmy and she donating to the jar at all?
0:52
Speaker 1: Or she just like this literally the dumbest idea. I
0:56
Speaker 1: don't think she has an opinion on this one. Okay, Yeah,
0:59
Speaker 1: she's just spend some money. Well, I keep the jar
1:03
Speaker 1: at home. I'll get money out of it when I
1:06
Speaker 1: need to. It's more just the ritual of like punishing myself,
1:09
Speaker 1: calling out that's good, I'm doing something stupid. Once a Catholic,
1:13
Speaker 1: always a Catholic. So um, oh yeah, this is stuff
1:17
Speaker 1: you should know. And uh, we are talking Chuck today.
1:21
Speaker 1: How are you doing, by the way, I'm great. Good,
1:24
Speaker 1: we're in the same room. It's still a little weird,
1:27
Speaker 1: getting used to it still. Yeah. I went to a
1:29
Speaker 1: baseball game last night, Oh my god. And that was weird.
1:32
Speaker 1: I mean it was great. Uh. And once we get
1:35
Speaker 1: on our seats, we were actually i mean they're fully
1:37
Speaker 1: just selling seats, but where we bought seats there just
1:40
Speaker 1: happened to be no one kind of around us, which
1:42
Speaker 1: was good. But yeah, I went to a Braves game.
1:45
Speaker 1: But you know, they're supposed to be policing and saying,
1:49
Speaker 1: you know, unless you're in your seats, eating and drinking,
1:51
Speaker 1: you should be wearing a mash. And so we the
1:53
Speaker 1: four of us, wore masks, you know, in and out
1:57
Speaker 1: in the bathrooms and the food lines and all that stuff.
1:59
Speaker 1: But no, buddy else was well, I mean Atlanta there's
2:03
Speaker 1: a lot of jerks, yeah, and Atlanta. Yeah, it just
2:07
Speaker 1: it is what it is. We took care of ourselves
2:08
Speaker 1: and it's fine. Yeah, it was fun. Um, well, that's good.
2:13
Speaker 1: I'm glad. Juddie good walk off, Homer. Oh yeah, the
2:16
Speaker 1: bottom of the ninth man. I've only seen like one
2:18
Speaker 1: of those in my life. It was amazing, great game. Yeah,
2:20
Speaker 1: it was cool. Who we play? We played the Mets
2:23
Speaker 1: in our star player Akunya blasted one in the bottom
2:27
Speaker 1: of the ninth first pitch. It was just great. I
2:29
Speaker 1: thought Freddie Freeman was our star player there. I mean
2:33
Speaker 1: they're one and two on any given day. Yeah, I
2:37
Speaker 1: wouldn't want to be number two, you know what I'm saying.
2:39
Speaker 1: But yes, no, of course not. That's why I'm number two. No,
2:43
Speaker 1: that's not true. You meet Jerry all tied for number one.
2:48
Speaker 1: But anyway, it was a little just's it's just a
2:50
Speaker 1: little jarring to be among a lot of people again.
2:53
Speaker 1: And but it also comes back quickly like, oh wait,
2:56
Speaker 1: I spent the first forty nine years of my life
2:59
Speaker 1: among people. A took a year off, and I'm back
3:02
Speaker 1: in this wing. That's good. That's good. I'm hoping to
3:04
Speaker 1: get back there myself. At any rate. This is still
3:08
Speaker 1: a little weird. So we're talking today about clefts, and
3:12
Speaker 1: most people when they think about clefs, they think about
3:15
Speaker 1: cleft lips. But there's a lot more to that, or
3:17
Speaker 1: trouble cliffs. Sure, that's a little different. There's an extra
3:21
Speaker 1: letter in this one that I'm talking about at the end.
3:24
Speaker 1: How is that spelled? Is that just trouble cleft? No
3:27
Speaker 1: cl ef Oh, there's no t trouble cliff cliff. I
3:31
Speaker 1: didn't take piano. That's okay, right, Um, But no, that's
3:35
Speaker 1: a cleft. This is a cleft. A cleft in this
3:38
Speaker 1: case is um. It's a it's a division, it's a trench,
3:41
Speaker 1: it's a void. I guess you could say and that
3:44
Speaker 1: that that is what we're talking about. It is a
3:48
Speaker 1: it is a very common, actually fairly common birth defect. Um.
3:52
Speaker 1: It occurs in the embryonic stage and a child is
3:55
Speaker 1: born with part of their lip and or part of
4:00
Speaker 1: their palate the roof of their mouth is another way
4:02
Speaker 1: to put it right missing, it's just not there, un joined.
4:07
Speaker 1: And we should probably say right at the beginning, Uh,
4:10
Speaker 1: this is a birth defect. But it is a visual difference,
4:14
Speaker 1: is what we call things like this. It is not
4:16
Speaker 1: a disability, although there are you know, many complications will
4:19
Speaker 1: go over, but it's a visual difference. And it is
4:22
Speaker 1: also the term hair lip is not something you should use.
