Hi everyone, and welcome back to Airway First, the podcast from the Children's Airway First
Foundation. I'm your host, Rebecca St. James. Today we're kicking off episode three in our
Sleep Lab Sleep Study series with today's guests, Jordan Russ. Jordan is a registered polysomnographic
technologist and sleep educator in Texas. Today, Jordan is going to walk us through
the final steps of understanding what it is to get a sleep lab, what you can expect as
far as the results and reporting go, and questions you may want to ask your sleep specialist
or your sleep technician during the process. So let's go ahead and get right to it and
jump into today's episode with our guests, Jordan Russ.
Good morning, Jordan. Thank you so much for being on the podcast today.
Thank you for having me.
Yeah, super excited. So for parents that might just be hearing this, this is actually the
third in a series of four for our sleep study series. So if you missed it, go back and grab
the first two. The first one was with JT. The second one is with Dmitri. Third is with
you and the fourth one will be with Dr. Gerald Simmons. So by the end of the series, our
goal is for parents to have a complete understanding of what a sleep study is, what to expect,
how to work with your kids, just everything. Yes.
Because it's a better experience for everyone. Right. That's so important and helpful.
Yeah, because it's a scary thing. I mean, even as an adult, I'm kind of intimidated
by this. Well, I'm not now, but I didn't know what went into a sleep study.
No, it is. It's intimidating. You walk in, you see all of the things. Someone's going
to watch you sleep or watch your child sleep. It's very eerie. And so anything that can
make the parents or the patients feel more comfortable and be a little bit more informed
going into it, I think is really important and helpful. And that helps some of the nervousness
and the anxiety of going into a medical procedure. Any medical procedure is scary. Then if you're
anxious, you're not going to sleep. But if you know a little bit about what's going to
go on, hopefully you'll sleep a little bit better so they can get better information
too.
Exactly. Right. And that's our goal.
Yeah.
And so, before we get into everything, let's just take a minute and talk about your personal
journey and how you got into this field.
Yeah. So I got into sleep in a very roundabout way. It was never my goal to even be in healthcare.
I grew up as a competitive dancer and went to the Performing Arts High School in Houston
for dance. And so my whole life was, you're going to be a dancer. You're going to either
be on Broadway or with a dance company in the Performing Arts in some capacity. And I originally
went to college in Boston to the Boston Conservatory that's now merged with Berkeley College of
Music for dance. So like I said, that was going to be my goal. My whole life was dance.
That's what my whole life revolved around. One injury kind of set me back and really
made me reevaluate, is this what I want to do for the rest of my life? I'm 19. I'm in
a ton of pain. I've been diagnosed with arthritis now. Am I going to have to work five or six
jobs just to be able to support my lifestyle that I want? And so I left after my second
year, much to my parents. They were not super happy because it was a very expensive school.
It was a lot to move to from Texas to Boston. And I had spent my whole life working towards
something. So I moved back home and I was like, I have no idea what I want to do. I'd
been to physical therapy. So I thought, well, maybe physical therapy, I could kind of work
in my knowledge of just your body and your muscles and how things work or nursing because
that's kind of what everybody knows. So I went to the local community college by where
I lived, just started taking some general science classes, just working towards kind
of my basics. And I applied to the nursing program, which is extremely competitive and
was put on the wait list. And so anyone who was put on the wait list, all of the other
healthcare programs reached out to them and said, hey, we have these other programs here,
if you want to look into something else. And so sleep was one of them. So I went to the
information session and the program director at the time talked about the program, talked
about the career. And I was like, oh, this is really interesting. Like I didn't even
know this was a career. And so I on a whim applied was accepted and then kind of the rest
is history. And so I've been in since 2013 is when I graduated from that program. So
it's just kind of evolved. I loved sleep. I loved the gratification of helping patients
being a part of their health journey. When you sleep, not great, you feel not great.
And you start to sleep better and feel better. And you kind of get that instant gratification
like, oh my gosh, they slept so good. And they feel good when they woke up and they
haven't felt good when they woke up in years. So I really loved that part of sleep itself.
So wrote round A, but unhappy and here.
Yeah, and we're happy you're here too. And it's so funny. I mean, I can relate a little
bit. My sister got accepted at HSPVA and she was a dancer like you. And I watched her,
I mean, she was my idol. And I watched her and what it did to her body. And now here
she is as an adult with arthritis and other things. And you just don't realize and she
ended up becoming a teacher and a chalet and all these great things.
Awesome.
It's funny, something maybe your passion and you may be just exceptional at it. Sometimes
the universe just kind of takes you the other way, doesn't it?
And you're young and you don't know how to take care of your body. So maybe you're not
doing the best things for it.
And it was such a hard field you were in too. I mean, people don't realize the wear and
tear.
It is hard.
It's hard emotionally. It's hard physically. It's all of those things. There's a lot of
rejection and at some point you kind of go, is this what I want to subject the rest of
my life to? And if it is amazing, do it. But it was one of those things where it was like,
can I get out while I can before I invest too much? And at the point of almost no return
with your physical being and your mental health too.
So I'm grateful for it. It taught me so much, taught me discipline and independence and
things that I never probably would have learned. And as a mom now, I see those things in my
kids. Oh, I had a lot of independence early on because I was kind of in this trajectory
that made you a little bit independent and where so it I'm grateful for it. I'm grateful.
But it led me to the knowledge that it gave me.
And you can use that now. That's the other thing I find so interesting. I mean, going
and looking at you and my sister that's completely different careers than where you started.
