Several of you asked me to share what happened at my meeting with the local
docs on the subject of tongue-tie.  You may recall that I noted that a
previous meeting had basically generated torn hair (from pedi's) and
incredulity and disbelief about the need to do a frenotomy.

Well....since I knew the person who had done that presentation and knew her
not to have more than one head (smart brain enclosed) and reasonable in
presentation, I concluded that this was the way the docs were "testing" the
new kid on the block.

I checked in advance and found that 5-10 Peds show up for these "Journal
Club" meetings.  When I arrived, there was no one in the room.  Within 5
minutes, one and then another showed and about 20 min. into the
presntation, an office nurse and another Pedi came in.  So much for
competing with gorgeous spring weather and spring break.  One Pedi had an
appt. with his barber!

Anyway, I showed the E. Jain video with some introductory remarks and gave
out a 2-page annotated bibliography and a single sheet with about 10
factors they need to pay attention to in considering whether tongue-tie is
the problem the breastfeeding mother and baby are having.  We then briefly
reviewed that sheet and I noted the key elements that are MOST likely to be
problematic and those that are considerably iffy-er.  I then showed the
video, and we talked over lunch after it was over.

One of the pedi's there is old enough to have trained (at Un. of Chicago!)
when they actually taught something about tongue-tie and he admitted he
does them in his office!  (I also have been informed that a plastic surgeon
in town also does them, but I have yet to meet him.)  One of the other docs
asked if lidocaine was necessary and I said, not really.  "After all, this
procedure is far less traumatic than a circumcision and rarely is any
anesthetic or analgesic used then."  The pedi who does them laughed and
nodded and said, "not necessary."  The other pedi (an Asian woman) remained
skeptical throughout the presentation, even after the senior doc poked her
arm and said, "Now that you have seen the video, you can do them, too."
She smiled (uncomfortably, it seemed to me) and said nothing.

In the course of the hour I was with them, we did end up talking about more
commonly occurring things (after all tongue-tie is probably only at an
incidence of about 1-2/1000 based on one study that looked at the frequency
of identification in a population born on site.  Those of us with referral
practices will see it with more frequency, but then again, that does not
reflect the usual incidence, since we would probably only see and hear
about those requiring help.

Those who were there were welcoming and seemed very pleased with the
presentation and our discussion and the senior doc asked for my cards.  He
also said something disquieting. "I hope you are not 'aced out' due to
politics and the managed care restrictions."  This may help explain why my
practice has not taken off at all.  I have only two pumps on site and am
thinking of returning them for total lack of rental business.  I have also
heard rumors that only nurses are allowed to see people on home visits,
although a previous client was a home visit referral from another pedi.
practice.  Time will tell whether I continue to go broke here or things
pick up enough for me to maintain my practice.

Well, folks, there you have it.  A little 1-hour presentation on a topic
that affects VERY FEW babies and about which LCs probably know more than
most MDs who are not at least 60 years old!  It was fun, I got a free lunch
out of it, and (hopefully) some future referrals.

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"We are all faced with a series of great opportunities brilliantly
disguised as impossible situations."
Kathleen G. Auerbach,PhD, IBCLC (Ferndale, WA USA) [log in to unmask]
WEB PAGE: http://www.telcomplus.com/~kga/lactation.html
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