4:26
Speaker 1: It was used for many, many years, even by doctors
4:29
Speaker 1: to describe this condition, but it is uh not a
4:33
Speaker 1: good nice term, so just stop saying it. Yeah, I
4:36
Speaker 1: don't know anybody who says that. I don't think so
4:37
Speaker 1: any but you know, some people just may not know. Like, well,
4:40
Speaker 1: I thought that's what it was called. Uh, And when
4:43
Speaker 1: doctors use a term, you can sort of understand, you know,
4:46
Speaker 1: like somebody falling into that trap. But it's not a
4:49
Speaker 1: term that we use anymore now. And I think that
4:51
Speaker 1: was a good thing to say. All right, So that's
4:52
Speaker 1: the c I A is finished. So um, like we're saying,
4:55
Speaker 1: it is, like you said, it is a birth effect,
4:57
Speaker 1: but it is just a visible difference. And there's I mean,
4:59
Speaker 1: that's that's it. I mean, it is tied in with
5:02
Speaker 1: some syndromes, some genetic syndromes, but plenty of people, I
5:06
Speaker 1: think in the United States somewhere between one and every
5:08
Speaker 1: seven um comes with some sort of cleft, either a
5:12
Speaker 1: cleft lip, a cleft palette, or both UM and there's
5:18
Speaker 1: that's it. That can be it. That's the only thing
5:21
Speaker 1: that is different about that child. There's no developmental problems,
5:25
Speaker 1: there's no and like you said, it's not disability. There's
5:28
Speaker 1: nothing else that's it. And what's fascinating to me, I
5:31
Speaker 1: had no idea about this, but I never really thought
5:33
Speaker 1: about it. Is that the the kid with the cleft
5:38
Speaker 1: lip or the cleft palette there, their palette or their
5:42
Speaker 1: lip just never finished forming. Yeah, they never You know,
5:46
Speaker 1: there's a symmetry generally running down the center of your
5:50
Speaker 1: nose and the two sides of the lip. You know,
5:55
Speaker 1: the stuff forms when you're in the in the womb
5:59
Speaker 1: very early on. It actually for both. I think the
6:01
Speaker 1: lip is first and then the palette, but you know
6:03
Speaker 1: they joined together, and in this case they just don't join. Yeah,
6:07
Speaker 1: you know the little a little bit under your nose,
6:11
Speaker 1: the bip joining the uh, the bottom of your nose
6:14
Speaker 1: through top lip. Yeah, it's filtraum okay. And that is
6:18
Speaker 1: where your lips joined together, your upper lip joins together, right,
6:23
Speaker 1: and that is where your mustache can part. Yeah, yeah,
6:27
Speaker 1: you got a little mustache part. I have a mustache
6:29
Speaker 1: part because mine. But you know, some guys, do you
6:31
Speaker 1: shave yours in just for looks or is it it
6:35
Speaker 1: just kind of parts? Naturally? Your hair doesn't quite grow
6:37
Speaker 1: right there. But you know, if you're like a Burt
6:39
Speaker 1: Reynolds type or Wilfred Brimley, you can just grow it
6:43
Speaker 1: over the whole. What's it called filtraum fil traum p
6:46
Speaker 1: h I l t r U Hiltraum, which would be
6:49
Speaker 1: a really great nerdy boy's name film. Yeah, yeah, and
6:54
Speaker 1: his brother Baxter. On the second thought, though, don't name
6:56
Speaker 1: your son filter so um. When you are in the embryonics,
7:01
Speaker 1: like you said, very early on, the lip forms in
7:04
Speaker 1: like the fourth to seventh week, and very frequently a
7:07
Speaker 1: woman might not even know she's pregnant at that time,
7:09
Speaker 1: and that lips forming, yes already. Um. I saw a
7:12
Speaker 1: really cool bbc UM Documentaries sequence basically where they took
7:19
Speaker 1: three D images of baby in utero and basically turned
7:24
Speaker 1: it into a flipbook video showing the face forming. Your
7:29
Speaker 1: nostrils are giant when you're when you're forming, and they're
7:33
Speaker 1: like on the top of your forehead. They moved down
7:36
Speaker 1: and each nostrils part of a tissue plate, and then
7:40
Speaker 1: the bottom jaw and your bottom lip are part of
7:43
Speaker 1: a third tissue place. So you have three forming and
7:46
Speaker 1: coming together. And as they form, new cells form new skin,
7:50
Speaker 1: and they just kind of move into place. If you
7:52
Speaker 1: have a cleft, flip or a cleft palette. Again, that
7:55
Speaker 1: that final meeting in the middle just never happened. Yeah,
7:59
Speaker 1: So when you watch something thing like that, are you
8:00
Speaker 1: amazed at the miracle of life or are you disgusted
8:05
Speaker 1: amazed at the miracle? Okay, yeah for sure, because when
8:07
Speaker 1: you think of nostrils on the top of the head,
8:10
Speaker 1: it's nothing like that most it did. It's neat, actually
8:15
Speaker 1: it is. Yeah, for sure. The miracle of life is
8:18
Speaker 1: what I'm going with. So there are different ways this
8:21
Speaker 1: can happen. Your your palette on the top of your
8:23
Speaker 1: mouth is in a couple of sections. The one closer
8:26
Speaker 1: to the front is the hard palette, and the rear
8:27
Speaker 1: it's a soft pallet. And if you have a cleft palette,
8:30
Speaker 1: it can be in the soft part the hard part.
8:34
Speaker 1: It can split both. Yeah, because if you do don't mouth,
8:39
Speaker 1: don't do that. The front part is is bony, that's
8:43
Speaker 1: your hard palate. If you go further back, it's really
8:45
Speaker 1: kind of tough to do, but you can go, well,
8:48
Speaker 1: what you gotta stop. You don't like that, No, I
8:50
Speaker 1: don't think anyone does. Um, I really you think some
8:53
Speaker 1: people like hearing that. I think it's kind of pleasant.
8:55
Speaker 1: Anybody who like that shout out. I want to hear you.
8:58
Speaker 1: I think there's some kind of a pressure point in
9:00
Speaker 1: your soft pallet too. For is it migraines or something
9:03
Speaker 1: I remember hearing about, like pressing your thumb into your
9:06
Speaker 1: soft pallet to do something that wasn't that it was
9:10
Speaker 1: something else. Well, you can cure an ice cream maybe
9:15
Speaker 1: multi functional. Anyway, In the very back, you have just
9:19
Speaker 1: a muscle like your hard palate, bony with some skin
9:23
Speaker 1: covering it. Further back, it's like muscle with skin covering,
9:26
Speaker 1: and that's your soft palate. It's like a little rib
9:28
Speaker 1: cage up there. And you can have this division, this
9:30
Speaker 1: cleft in either part or both. Right, that's correct, That's
9:34
Speaker 1: what I said. So, Uh, an incomplete cleft is missing.
9:38
Speaker 1: It's a little notch and it's missing from the middle
9:41
Speaker 1: of the upper left. A complete cleft is all the
9:44
Speaker 1: way through into the nose. And then with the lip,
9:48
Speaker 1: it's it's always the upper lip, but it's usually off
9:51
Speaker 1: to one side or the other, I think because of
9:53
Speaker 1: that symmetry and how it forms. Yes, uh, And it's
9:56
Speaker 1: always the upper lip because it only affects the two
9:59
Speaker 1: top plates of flesh that are forming that from your
10:02
Speaker 1: upper lip in your face and those forehead nostrils that
10:05
Speaker 1: come back down to your nostril area. That's right. God,
10:08
Speaker 1: it's just like old times. Cherry's literally dropping food out
10:10
Speaker 1: of her mouth onto the table. Is amazing. No, but
10:15
Speaker 1: it's so funny. I don't know. I think there might
10:18
Speaker 1: be a little all day and she chooses to eat
10:20
Speaker 1: when she's in here. I think we should take a break.