But like you said, you can take that discipline and you can take, you have a different, I
would think perspective of relating to people because of what you experienced and what you
had to go through and you understand pain and life pain and having to squish it down
and just keep moving. I would think that that actually helps you a little bit.
It does. It helps you relate and have some a little bit more empathy for patients to
understanding sleep itself. When you don't sleep, you feel awful and it can be chronic
pain and can lead to the depression and lead to a lot of different things that you don't
even realize kind of all ties back to it. And so just being able to relate to patients
is really huge. Yeah. Yeah. Yeah. I would think so.
So okay, so we're going to kind of build on all of this appearance. Don't think we're
just off on a limb here, but stay with us. So today we're going to talk really, we're
going to dig a little bit deeper and build on what we went over with JT and Demetri.
And we're going to talk more about what it's like to have a sleep study and prepare for
it and all just the little ins and outs that go with it. So you are in and I'm going to
slaughter this. So I do apologize. I registered Holly Somnac graphic technologist. Not sure
that is so hard for me to say. So let's just start there. We kind of have a high level
because of the two previous episodes of what this role does and how parents would interact
with it. So let's just talk a little bit more about, for start to finish when you walk in
with your child. This is like you're Julie McCoy of the night. You will walk them through
everything. You're going to guide them through everything. How does this interaction take
place? Yeah. So the role of the sleep technologist
is to get information from the parent and the patient to apply all of the electrodes
that we're going to put on. They also are going to be in charge of the recording and
getting all of that data and information for the physician to look at. We're really the
eyes and ears as well. It takes about 45 minutes to put all of the electrodes on. So in that
time, the tech is talking with the patient, talking with the parent. And in those conversations,
sometimes you learn things about maybe sleep habits or maybe what's going on in their life
that could be causing some of these sleep issues that they're having. And so you get
a lot of information as well that you don't always get from the physician in a clinic
appointment. And so our job is to get that information, really be the eyes and ears,
put on all of the electrodes, make sure that we maintain a really good quality study so
that the physician has all of the data that we need because we would hate for you to have
to come back because something fell off or we didn't get them what we need. And then
in the morning, we will let you know when the results would be ready. Our scope of practice,
we cannot give you any results or tell you how you did. So in the morning, a lot of times
I'll be like, okay, well, how did my kiddo do? And it's well, we got the information
that we need. And then the physician will look at it and run the reports and figure
out kind of what's going on with your child and what's an appropriate treatment plan.
So we cannot give you any results. We can't tell you how you did other than, hey, we did
get the information that we need. And then we take everything off of them in the morning,
clean them up. And then from there, the physician kind of takes over after that with appointments
and going over the information that they gather, the diagnosis if there is any and what the
treatment plan is.
Gotcha. As far as your engagement throughout the night, so obviously you're there in the
beginning, you're there at the end. And as we saw with Dmitri, you're actually not in
the room all night. You're in the facility, you're just in a different location monitoring
all night.
Yeah. So most places, it depends kind of where you are if you're in a private lab or a hospital
lab. They're all set up a little different, but all the techs are in a control room. And
so that can either be right outside of the patient's room or it could be down the hall,
but we're very close in proximity. And what we're doing all night is where you're being
recorded video wise. And that is just to see what position you're sleeping in. Are you
kicking your legs, doing any kind of weird movements that is not typical for sleep that's
going to help with a sleep disorder diagnosis. We're also looking for, are you talking in
your sleep? Are you audibly snoring? Where not only are we getting a signal on our snore
sensor that's on their neck, but also can we hear you snoring? There's an intercom in
there. So if you have to get up or you have anything, you just talk out and we can hear
you and communicate with you that way. And then we're also monitoring all of those electrodes
that we have on you are displayed on a computer screen. And so we're monitoring that all night
long. And so our job is to make sure that all of those electrodes are staying on, we're
getting a good signal. And then we're also making sure, are you safe? So if something
starts to change clinically and do you need any interventions, we are observing you that
whole time. So if anything changes with your heart rate or your breathing or your brain
waves even, we are monitoring that. So if we need to intervene in any way in that capacity,
we can. So yeah, we're with you the whole night, even though we're not right there next
to you, we are right all night long. We don't leave the facility. We're right there with
you and making sure that we are safe and that we're getting really good information. So
the physician has a really good data to look at to come up with a diagnosis and a treatment
plan for you.
Right, which makes total sense. And then the parents and just to clarify so that parents
if they didn't hear it before, they are in the room with the child all night. Your child
is never alone.
Correct. Yeah. And minors, we can't leave them alone. So if they have to run into their
car, they need to take their kiddo with them. Usually they allow one parent to stay and
they sleep in the room with them, whether it be like a couch or a pullout bed, depending
kind of what the facility has, but they will be with the patient all night. They don't
encourage the parent to sleep in the same bed as the child if possible. And that's just
for a couple of reasons. So the snore sensor is a lot of times a microphone. So if the
parents are right next to the kiddo and think it's the child, or if the parents moving
around, it moves the kiddo around and makes it look like maybe they're waking up more
often than they really are. But if that's the norm and that's the only way your child
sleeps, the most places will allow it. And then that may be a conversation of, is this
our normal? Is this just because it's a new environment and so they need your comfort
to be able to fall asleep and then kind of go from there? Or is it they don't sleep?