10:23
Speaker 1: I think so too. All right, that's a good opening, Uh, salvo,
10:28
Speaker 1: So we'll be back after this. I think I might
10:52
Speaker 1: have missed you salvo did I don't think so? Was
10:55
Speaker 1: that right? Yeah? I associate that with like a timpani
10:59
Speaker 1: or and in going off. Yeah, all right, I think you.
11:03
Speaker 1: I think you used it correctly. A cleft that you
11:06
Speaker 1: got wrong. Yeah, back to clefts. They are developmental defects,
11:10
Speaker 1: like we said, very early, and what causes them, you know,
11:16
Speaker 1: genetics can play a part. I think if you're a
11:19
Speaker 1: parent you have with a cleft either a palette or lip,
11:23
Speaker 1: you have it like a two to eight percent chance
11:25
Speaker 1: that your kid may if you have a biological child,
11:28
Speaker 1: and then that goes up if you have siblings and
11:31
Speaker 1: or if you have your parents and it's sort of
11:33
Speaker 1: passed down. I think that number can go up to like, yeah,
11:37
Speaker 1: it can if you if your parent has a sibling
11:40
Speaker 1: that has a cleft as well, the chance of your
11:43
Speaker 1: your kid having ACT is definitely increased. And then um,
11:47
Speaker 1: it can keep going up depending on whether or not
11:50
Speaker 1: your parent has a genetic syndrome that they're passing along. Um.
11:54
Speaker 1: I think there's something like three hundred to four hundred
11:57
Speaker 1: different genetic syndromes are associated with cleft lip or cleft
12:02
Speaker 1: palette um and together we should say they're both called
12:05
Speaker 1: orofacial clefts. Oh yeah, we didn't say that to me.
12:07
Speaker 1: And I've also known and I've also seen it abbreviated
12:10
Speaker 1: as c l slash p lips slash pallet um. That
12:16
Speaker 1: seems to be kind of like the shorthand for it,
12:18
Speaker 1: because doctors don't like the right full words and their
12:21
Speaker 1: handwriting is just terrible. Um. And then I've also seen
12:24
Speaker 1: them called affectionately as cleft eas. Oh that's nice. So
12:28
Speaker 1: and you know, we'll talk about the uh, you know,
12:31
Speaker 1: acceptance of facial differences if you have a cleft or
12:35
Speaker 1: have friends or family members, and that's a big, big
12:37
Speaker 1: part of it. And I think something like cleft E's
12:39
Speaker 1: might be a way of embracing that s. So there
12:42
Speaker 1: are some other things that could be risk factors and
12:46
Speaker 1: increase the risk of all kinds of birth effects, certainly
12:49
Speaker 1: including clefts. And one of them is if you're smoking
12:52
Speaker 1: and drinking booze while you're pregnant. UM. One of the
12:55
Speaker 1: reasons alcohol effects UM, any kind of birth effect, is
13:00
Speaker 1: because it disrupts the absorption of UH follic acid. And
13:05
Speaker 1: that's another reason you might if you don't have enough
13:08
Speaker 1: fallic acid. That's why pregnant women take extra It's a
13:11
Speaker 1: natural form of B nine. It's a vitamin. And yeah,
13:15
Speaker 1: I think. And then late nineties the FDA said you've
13:18
Speaker 1: got to start putting extra folic acid in like all
13:21
Speaker 1: kinds of common foods. Remember that store your recyclables starting, yeah,
13:27
Speaker 1: and and just like put it in bread and pasta
13:29
Speaker 1: and grains and cereals and things that people eat a
13:32
Speaker 1: lot of. UH. It's naturally found in sunflower seeds and
13:36
Speaker 1: fruits and beans and peanuts and stuff like that. So
13:40
Speaker 1: you want the follic acid, I think if you're pregnant,
13:43
Speaker 1: they recommend you take at least UH six hundred milligrams
13:48
Speaker 1: per day. And and if you're just a regular non
13:51
Speaker 1: pregnant humans a day, yeah, if you UM are in
13:55
Speaker 1: your reproductive stage or age. Right, but you you need
14:00
Speaker 1: folic acid anyway, right, why not just as a person? Sure? Yeah,
14:03
Speaker 1: I get a lot of bread, I get a lot
14:05
Speaker 1: of folic acid. Uh So smoking and drinking is one,
14:09
Speaker 1: Diabetes is another. Right, Yeah, that's a really big risk factor.
14:12
Speaker 1: Diabetes and obesity both seem to be correlated to increased
14:17
Speaker 1: risk of clefts. I'm not sure what the incidences for
14:20
Speaker 1: women with diabetes, but it is an increased risk UM.
14:24
Speaker 1: And then there's also a couple of epilepsy medications that
14:27
Speaker 1: increase your risk. UM. The thing about all this is
14:30
Speaker 1: there is no UM definitive understanding your explanation of why
14:37
Speaker 1: clefts form of what it is that causes some children's
14:43
Speaker 1: um lips just not to join together or their palettes
14:46
Speaker 1: that not fuse together at that last final stage. UM.
14:50
Speaker 1: It seems to be multi factorial is what they call it,
14:52
Speaker 1: where there's just a bunch of different factors. UM. And
14:55
Speaker 1: also in addition to genetics, like your parents having one
14:58
Speaker 1: of your parents having a sibling with one UM depending
15:02
Speaker 1: on your race, actually your your risk is increased. Apparently,
15:06
Speaker 1: it's far more common among Asian people, UM and Native Americans.
15:11
Speaker 1: I think it's the highest among Native Americans, something like
15:13
Speaker 1: three points six out of every uh thousand births. I
15:20
Speaker 1: believe um to two among Asian people. It's the lowest
15:26
Speaker 1: among African Americans. I think Chinese babies are more commonly diagnosed.
15:33
Speaker 1: Is a diagnosis or just what do you even call that? No,
15:36
Speaker 1: you're diagnosed, But I mean it's like very easy diagnosis.
15:39
Speaker 1: It's like, okay, you're a child has a cleft flip. Right.
15:42
Speaker 1: But what's what's interesting, Chuck, is with the cleft palette.
15:45
Speaker 1: You can have a cleft palette, but it not be visible.
15:49
Speaker 1: It can actually be hidden. That's called the submucosis cleft palette.
15:54
Speaker 1: And they might they you might never be diagnosed with
15:57
Speaker 1: it because there may be no problem with that or
16:00
Speaker 1: that arise from it, like with other cluts, like we'll
16:03
Speaker 1: talk about. Yeah, but um, that's kind of rare from
16:05
Speaker 1: what I understand, right, And the palette is less visible
16:08
Speaker 1: anyway as opposed to the lip. Uh. And you know,
16:12
Speaker 1: if you see any kind of photo image of cleft palette,
16:14
Speaker 1: is usually the doctor taking a picture of someone with
16:17
Speaker 1: their mouth wide open, kind of tilting their head back
16:20
Speaker 1: so you can get a good angle on it. Um
16:23
Speaker 1: health problems that are associated with clefts are uh, they
16:28
Speaker 1: can be numerous. It's it's not you know, it seems
16:31
Speaker 1: like everything is something that can be overcome. But they
16:35
Speaker 1: are challenges, nonetheless, and they are challenges that especially can
16:40
Speaker 1: just make a kid when they're growing up field not
16:43
Speaker 1: so great about themselves. So that that's a big, big
16:45
Speaker 1: part of overcoming these challenges. But to be sure, there
16:49
Speaker 1: are some physical things that happen, like it can interfere
16:53
Speaker 1: with how your teeth are forming and growing in Uh.
16:56
Speaker 1: Sometimes you might have to get bone graphs on the
16:59
Speaker 1: upper portion of your gums, especially if you have a
17:02
Speaker 1: cleft lip. Yeah, cleft lips, it seems like it's usually
17:05
Speaker 1: where the teeth problems come from. Uh. And then one
17:07
Speaker 1: of the first things you know, if you're nursing your baby,
17:11
Speaker 1: then if your baby has a cleft lip or and
17:15
Speaker 1: or a cleft pallet, they may have trouble latching on
17:18
Speaker 1: and getting a good like a good suck is what
17:21
Speaker 1: they call it. Yes, And if you luckily, there are
17:24
Speaker 1: different um methods for improving that. There are certain types
17:28
Speaker 1: of bottles which can help with that. So again that's
17:31
Speaker 1: a problem that can be overcome pretty routinely. It's the
17:35
Speaker 1: easiest to overcome and to nurse a child with a
17:38
Speaker 1: cleft lip because you can set the baby up and
17:42
Speaker 1: as usual chuck them in the air um, and you
17:48
Speaker 1: can just after they latch on, you just kind of
17:51
Speaker 1: put your finger over their cleft flip oh and just
17:54
Speaker 1: like close the gap. Basically, it's it's easy as pie.
17:57
Speaker 1: With a cleft palette, it can be much more difficult
18:00
Speaker 1: because we use our palette to create suction, use your
18:03
Speaker 1: tongue and your palate, your soft pallet in particular to
18:06
Speaker 1: create suction. So there's specialized bottles for feeding babies with
18:11
Speaker 1: cleft pallets. Uh. And in particular, if the baby is
18:15
Speaker 1: just not able to latch on for breastfeeding, they still say, well,
18:19
Speaker 1: just pump your breast milk and feed your baby the
18:22
Speaker 1: bottle milk because unfortunately, because of that gap in their
18:26
Speaker 1: their palette, uh, there there's basically a passage into their
18:30
Speaker 1: nose and sometimes their ears, so breast milk can get
18:33
Speaker 1: in there, and they found it's far less irritating breast
18:36
Speaker 1: milk is than um formula when it does get in
18:39
Speaker 1: the little baby's ears and nose. That's right. And because
18:43
Speaker 1: of that same gap there, I think throughout you know,
18:47
Speaker 1: we'll talk about the surgeries, but throughout childhood, babies and
18:50
Speaker 1: children with cleft palets and lips have higher incidences of
18:54
Speaker 1: ear infections, UM, sometimes chronic Sometimes they might have trouble
19:01
Speaker 1: hearing and learning how to talk. But again, these are
19:04
Speaker 1: all early challenges that it's such a common birth defect
19:08
Speaker 1: that they really really know a lot about how to
19:10
Speaker 1: overcome this stuff. That's exactly right. Fortunately, especially in the
19:14
Speaker 1: developed world, there's a lot of services available that are
19:17
Speaker 1: pretty routine. Yeah, and if you're fortunate enough to live
19:20
Speaker 1: in a country with socialized medicine, you get it all
19:22
Speaker 1: for free. And if you're not, you're gonna be dropping
19:25
Speaker 1: some money on surgery. I think the statistic is two
19:29
Speaker 1: hundred thousand dollar average for medical procedures over the course
19:33
Speaker 1: of your life. Uh. And I don't know if that's
19:37
Speaker 1: figuring in insurance. If that's a two d thousand dollars
19:40
Speaker 1: sort of total and you pay a portion of that
19:42
Speaker 1: if you're insured, I get that that's out of pocket.
19:45
Speaker 1: Oh you think so. I think so interesting. So do
19:48
Speaker 1: you want to talk specifically about some of the treatments
19:50
Speaker 1: for class. Yeah. So, Um, the diagnosis of cleft often
19:57
Speaker 1: happens um through ultrasounds. Uh, so you will know your
20:02
Speaker 1: baby is going to be born with a cleft lip
20:04
Speaker 1: especially is how you know. But a cleft palates probably
20:07
Speaker 1: diagnosed after birth, but shortly after birth, usually upon the
20:10
Speaker 1: first examination by the doctor and they'll say, okay, well
20:14
Speaker 1: your your child has a cleft pallet. Um, don't panic.
20:18
Speaker 1: There's a lot of stuff in place. We know exactly
20:20
Speaker 1: what to do, we know exactly when to do it.