And this is the only way I can get them to sleep, right? And so it's just what I've had
to do for them and for me. So that's our normal. And those are conversations then that they
can have with a doctor to kind of go, okay, how do we go from here? And so all these things
are just good observations that the tech is observing as well. And they may ask those
questions too of, is this a normal thing? Is this just because we're having a sleep study
and they're a little nervous? And then they're just documenting that the tech is not judging
anyone either. A lot of us are parents, right? You do things as parents that you're like,
maybe you said you would never... It's what you have to do, right?
Have to do. And so if they're writing those things down, it's not to be judgmental or
to ridicule or anything. It's just to kind of be the eyes and ears for the physician.
So they have an understanding of, hey, yeah, the parent is sleeping with the child because
this is the only way they can get them to sleep. And for their well-being and the child's well-being,
this is what they've had to do. That's how we're going to test it. That's how we're going to do it. Yeah, exactly.
Yeah. And that's one thing too, by the way, just to remind parents, I think that is an
excellent reminder. When it comes to sleep and airway issues in general, if you're just
finding the podcast and starting to learn about airway and health, take that mom or dad guilt,
work that just out of the way. We want no part of that. I didn't know with my kids. And when I'm here
and to your point, as a single parent, my tiny people hung out with me a lot, right? Especially
when we had moved into a new place or it happened. We all do what we do as parents and we're doing
what we think is best for our children. So it's all good. Yes. I need to be a sleep professional.
I mean, my kids have slept with me from time to time. My oldest, he was a terrible sleeper.
And I knew all the tips and tricks and things, right? From being in sleep with them,
add issues with them sleeping. And so it's really important to be honest with your sleep tech. And
sometimes it's easier to be because they're not that physician. They're sometimes easier to talk to.
And so really letting them know, like, hey, this is what we had to do because maybe you've had a big
life event that has happened and your kid is going through some things. And that's the whole day
they're finding comfort. That's okay. It's not this taboo thing that you don't want to tell.
It's really important for the physician to get the whole picture of what's going on
so that they can support you. And if your physician's being judgy or rude, find a new one.
Right? There's so many out there that are going to be supportive and understanding of your situation
or whatever is going on with your life that it's important to find one that's going to,
that you feel comfortable with and feel like, okay, this is a good thing.
Right. Exactly. Right. Because we're all walking each other through this journey
together, you want the people surrounding you that you can trust and be honest with and
not have that judgment. Or this should be a judgment reason. Yes. Totally agree.
Yep. Okay. So let's talk a little bit more. So parent, child, we've entered the facility,
we've met our attack, we're having a good time, calm, we're giggling, right? We're getting the
tiny person all hooked up. Now, Dmitri showed us a couple of items so that parents can kind of get
some of these, their bearings, but there's a lot of equipment that is about to go in this tiny person.
Yes. There is a lot and it all serves a purpose. So you walk in a lot of times at NARD, you plugged
into a little head box. There's a lot of colorful wires and there's a lot of things. And so when
we're doing sleep setting, we really want to get all of the information that we can from the patient
head to toe. So your brain waves, their eyes, chin, snoring, breathing, their heart, their legs,
we want to look at a lot of different things. And that is one so that we can get all of the
information in one setting. You're not having to come back three or four times to get all of that
information. And like I said, it all serves a purpose. Sleep is relatively new in terms of
technology and healthcare. And so there are a lot of really cool things coming out that are
hopefully going to reduce the number of electrodes and things that we have to put on the patient.
But for right now, there is a lot and it is overwhelming. It's important to know that no
needles, by the way, no needles. Yep, nothing. They're all just sticky. They're all sticky. If
anything hurts, tell your tech. Can it be a little uncomfortable just because it's a lot of stuff?
Yes, but nothing. Burn, hurt, irritate you. If it does, please tell your technologist.
That's a good question. What if your child has latex sensitivities?
Do any of this bother them or do they need to tell the tech about?
They could tech ahead of time because they could use some different tape. They can
put the electrodes on a little bit differently in terms of cleaning the site that we put the
electrodes on. So if your child has any allergies, sensitivities, blonde kiddos, tend to get a
little red with the cleaning solution that we use. Interesting.
It will be normal, but if it, and it may kind of not burn, but tingle a little bit, if it tingles for
a few minutes and longer and isn't going away, let the tech know. They may have to take the
electrode off, wipe underneath it with a paper towel, make sure they get it all off of there,
and put the electrodes back on. I feel like the only thing that sometimes causes some irritation
is the solution that we clean the patient's scalp with for where the electrodes go. Sometimes
can be a little irritating just because it's a little bit abrasive, kind of like a
toothpaste consistency with little beads in it, and it's meant to be in the skin, get any dead skin,
oil, dirt, anything from where you're going to put that electrode. And so because of that can be a
little irritating. So if it's lingering in your child's, oh, my head's burning or itching, let
your tech know because they can make sure they go in and really make sure they got it all out,
and so that it stops irritating them. Maybe they could, if you have a child that's sensitive,
maybe they could test the arm or something when you first get there.
Yeah, and if your kid has some sensory issues too, a lot of times we are standing behind the
patient, and sometimes that can be a little jarring to the patient because they can't see what's
going on. So a lot of times, techs will take their hands, the patient's hand, scrub a little,
actually put the electrode on their hand so they can see what's going on before they start
putting all the electrodes on their head. So yeah, if your kid has any sensitivities, any
sensory sensitivities, bringing things to distract them, letting the tech know, being involved,
don't feel like as a parent that you can't be right there next to them helping, talking through.