20:23
Speaker 1: But it's gonna be really tough for you and your
20:25
Speaker 1: family because your baby, before your baby turns one year old,
20:29
Speaker 1: and as actually as early as maybe three months old, uh,
20:33
Speaker 1: they might be they will undergo a surgery, like a
20:36
Speaker 1: major surgery where they are given general anesthesia and um,
20:41
Speaker 1: basically it's a form of cosmetic surgery to to repair
20:46
Speaker 1: is what they call it, um their cleft lip or
20:48
Speaker 1: the cleft palette or both. And it's it's basically the
20:51
Speaker 1: first in a very long line of surgeries that will
20:54
Speaker 1: take up their first eighteen years pretty easily. Yeah, it's
20:57
Speaker 1: called the first one is called kylo plasty uh c
21:01
Speaker 1: h e I l o plasty, and this is uh
21:06
Speaker 1: it can be a few surgeries. Like I said about
21:08
Speaker 1: the teeth, it can include bone graphs. And I think
21:12
Speaker 1: the cleft palate surgery is a little bit later. That's
21:15
Speaker 1: only for cleft lip and cleft pallet though, is still
21:17
Speaker 1: before they're eighteen months old. And you know, even though
21:20
Speaker 1: it's routine, it is like you said, it's it's stressful
21:22
Speaker 1: for a parent too to see that little baby go
21:25
Speaker 1: under general anesthesia and go under the knife. Yeah, and
21:28
Speaker 1: when they come out, I mean, you know, they're in pain,
21:31
Speaker 1: they're not very happy, they're pretty uncomfortable. It's no fun. Fortunately, um,
21:36
Speaker 1: they've actually come up with a procedure called nasoalveolar molding
21:42
Speaker 1: or any um, thank god uh where this reduces the
21:48
Speaker 1: number of follow up surgeries because they don't always get
21:50
Speaker 1: it on the first surgery. They might just kind of
21:52
Speaker 1: be like, well, this is the first step, and we're
21:55
Speaker 1: gonna let this heal and kind of fuse a little
21:57
Speaker 1: more closer together, and then we're gonna try it again
21:59
Speaker 1: and again, and we'll finally get there after a couple
22:01
Speaker 1: of surgeries. Are a few Uh an a yum kind
22:05
Speaker 1: of does that follow up surgery ahead of time by
22:08
Speaker 1: molding the little baby's astoundingly malleable features ahead of time
22:14
Speaker 1: before the surgery. Yeah, it almost sounded like braces for
22:19
Speaker 1: your faces. That's right. Uh. It's a clear plastic retainer
22:25
Speaker 1: inside the mouth, and like you said, it helps mold
22:27
Speaker 1: it as they grow, and then like braces, they adjust
22:31
Speaker 1: it as they grow and maybe like tighten it down.
22:34
Speaker 1: I think for cleff lips um they add a little
22:37
Speaker 1: if it's a small one, they add a little plastic
22:39
Speaker 1: post that's up in the nose to lift that up
22:43
Speaker 1: because it can also affect the shape of your nose
22:45
Speaker 1: early on too. I'm not sure if we mentioned that.
22:48
Speaker 1: So it's all sort of tied in together developmentally, and
22:51
Speaker 1: it sounds like this nam retainer device sort of just limits,
22:56
Speaker 1: like you said, what's going to happen in the future. Yeah,
22:58
Speaker 1: And it just brings a head cliff closer together so
23:01
Speaker 1: that when they actually do go in to do the surgery,
23:04
Speaker 1: there's far less trauma and it's it's far more successful
23:10
Speaker 1: bringing it together. Um. The palette surgery is called the palettoplasty,
23:15
Speaker 1: and it actually because the especially if it's going through
23:18
Speaker 1: the bony part of your hard pallet. Um. They may
23:22
Speaker 1: use bone graphs to kind of fuse that, or they
23:25
Speaker 1: may just basically cut the gums along the roof of
23:29
Speaker 1: your mouth from the mouth and bring it together and
23:32
Speaker 1: just basically cover it up. And for all intents and purposes, Um,
23:37
Speaker 1: the palette has been fixed. There's not milk going in
23:40
Speaker 1: their ear canal any longer rub their nose. Um, they're
23:44
Speaker 1: going to be able to speak clearly because they'll have
23:47
Speaker 1: that soft palette, which we use to basically make almost
23:50
Speaker 1: every sound we make phonetically. We use our soft palette
23:54
Speaker 1: to close the airway. I'm doing it right now, literally,
23:57
Speaker 1: right now, I'm doing literally. Um. So if you could
24:01
Speaker 1: just kind of cover that cleft palette with gum tissue,
24:05
Speaker 1: I mean, you've fixed a lot of the issues that
24:08
Speaker 1: arise from having a cleft pallet. Yeah. I mean, in
24:11
Speaker 1: addition to that speech surgery, there may be speech therapy
24:15
Speaker 1: that your kid might undergo early on. Um, they're rhino plastic.
24:20
Speaker 1: Sometimes because I did mention the nose, sometimes the rhino
24:23
Speaker 1: plastic comes into play. Uh. And then there's also worth
24:29
Speaker 1: man or though Nathnick Nathic ornatic. That g's gotta be silent,
24:37
Speaker 1: don't you think? I don't know? Man, all right, you
24:40
Speaker 1: take a stab or thug natic? Yeah, I think that
24:43
Speaker 1: was it, really yeah, I think so. All right, Well,
24:46
Speaker 1: this is jaw alignment surgery, and this is uh, this
24:50
Speaker 1: is something that happens later on because your jaw has
24:53
Speaker 1: to stop growing. This is sort of similar, I think
24:55
Speaker 1: to my issues with my crossbite, and it's all sort
24:59
Speaker 1: of the Donic related in a way as well. Um,
25:02
Speaker 1: and that that ridge that's at the like right behind
25:06
Speaker 1: your teeth, that your adult teeth actually grow out of
25:09
Speaker 1: that And if you have a cliff lip in particular,
25:12
Speaker 1: like you were saying, um, you might need a bone graph.
25:14
Speaker 1: That's another surgery that you were talking about implants, so
25:19
Speaker 1: that like for your front teeth in particular. Um, So
25:23
Speaker 1: that's a that's a pretty decent amount of surgeries and
25:25
Speaker 1: that's not necessarily one and done for any of them.