Some parents like, oh, I'm going to be in the way. I'd rather you be in the way and me tell you,
like, hey, you want to sit down, I think I got this, or then you kind of sitting off to the side
and your kid freaking out because I'm a stranger, I'm putting all this on them. So don't be afraid
to be in there. Ask what can I do to help? Bring those iPads, bring whatever games, snacks, whatever
you need to do to kind of be able to distract them a little bit because it is, it's a little scary,
especially if you're a beginner or they don't truly understand what's going on and we're messing
with their head and putting all of these things on their body. It can be a little uneasy. So...
Well, yeah, and especially if you think about, you know, and it didn't even occur to me until you
said it, to them, you're the stranger and you're touching all over them. And, you know, we've all
had surgery and so you have to lift up your shirt and a lecture then. So here's the stranger
all over them. So yeah, I could see maybe sitting beside them, talking to them is going to help
them realize it's okay because we've spent so much time saying, don't let a stranger touch you,
don't do this. And they're going to be all up on them. They're going to be all over them. And having
pajamas that are looser are helpful too so that we can just kind of put stuff over the pajamas or
if we do have to put in the EKG electrodes, we can just kind of gently put them in and they
don't have to take anything off or anything like that. Does one shirt and loosey shorts better?
Or whatever it your child's comfortable in two pieces. Ideal. The electrodes that we put on
their leg is going to go kind of under their knee on that muscle. So if they have pants on, we need
to be able to roll the pants up at least to their knee to put those electrodes on. So if they're
tighter, they just still are they stretchy enough that we can get those electrodes on their leg
and then still be able to kind of pull the pants over or shorts are great. It's comfortable that
we can still put this stuff kind of over and still get to everything without them having to take
anything off. And what happens if the child suddenly has to get a restroom in the middle of
the night? Nothing has to be removed, right? We just kind of march it into the bathroom and then
then march them back. Exactly. So there's that intercom in the room so they can yell out. You
can yell out as the parent, hey, they got it for the bathroom. We'll come in the box that all of
the electrodes are plugged into, detaches from the wire that kind of sends all the signals to the
computer. So we'll detach it, give the box either to the patient or the parent, depending on their age,
and they go to the bathroom. They're wearing everything and then they come back and we just
plug that right back in. If anything falls off in the trip, we can put it back on. It's no problem
at all. Diaper change in the night, totally fine. Just let your tech know, especially if your kid is
maybe older and has bathroom needs, letting the tech know, hey, if they have to go to the bathroom,
we got to go quick or, hey, I need to change their diaper or they have feeds in the night.
Anything like that, let your tech know who started so they can know priority. You know what I mean?
Okay, if they have to go to the bathroom, I need to be in there quick and getting them to the
bathroom and things like that. Or if they need diaper changes, I may have to take off those
leg electrodes just to unsnap them so they can change the diaper real quick and I could snap
them back on. All of those things are just helpful to tell your technologists before you get started
so that they know, hey, I'm going to anticipate this happening. I can be in there to help the parent.
Okay, and that makes total sense. I was just going to head out. The other thing I was going to
clarify because I do believe Dmitri touched on this, especially with the younger's routine is so
important. So if they're used to a nighttime snack or, hey, we can watch Disney or whatever it is,
I'm going to read a book, you can bring all that to the facility and still do all that, correct?
Yes. We want to see the patients in normal, right? What does their every single night's
week look like? Now, you're in a different place in a different bed, but try to keep as much of
that routine as possible. So one, that they're comfortable and two, we can really kind of see,
is it normal for your child to ask for all of these things and then take an hour to fall asleep?
Or is that kind of abnormal because they're in a different environment? So yeah, if they
have a special snack or a bottle, anything that they need, make sure you ring with you.
Most sleep labs do not have snacks or drinks. They may have a water or something like that,
but anything that you need, ring with you. It is considered an outpatient procedure.
So if they need formula or diapers, make sure you bring all of that with you because
they may have an extra diaper or two, but they won't have any formula. They won't have anything kind
of special tea that your child may need. So bring everything with you. The more the merrier, if you
don't use it, that's okay. You had it with you just in case. I'm talking blanket, stuffed animals.
What if they have one of those little nightlights that lights up the room? I mean,
anything that they need, if they have white noise, a lot of pediatric labs have noise machines in
the lab, but if your child has to sleep with this certain rain sound, that's my children.
They all fell asleep to the same exact rain sound, to the say they can't sleep without it. So it would
be something I could bring with me just so that I had it just in case. Anything, bring a suitcase
if you need to. That's totally fine of whatever it is that they need so that they're comfortable
and that they're going to sleep because if they come and don't sleep, they're probably have to
come back again because that's the whole point, right? We need them to sleep. We need to be able
to see what's going on with them and what is their norm. In the morning, if it took them a
long time to fall asleep in the morning, tell your tech that, hey, that's not really their normal
or yes, that is their normal. The tech will just write that down and that'll help the physician
know as well. Okay, yeah, it took them longer to fall asleep, but that's not an issue they normally
have. So we're going to talk that up to being in the sleep lab or yeah, they normally take an hour
to fall asleep and they did that tonight. That is their normal. That's an issue that the parents
are dealing with. And so all of those things are just super helpful because again, we're the eyes
and ears for the doctor. And so any you share with us is super helpful in the doctor coming up
with a plan for your child and for you. Which makes sense. And I mean, I would assume you would
know these things before they get there, but do you handle it differently? Should the parents
prepare differently if you're the parent of a child of that as Down syndrome, for example,
or severity or on the spectrum? Does that change things that change how you as the tech would
work with them or is everything still pretty consistent? Yeah, so I would approach everything
the same way. I'd go in, try to feel what's the vibe, right? How is the kid interacting just
from the time we walked from the lobby to the room? How is the parent interacting with them?
I think it's really important for if the child has anything like their hyper, they're not going to
sit in that bed. Okay, they don't need to sit in the bed until we're ready to get going. All of
those things are super helpful for us. Anything we know ahead of time would just help us with how
long it may take us to put those electrodes on. Is your kid maybe going to need a break halfway
through because that's a long time for them to sit. Can they not sit for 45 minutes? Am I going to
need another tech and maybe we can tag team it to speed it along? All of those things are just kind
of good for us to know, to judge how long is it going to take us to get everything on your child
and to get the study going. Insurance requires at least six hours of recording. We need to prioritize
a little bit timing. We have plenty of time, but also if your kid is going to need breaks or if we
anticipate it's going to take a lot longer to put everything on them, how do we gauge that so that we
can still get the amount of time that we need of recording. Maybe bring them in earlier or something
like it we know ahead of time. Yeah, or grab another co-worker and say, hey, we're going to team this
and that way we can get it done a little bit quicker. If possible, I can have some toys pulled
out already or child life maybe can bring some sensory things and already have that available
if those are things that are helpful. So anything that you can tell ahead of time,
whoever calls you to kind of confirm your appointment is so, so helpful because that gets
relayed to the techs and then they know kind of what they're going to be walking into and what they
can anticipate a little bit throughout the night. What makes sense? So speaking of walking into
Excellent Segway. So let's talk a little bit about as the parents, you're there at night and boop,
tech shows up. Right. So that you're not startled and you know it's going to happen.
What are some reasons the tech may come in and then when the tech is there, as a parent, is it okay
to ask questions? Do we just need to be quiet, just kind of wave and what's the protocol for that?
So whatever you're comfortable with, if you have questions, ask those questions. They may not be
able to answer them because of our scope of what we can and can't answer, say or give results or
information or things like that. But don't be afraid to ask them if they don't know the answer or
can't give you the answer. They'll tell you that. If we have to come in the middle of the night, a lot
of times it's because an electrode has either fallen off or they're laying in a position that
we're not getting a good signal or a good reading or maybe we're getting a kind of a weird reading
on our computer and we want to come look, lay our eyes on your kiddo and see is that accurate.
So that'd be something in before the study starts. A lot of techs will ask the parent,
do you want me to wake you up every time I come in the room? Is it okay to just kind of sneak in
and try to fix what I need to fix? Let you sleep, let the kiddos sleep. What are you comfortable with?
Those are questions that the tech should be asking the parents. Doesn't always happen.
Things can get a little busy or they can get a little. Sure. So if the tech has to come in
the middle of the night, it's usually to fix one of the electrodes or sensors that are on the kiddos.
Kiddos like to be a little bit snotty and one of the electrodes that we put on is like a nasal
cannula like you would give oxygen. We're not giving oxygen, we're actually measuring the pressure
of the air coming out of your nose, but it gets moist especially if they're a little bit snotty
or been crying and if any moisture gets in there, our signal is not so fabulous. So we may have to
come in, clean it out or replace it completely and that's a common sensor issue that we have,
especially with little ones that are a little bit snotty or they've been crying or anything like that.
The pulse ox that we put either on their finger, on their toes, sometimes they like to play with
it because that has a little bit of a red light on it. So if they do, if they pull it off or we're
not getting a great reading, we'll have to come in and move it around. So any reason we come in
is just to fix any electrode that it may be. And so a lot of times we can come in and kind of
sneakily fix things without ever waking up the patient or the parent. If for some reason they
come in and they say, hey, we have to put a CPAP mask on your child and that was not planned,
that could be because they did show obstructive sleep apnea and it was severe enough that we
need to intervene in the middle of the night and put a mask on them and go ahead and put them on tap.
If it was ordered for the study to be that way, like a half-and-half diagnostic, half-treatment,
we would have discussed that ahead of time before the study started so that you knew, hey,
there's a possibility I'm going to come in the middle of the night, put this mask on your child
and this is what the purpose is to help.
That's nice because the child would see it too so they're not startled.
Yes. Now sometimes it's not planned. They are so significantly having some issues breathing
that we need to come in and intervene in the middle of the night and if that's the case,
we'll wake the parent up, let them know the purpose of it, put the mask on the child and
start our titration in the middle of the night. That's rare. It doesn't always happen.
If they're there and maybe they have a trach and we're doing some trials of capping their
trach or uncapping their trach, we may be coming in and maybe it was planned to be capped but
they're not doing so fabulous so we need to come in and uncap it. We would wake the parent
up and let them know so that they understand what's going on with their child as well and
we're not beginning doing a bunch of things and they're sound asleep and they don't know what's
happened. So whatever you feel comfortable with, if you have a medically complex child in any capacity,
ask those questions. The tech may not always know it or know what answer to give you but they can
at least write it down and let the physician know that, hey, the parent had a lot of questions about
their trach or about next steps or what is this going to look like in the future so that the
physician knows they need to discuss those things with you when you have your clinic appointment.