25:28
Speaker 1: Especially I think rhinoplastic can be uh can take multiple
25:33
Speaker 1: surgeries to kind of get the nose back where you
25:35
Speaker 1: wanted to. But again, like this is the doctors who
25:40
Speaker 1: handle this stuff at children's hospitals around the country and
25:43
Speaker 1: basically everywhere and the um the global North just know
25:48
Speaker 1: exactly what they're doing and what to do and when
25:51
Speaker 1: to do it, and it's the The outcome is usually
25:54
Speaker 1: very good. The prognosis of a baby born with a
25:57
Speaker 1: cleft lip um is you know, is pretty good. Yeah,
26:02
Speaker 1: it's great. Um, there can be scarring obviously, especially that
26:05
Speaker 1: first surgery. They're sort of a signature scar from a
26:08
Speaker 1: cleft lips surgical procedure, and kids can be very self
26:12
Speaker 1: conscious about that stuff. But I think you know, they
26:15
Speaker 1: encourage parents to try and uh just be open about
26:19
Speaker 1: that stuff and get them to to own that as
26:20
Speaker 1: a as a facial difference and as a visible difference,
26:24
Speaker 1: and and to really drive home to the kid like
26:27
Speaker 1: this is not going to you know, you can still
26:29
Speaker 1: be an athlete, you can still it doesn't affect any
26:32
Speaker 1: kind of uh learning or anything like that in school. So, uh,
26:37
Speaker 1: it's really up to the parents and then through the
26:39
Speaker 1: help of like friends and family hopefully to to get
26:42
Speaker 1: that kid on the right track. And that that's a
26:43
Speaker 1: huge one to supposedly like parents who are given, especially
26:47
Speaker 1: with an ultrasound a diagnosis of a child with a
26:50
Speaker 1: cleft lip um, can they can take the news pretty hard. Yeah. Um,
26:55
Speaker 1: I was reading Uh, I don't remember I read it,
26:57
Speaker 1: but it was basically like a first person account of
26:59
Speaker 1: having a child with a cleft lip. And the woman
27:03
Speaker 1: was saying, she was really worried that she's gonna have
27:05
Speaker 1: trouble bonding with her baby. Remember our cute episode in
27:09
Speaker 1: the kinder kindIn Schema. Um, she was basically worried about that. Uh.
27:14
Speaker 1: And then she said the moment she saw her baby,
27:16
Speaker 1: she just fell totally in love and it was like
27:19
Speaker 1: it was just like having any other baby. It was
27:22
Speaker 1: her baby, so of course she loved it no matter
27:25
Speaker 1: whether she had a cleft lip or not. But that
27:27
Speaker 1: is that is a common concern among parents when their
27:30
Speaker 1: first you know, getting their feet wet with this. Um.
27:34
Speaker 1: But I was reading some studies and they found that
27:36
Speaker 1: there are basically no bonding issues that that differentiate parents
27:45
Speaker 1: and children of kids with cleft palates or lips um
27:50
Speaker 1: from from kids without cleft lips. That that they basically
27:54
Speaker 1: the outcome is the same. One of the things that
27:57
Speaker 1: you do have to be careful with though, is it's
28:00
Speaker 1: very easy for you to become an overprotective parent because
28:03
Speaker 1: you're dealing with a baby that you're sending off for surgery.
28:08
Speaker 1: You don't want any harm to come to it. You've
28:10
Speaker 1: now seen your baby with like a heart monitor, like
28:13
Speaker 1: i V tube sticking out of them, and that's just
28:16
Speaker 1: not a sight you want to see. It can really
28:18
Speaker 1: make you even more protective of your baby than before.
28:21
Speaker 1: And then when they come home and they're being teased
28:23
Speaker 1: because of their facial difference, which they cannot help and
28:27
Speaker 1: they had. They're not guilty of anything. They don't deserve
28:30
Speaker 1: any of that kind of bullying or teasing. I'm sure
28:32
Speaker 1: it makes you want to go kill those little kids
28:34
Speaker 1: who are doing that. UM, so you got you kind
28:36
Speaker 1: of have to. It's a definite crucible for uh, for
28:42
Speaker 1: parents that that you have. It's an additional challenge that
28:46
Speaker 1: you would have to to take on. But parents do
28:48
Speaker 1: it all the time and their kids turn out totally
28:50
Speaker 1: normal all the time. All right, Well, take another break,
28:55
Speaker 1: are another break, and we'll come back and finish up
28:58
Speaker 1: right after this. See alright, so we should talk about
29:23
Speaker 1: some of the great things that are going on around
29:25
Speaker 1: the world, but we first have to talk about some
29:28
Speaker 1: of the not so great things. Um. We've been talking
29:31
Speaker 1: to this about this from the perspective of someone in
29:33
Speaker 1: the United States, where it is very common and very
29:36
Speaker 1: treatable and outcomes are great. Unfortunately, in developing countries there
29:41
Speaker 1: are a lot more challenges. Of course. Uh. There is
29:44
Speaker 1: a lot of stigma attached to this anywhere, but especially
29:48
Speaker 1: in developing countries. You might come into a situation where
29:52
Speaker 1: um uh, like a father might blame the mother and
29:56
Speaker 1: say you were to blame because you didn't do whatever right,
30:00
Speaker 1: that my child looks like this, and there can be
30:02
Speaker 1: a lot of shame involved. I think there was a
30:04
Speaker 1: study in Kenya where mothers of babies were blamed by
30:08
Speaker 1: their husband and extended families for that. And they interviewed
30:12
Speaker 1: some of these women and some had contemplated taking the
30:15
Speaker 1: baby's life or their own life or both. Uh. And
30:18
Speaker 1: that is just unspeakable, uh, unspeakably tragic, of course. Uh.
30:24
Speaker 1: Their access to medical care is different. Obviously. The further
30:29
Speaker 1: they are away from good care and the more expensive
30:32
Speaker 1: it is, the harder it becomes to overcome these challenges.
30:35
Speaker 1: But there is great news because there are some great organizations.
30:40
Speaker 1: One's called Smile Train, one's called Operations Smile and what
30:43
Speaker 1: they do instead of sending in doctors, they try and
30:46
Speaker 1: go in and train up doctors in these places to
30:50
Speaker 1: deal with this better, to teach them how to perform
30:52
Speaker 1: these surgeries, and to help educate the public at large
30:56
Speaker 1: about facial differences and that it's it's okay. Yeah, I
31:00
Speaker 1: was looking at Charity Navigator. You ever go on there, man,
31:03
Speaker 1: they're great. Um, it turns out Operations Smile has like
31:08
Speaker 1: a seventy, which is fine, but Smile Train is a
31:13
Speaker 1: Charity Navigator. No. No, they've been around for a while now.