You're listening to Airway First with today's guest, Jordan Rass. You can find out more about
the Children's Airway First Foundation and our mission to fix before six on our website at
childrensairwayfirst.org. The CAF website offers tons of great resources for both parents and
medical professionals. In our parents' portal and clinicians' corner areas, you can find educational
and informational content including videos, blogs, our recommended reading lists, comprehensive medical
research, podcasts, events, parent support, and several educational opportunities. Parents are
also encouraged to join the Airway Huddle, our Facebook support group which was created for
parents of children with airway and sleep-related issues. You can access the Airway Huddle support
group at facebook.com backslash groups backslash airway huddle. Are you a medical professional
or parent that is interested in being a guest on the show? Then shoot us a note via our contact
page on our website or send us an email directly at infoatchildrensairwayfirst.org. As a reminder,
this podcast and the opinions expressed here are not a medical diagnosis. If you suspect your child
might have an airway issue, contact your pediatric airway dentist or pediatrician. And now let's
jump back into my interview with today's guest, Jordan Russ.
Okay, so let's say we've gone through the night you got at least six hours that you needed recorded.
How does this wrap up process? Yeah, so we come in the morning and we'll let you know the study is
over. We have to do some things called bio-calibrations before we take everything off. And that is
an insurance thing to show that, hey, yes, everything was working throughout the night.
We did them before you went to sleep and then we do them again when you wake up.
Just simple things. We ask you to open your eyes, close your eyes, blink, breathe normally,
move your legs. It's just to check all of those sensors and electrodes that we have on you to
make sure that, yeah, they were working throughout the night. Once we do that, then we'll come in
and we'll unhook you. So we'll take all of the electrodes off of you, clean up your head. You
probably will have some gunk in your hair. It's the paste that the electrodes stick with and conduct
electricity, shampoo and lots and lots of conditioner. It's heat activated, so the hotter
the water, the better it kind of melts away. But you will have some of that in your hair. The tech
will try to clean it up as much as you can. The plan to be able to go home and release, scrub
your patient's hair, they may have the body too. Sometimes it leaves it on there too.
So we'll have sometimes you'll have tape residue, some patients, we have that electrode on your
neck that's for your snore and we tape it down. Sometimes when you take that tape off, they'll
have a little redness around it. Totally normal. It's just from having that tape on for so long.
We try to use some tricks like alcohol pads or hand sanitizer to put on the tape first,
so we're not ripping it and giving you a wax job very quickly. Nice. It's about it. So we'll take
everything off. There may be paperwork that you ask your child depending on their age.
How did they feel like they slept? They feel like that was normal. Did they feel like they had any
dreams? They'll ask those kind of questions. They will let you know the typical time that it takes
for the physician to read the study and get back with you. So whether that be a couple days,
a couple weeks, let them know, hey, someone will be contacting you to schedule an appointment to
go over your results. Again, we can't give you results in real time at that moment. So you may
feel like they're a little vague with you, but it's just because we can't give you that information
as much as we would love to sometimes because we kind of know what was going on. Answer any
questions and then you're free to go after that. Free to go home. Usually they don't serve breakfast,
so they tend to wake up about 6 a.m. Get everything off of you so that you're out of there by about
6.30 in the morning is typical for most pediatric sleep labs. Yeah, so you can actually get out.
If you need to get to work or get to school, you have time. Right. So as far as a sleep study
itself, just for kids, because I mean, as you mentioned, it is a new field, but especially
for kids and parents, I mean, this is a whole new work hold for most of us. Why would a child need
a sleep study and why are at home studies really not great options for our tiny people?
Yeah, so there's a couple of reasons. So there's 80 plus diagnosable sleep disorders. So a lot of
times the physician may not truly know what's going on with them. So the best thing is let's
have a sleep study and try to see what is going on with their sleep. A lot of times it's the parent
has witnessed them sleeping with their mouth open a lot or snoring. Maybe even the dentist has seen
some decay in their teeth because they're sleeping with their mouth open. If they have a larger tongue,
a lot of times before they get their tonsils and adenoids out, they'll have a sleep study.
Then say, yes, they have sleep apnea. Let's take out their tonsils and adenoids. Let that heal.
Have another sleep study to make sure everything is... That's a lot of what we see is the tonsils
and adenoids. If they're enlarged, you want to see if, hey, is it causing some issues? Yes. Okay,
let's take those out and see if those issues resolved. It could be they have a respiratory
illness and we need to get that long-term data of their oxygen, their carbon dioxide, their breathing.
What does their heart look like? Do they have a trach? How are they doing with their trach
throughout the night? Do they still need to be on a ventilator or any sort of respiratory support
at night? We see that a lot. They're overweight or they have Down syndrome where they typically
have a smaller mouth and a larger tongue. As we sleep, our tongue likes to fall back and is our
tongue falling back and closing operator weight. Different childhood diseases and disorders have
a lot of sleep issues because of either anatomy or their lungs need some more support. Let's get a
good comprehensive data of what it looks like when they're sleeping for a long period of time
and see what kind of support do they need throughout the night. That's a lot of what we see.
Homesleep testing doesn't record as much as an in-lab study. In an in-lab study, we're recording
your brain waves, we're recording your eye movement, your chin movement. If you're soaring,
are your legs moving? How are you breathing? What's your oxygen? What's your carbon dioxide?
What's your heart doing? We're recording, like I said, a lot head to tail. For a home study,
we're only monitoring a few parameters, mostly respiratory. We're not going to have those brain
waves. I'm not going to be able to see how much sleep you actually got, be able to see how often
did you wake up throughout the night. We're not going to be able to maybe see what your heart rate
was throughout the night or if you snored, depending on the type of homesleep study that you had.
There's different types that record different parameters. Most of them, like I said, are going
to record your breathing. They may have a chest belt and they'll probably have a pulse ock. We'll
know your heart rate and your oxygen saturation, but we won't be able to see your heart rhythm
necessarily like we can in an in-lab study. It's just less parameters. It's really to see,
do you have sleep apnea or not necessarily looking for some of these other disorders?
It sounds kind of snotty about this, but just to clarify, because I know if my mind went here,
someone else's mind went here. It kind of sounds like just in general, home study is really not
much better than your Apple Watch. I was thinking you could record a little bit more, but I guess
you really can't. That's where the technology is coming out, is really how to
we record more with these home studies about having the patient have to put it all on.
So you have to remember for a homesleep study, the patient is responsible for putting those
items on themselves. So we want to make it as simple as possible.
Right. Right. Because what if you put that monitor in the wrong place and you're really
going to get something? There's a lot of room for human error. There's a lot of,
I think, falls off. There's not someone watching you to say, oh, we need to take that back on.
So for home studies, it really was designed for adults who probably have a really high
pre-test probability to have obstructive sleep apnea. So maybe they've met with their
primary care doctor and the doctors. Yes, you have OSA. Insurance doesn't want to pay for an
in-lapse study because maybe they're otherwise relatively healthy as an adult. So they'll pay
for a homesleep study as like a, let's see, do you or don't you? And so the homesleep study can
give us the information of, yeah, they probably have OSA so we can treat them. Or maybe it was
inconclusive and now insurance will pay for an in-lapse study. Gotcha.
You know, we can't really narrow it down to you're one of these 80 with a homesleep study.
That's literally kind of a yes or no. Exactly. And so with kids, we really need to be able to
identify what is going on with them. And so in the world of sleep, 13 is kind of the age that
they categorize pediatric and adults. So when we're looking at sleep, pediatrics is considered
12 and under and 13 and over is adults. However, the physician can use the pediatric rules for 18
and under. So that's where the study is like, it's not approved for anyone 13 and under because
that's where in the world of sleep, our rules and guidelines separate 13 as you can use adult
rules for interpreting and treating your patient. So with that said, most 13 year olds are still
probably having in-lapse sleep studies unless it is maybe they're just overweight and the doctor's
trying to see how much is maybe they're overweight affecting their sleep and things like that. So
that's where that home study is really more designed for our adult population who don't
really have a lot of health issues or medical issues and insurance is saying, hey, we're only
going to pay for this. And so we're going to start there. Okay. These kiddos, insurance will pay for
an in-lapse study and allow them to get that more comprehensive data and information for the physician.
And that makes more sense to me too that we would definitely go that extra step. We're going to skip
this and just go straight for the big money because these are developing humans and we've
got to get to them fast because this is impacting their brain and their brain functions and their
overall health and they'll carry this into adulthood. So I understand the urgency. It does
make a little more sense. Yeah. And insurance and as sleep is becoming more recognized and more of a
topic that general practitioners are having more knowledge of, that they're being educated on more
in medical school and residency. And it's just more of a common place that we're seeing the
importance of good quality sleep and overall health outcomes. Right. If you have sleep apnea
that's untreated, you're more at risk for heart attack and stroke and high blood pressure, gaining
weights, diabetes, all of those things. So if we can treat their sleep and lower their risk for all
of those other things, why wouldn't we do that? Right. And insurance is starting to realize that
as well that, hey, if we maybe spend a lot of money upfront, but it can help them long-term
to help kind of mitigate and hopefully reduce their risk for a lot of other health issues.
Same for kids. We're seeing their school performance suffer because they're not getting
good quality sleep. Kiddos who don't have good sleep are not necessarily fatigued and tired.
They're super hyper and crazy. ADHD. ADHD. And so there's that correlation now of,
are these kids really ADHD or what does their sleep look like? Are they just not getting enough
sleep? Is that education that the pediatrician can help the parent with? So now more pediatricians
are having those conversations with, hey, a six-year-old still needs 10 to 11 hours of sleep.
So yes, they may be able to stay up till nine o'clock, but if they're having to get up at six
o'clock for school, that may not be good. And so we may negative behaviors or things that can just
be mitigated by going to sleep an hour earlier. Little conversations like that are happening
more and more as more information is coming out and more research is coming out showing
how important good quality sleep is for everybody. Yeah. For kids, for teenagers. Okay,
teenagers like to stay up all night. Well, that's normal because of their hormone changes.
They're wired, yeah. So their circadian rhythm is changing. So it kind of helps the narrative of
later start times for school. Exactly. And all of those things. So as sleep is getting more research
and more mainstream, I think we're going to start to see the emphasis on really supporting patient
sleep and supporting them as their overall health. Yeah, which I love that. And by the way,
it just doesn't hurt to mention this again, if you go through this with your child and
previously they've been diagnosed with ADHD and you've been giving them medication and we find
out it was an airway or sleep issue, please don't feel guilty doing what you thought was best for
your child. You did what you know and here's where you are now and keep moving on. It's all good.
It's all good. And that's, it's one of those things you don't know what you don't know. And if you were
never educated on how much sleep your kiddo needs or they're doing all these extracurriculars, you
have to get up to go to work. So maybe they're going to daycare before school because of your
job schedule. That's okay. And so what are some little changes that maybe we can make
to support not only you, but also support your child and reevaluating constantly of,
hey, all of a sudden we're starting to have issues and we've never had issues before.
What are some little things maybe we can start changing and see, do we see a change in behavior?