31:17
Speaker 1: That's amazing. Both of them have, like, um, they're spending
31:21
Speaker 1: tens and tens of millions of dollars a year on
31:24
Speaker 1: providing like these services for children around the world. So
31:28
Speaker 1: seventy five or a hundred, hats off to both of
31:30
Speaker 1: them for that. That's great. I think Operations Smile has
31:34
Speaker 1: thirty one medical centers in sixteen countries and they have
31:39
Speaker 1: these international medical missions every year, like over a hundred
31:41
Speaker 1: of them that they where, Like I said, they just
31:44
Speaker 1: go in they teach the doctors instead of bringing in doctors,
31:48
Speaker 1: and I think the whole teacher person to fish thing
31:50
Speaker 1: all right comes into play. Teach a person to fix
31:53
Speaker 1: a cleft flip and they'll be doing it again and again.
31:56
Speaker 1: That's the old thing. So uh, there are actually like
32:01
Speaker 1: since it's I think one out of every seven fifty
32:04
Speaker 1: berths in the United States alone, that might even be
32:06
Speaker 1: like a European statistic too. Um, there's a lot of
32:11
Speaker 1: famous people who have cleft flips because, like you said,
32:14
Speaker 1: if you have a cleft lip or a cleft palette,
32:16
Speaker 1: it doesn't prevent you from doing anything. Um, so you
32:19
Speaker 1: could excel at say acting as maybe Mike Hamer if
32:25
Speaker 1: you wanted to Stacy Kea. Yeah, is that you're talking about? Yeah,
32:29
Speaker 1: Stacy Keach has that cleft palette or I guess cleft
32:32
Speaker 1: lips surgery scar forward surgeries. Actually that Stacy Keach had
32:37
Speaker 1: uh cheech marin sure. I guess he can still smoke
32:40
Speaker 1: downs a weed. I was gonna say, he's got the
32:42
Speaker 1: suction thing down maybe, So who else? Uh? Joaquin Phoenix
32:47
Speaker 1: actually is widely considered to have a um like a
32:51
Speaker 1: cleft scar. It has what looks like that cleft scar
32:55
Speaker 1: like he had a cleft lip repair, a chilly a
32:59
Speaker 1: kilo plastic um, but he doesn't. He has a microform
33:04
Speaker 1: cleft that was It's it's looked like that since birth. Um.
33:08
Speaker 1: And apparently Wendy Williams, the talk show host, got just
33:12
Speaker 1: jumped all over last year because she was talking about
33:15
Speaker 1: how cute she thought it was and then was like
33:18
Speaker 1: basically pulling her Yeah, she didn't do it right at all.
33:22
Speaker 1: She was ultimately trying to give him a compliment, but
33:25
Speaker 1: she did not do it in the right way. Definitely
33:29
Speaker 1: suffered for it. Um. And then Peyton Manning is another one. Yeah,
33:33
Speaker 1: I think his was a palette, right, he had I
33:36
Speaker 1: think a lip too. No, I guess it says palette.
33:41
Speaker 1: I thought he had a cliff flip because I feel
33:43
Speaker 1: like I've seen him he has a scar, like his
33:45
Speaker 1: lip looks turned up a little bit. But maybe it
33:48
Speaker 1: was just a cliff palette. So he had a couple
33:50
Speaker 1: of surgeries, and he had I think he had braces
33:54
Speaker 1: for like eleven years, from like age four. Yeah, man,
33:58
Speaker 1: that's to four to fifteen having races. I mean I
34:00
Speaker 1: had braces twice and that was bad. That's the Jolly
34:03
Speaker 1: Rancher years. And Peyton Manning missed out on those. I
34:06
Speaker 1: can assure you he did. Did you like the individual
34:09
Speaker 1: candies or the sticks? The sticks? That was just too much, man,
34:13
Speaker 1: it was over the top was it for me? I
34:16
Speaker 1: kind of liked him because the more you uh licked
34:19
Speaker 1: on him and sucked on him that you can make
34:21
Speaker 1: him into a knife basically right, like a poop knife.
34:24
Speaker 1: But it was very sharp. What was your flavor? I
34:28
Speaker 1: was always green apple? Same here. I love those watermelon
34:31
Speaker 1: are good too. It's okay, it's old fast. Don't come
34:34
Speaker 1: at me with grape. I don't. I don't like the grape.
34:35
Speaker 1: I don't. I had no problem with grapes. What about
34:37
Speaker 1: the blue? I think blue raspberry one have been remember
34:41
Speaker 1: that maybe? But boy, those green apple, yeah, they're good.
34:44
Speaker 1: I haven't had one of those in forty years. I
34:46
Speaker 1: think I still have. I haven't either. I still have
34:49
Speaker 1: some stuff to my mole. Wow, Dennison never just couldn't
34:54
Speaker 1: even get it out. They try, they try, and they fail,
34:58
Speaker 1: every single one of them. So Peyton man Ing uh, he,
35:01
Speaker 1: like I said, has done a lot with his money
35:04
Speaker 1: over the years, in addition to throwing lots of touchdowns,
35:06
Speaker 1: a lot of philanthropy, and I think even the St.
35:09
Speaker 1: Vincent's Childrens Hospital in Indiana they renamed that Peyton Manning
35:13
Speaker 1: Children's Hospital at St. Vincent because they have the leading
35:17
Speaker 1: or one of the leading pediatric cranio facial centers in
35:21
Speaker 1: the country, and he has shoveled a lot of money
35:23
Speaker 1: their way. UM. There's also one other thing we're talking about,
35:26
Speaker 1: how other kids and other countries don't have access to
35:30
Speaker 1: a lot of the services UM. And apparently a lot
35:33
Speaker 1: of people have said, I want to adopt a child
35:37
Speaker 1: from a developing country, and I am going to just
35:40
Speaker 1: basically go ahead and go right onto the canonization track
35:45
Speaker 1: and adopt a child from a developing country who has
35:48
Speaker 1: what's called an unrepaired cleft and like, you know this
35:51
Speaker 1: going into it, Yes, you sign up for it. There's
35:53
Speaker 1: actually a group by the way called Rainbow Kids UM
35:56
Speaker 1: that connects people to adoptive parents to children with developmental
36:02
Speaker 1: UM or other kinds of special needs UM and that
36:06
Speaker 1: includes kids with cleff lips, cleff pallets, that kind of thing,
36:08
Speaker 1: which I think is pretty great. That is great, and
36:10
Speaker 1: then you know that's one of the stressors of the
36:13
Speaker 1: many stressors of adopting a kid period. I can say
36:15
Speaker 1: from experience and that you are oftentimes dealing with a
36:19
Speaker 1: birth mother that may not have practiced great prenatal care.
36:22
Speaker 1: Add access to it, UM, smoking and drugs and alcohol
36:26
Speaker 1: could play a part. And you you sign up for this,
36:29
Speaker 1: and you they ask you these questions beforehand. They're like,
36:32
Speaker 1: what would you do if you are in the birth
36:35
Speaker 1: room and the baby comes out with a cleff flip
36:38
Speaker 1: or a cleft pallet? Like, what's your real They ask that. Yeah,
36:41
Speaker 1: I mean it's just called your tolerance list, Like what
36:45
Speaker 1: if this happens? What if this happens? What if you
36:47
Speaker 1: go in there and the baby comes out that's an
36:49
Speaker 1: unexpected race? And you're like, okay, well could that happen? Yeah,
36:54
Speaker 1: They're like, well sure again, so how are you gonna
36:56
Speaker 1: And then they you know, they tap on their on
36:59
Speaker 1: the clipboard and look you and they're like what would
37:01
Speaker 1: you do? So you just got to fill out all
37:02
Speaker 1: this stuff, and uh, it's really interesting and it makes
37:06
Speaker 1: you do two things. That makes you really take a
37:08
Speaker 1: hard look at what matters and also take a hard
37:11
Speaker 1: look at your own family and genetics, and eventually probably
37:15
Speaker 1: end up saying like, hey, we're no prize either, so
37:19
Speaker 1: let's just do this. That's fantastic. Yeah, it's real, it's
37:21
Speaker 1: really do an adoption podcast. When I agree, I agree.
37:25
Speaker 1: Jerry could even maybe say a few words. She just
37:27
Speaker 1: thumbed up and then shook her head. She did. She's
37:30
Speaker 1: a little sleep now. She just finished the lunch. We'll see. Uh,
37:35
Speaker 1: so you got anything else? I got nothing else? Okay, Well,
37:37
Speaker 1: if you want to know more about cleft lips and
37:39
Speaker 1: cliff palettes and cranio facial clefts, then you can go
37:43
Speaker 1: do some more research online. Since I say good, do
37:46
Speaker 1: more research online, it's time for listener. Ma, I'm gonna
37:52
Speaker 1: call this. Uh. I inadvertently said something and I didn't
37:57
Speaker 1: even know what it meant. I don't think we did this,
38:00
Speaker 1: and yet did we about Netflix and Chill? I don't so,
38:04
Speaker 1: I said, Netflix and Chill have heard. It's an expression.
38:08
Speaker 1: There's a been and Jerry's flavor that I love. What's it? Oh?
38:12
Speaker 1: I can't even remember. It's just really good. It's got
38:15
Speaker 1: a lot of good, delicious, crunchy sweet things going on.
38:19
Speaker 1: It's one of my favorite flavors. I'll check it out.
38:22
Speaker 1: But let me just read this welcome back stuff you
38:23
Speaker 1: should know. Team listening to your appendix episode had a
38:26
Speaker 1: good laugh During the podcast, Chuck said our immune system
38:29
Speaker 1: is not good at Netflix and Chill and I really
38:32
Speaker 1: started laughing. Did you know what this meant? Yes, why
38:36
Speaker 1: didn't you say something when I said it? I don't know.
38:38
Speaker 1: I must have been thinking of my next joke or something,
38:41
Speaker 1: because I don't know how I missed that. Did you know, Jerry?
38:43
Speaker 1: Do you know what that? Man? I'm an idiot. I
38:46
Speaker 1: can listen if I snorted. Last week, my thirty year
38:49
Speaker 1: old daughter was visiting. I said to her, let's Netflix
38:51
Speaker 1: and Chill and she promptly told me, mom, that is
38:54
Speaker 1: code for having sex. What who knew? Obviously? Stuff you
38:59
Speaker 1: should know. Oh did not get the slang Dakota memo either,
39:02
Speaker 1: and we should say Chuck did not. I'm absolving you
39:05
Speaker 1: and Jerry, but thanks for making me laugh. And that's
39:08
Speaker 1: from Rosie. And Rosie said that I could read this
39:10
Speaker 1: and her daughter would get a good laugh about it.
39:12
Speaker 1: But I feel like a rube. I had no idea that,
39:16
Speaker 1: And it makes sense now, like I could see some
39:18
Speaker 1: kid being like, what did you guys do last night? Well?
39:20
Speaker 1: Just you know Netflix and Chill, when in fact they
39:22
Speaker 1: were doing you know, unspeakable things. But now I know
39:26
Speaker 1: Netflix and Chill. Yeah, I don't know how I let
39:29
Speaker 1: that one passed. Maybe it was purposeful, that's right. Um, Well,
39:34
Speaker 1: thanks for that one. Who was that again, Rosie? Rosie
39:38
Speaker 1: appreciate that. Um, and I'll bet that was a really
39:40
Speaker 1: great conversation you have with your mom. I'm glad we're
39:43
Speaker 1: clearing this up though, because there's probably a lot of
39:45
Speaker 1: people that were like, what is is Chuck that dumb? Right?
39:49
Speaker 1: Or maybe they thought like you had just gotten bone
39:51
Speaker 1: dry and your sense of humor and timing and delivery. Um. Well,
39:56
Speaker 1: if you want to get in touch with this, like
39:58
Speaker 1: Rosie did, we want to hear from you, you can
40:00
Speaker 1: email to us directly at stuff podcast at i heeart
40:04
Speaker 1: radio dot com. Stuff you Should Know is a production
40:09
Speaker 1: of I Heart Radio. For more podcasts my heart Radio,
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40:15
Speaker 1: listen to your favorite shows. H