If not, that's okay. There's true ADHD kids out there. It's not always a big issue. But sleep is
a big issue and especially in kiddos when they don't act tired or they get a second wind and get
real hyper at night. Sometimes they're a little tired and then we've kind of missed that window
to get them to sleep and that's okay. And I've been seeing pediatricians even from my first
child to my third child where the pediatrician is now educating on sleep and how much sleep they need
and what is normal sleep at different ages. Where with my first, he never expressed that to me and
he didn't even know I was in sleep. So just the education in general that parents are getting and
their pediatrician appointments, I think is improving too and helping with that narrative of
getting good quality sleep. I totally agree. I agree. And I'll put links in the show notes to some
of these things, but there's some really, really great books. If you want to read some of them,
there's Why We Sleep, a fantastic book for sleep-wrecked kids sharing more. Fantastic. And that gives
you as a parent a lot of sleep hygiene and a lot of tips that you can do that like you've been
discussing that you can try with your child. Brave parent is another one. We'll put a link to that
one in there. And then our website's got some really great stuff. We've collaborated with some
of these authors. So we're not just pulling this out of thin air, but there's also the Texas Sleep
Society and the Sleep Education Consortium. And that's for physicians and ballet professionals
as well. Check out these resources. But as parent, as you mentioned, there's 80 different
diagnosis you can come up to. Head on over to the Sleep Education Consortium and check some of
these out because I think as a parent, once you understand and you have this knowledge,
you can make better decisions to help your child. Exactly. And it goes back to that guilt, right?
We don't know what's going on. Well, I mean, you feel like, oh, is it something I did? Did I
get them up with good sleep habits or we had this great schedule, but we had this huge life
change and job changes and maybe we had to move or whatever. And now they're all out of whack.
It's okay. It happens even with us as adults, right? We go through loads of our sleep. And so
there's so many resources out there, like you said, now that you can find, even if you're just
searching, I have a six-year-old boy, how much should he sleep? Right? And there's tons of data
out there and, oh, my six-year-old is having this issue. What could it potentially be? Because a lot
of those AD sleep disorders are more adult-based or maybe more age-based. And little kids, we see a
lot of sleep talking, sleepwalking, night terrors. All of that's normal. We expect them to grow out
of it as they get older. It's due to how much deep sleep that they get. So sometimes it's just
looking at those things and realizing, okay, night terrors are terrifying for the parent,
but the child has no idea what's going on. They are sound asleep when it's happening.
They will not remember it. I was gonna say they're not gonna remember it. That's the right thing.
So sometimes it's just giving yourself that peace of mind of my child is standing screaming at
midnight. And it's hard for the parent, but the kid has no idea they're gonna go back to sleep.
They've been asleep the whole time. They're gonna grow out of it. So just sometimes giving the
parent some of that peace of mind is super helpful too. So like you said, there's so many resources
out there. It can be daunting, but ask pediatricians, start there if they don't know and say, hey,
who can you refer me to? You may go to a sleep doctor and they say, no, they don't need a sleep
study. Maybe let's just keep a sleep diary for two weeks and kind of see what is normally happening.
Medications affect sleep a lot. So if your kiddo is on some medications, look up the effects of
Swiss. It's something maybe it just the time of day that they take it changes. So there's a lot
of little tweaks that can be made that can help your sleep. Yeah. And I'll just throw this out here
if I were a betting person because I've heard this from other parents and I went through this.
I'm sure you went through this. I've heard this from other guests. As you're going along your
child's sleep and airway journey and you're doing your research, you're going to these websites,
you're reading the books, you're listening to the podcast, you're talking to your providers,
you're going to have these moments where you look in the mirror and go, because you realize, oh,
I could be doing better. This is impacting me. I mean, I come from a long line of people that
wore the fact that we got about four hours of sleep because that's just how we're built.
Like I came out of the womb, not sleeping. I've heard this my entire life as a badge of honor.
Yes. And people would always joke me, why do you ever sleep? No. Well, guess what? Your girl
sleeps now. I've worked really hard to tell my body, no, that's not good for you because you also
start as you do the research looking down the road. While dementia, Alzheimer's runs in my family,
high blood pressure, diabetes, guess what's all related to sleep and airway? Yes. Like mind blowing
and you realize, oh, I didn't know. My parents didn't know. Let's make some changes. And I think
that also trickles down because now your children are seeing, mom or dad is adjusting and look at
what it's doing for them. Oh, maybe it's not so scary. I can do it. Right. It's how we prioritize
eating. Right. We prioritize maybe, okay, I could start changing little habits here and there. Same
way with sleep. Prioritizing sleep is a prescription almost of how much sleep should I get? What kind
of little things can I change? How can I adapt my schedule to support me because I will ultimately
feel better if I'm getting the amount of sleep that I need. Women need more sleep than men.
We need different sleep needs throughout the month, depending on our hormones and our cycle
and things like that. And so understanding that and prioritizing that, like you said, it trickles
down. Your kids watch everything you do, whether you realize it or not. So if they see mom and dad
going to bed and shutting everything off and having a nice, cool, quiet environment, they're
going to do that too. And all of the things that I used to fall asleep with the TV on because
that's what I did as a kid because that's my parents did. And so, exactly. I did that. And then
learning, oh my gosh, that's light, those blue light and all the light that I'm getting. It's
impacting how I'm sleeping even though I feel like I'm sleeping and making those changes. And
it's not wrong. It is what it is. And so, what are the things that we make that then will support
our kids too. And they'll do better. They'll have better attitudes. They'll have less meltdowns.
Right. If they do have any chronic illnesses, those will hopefully improve a little bit because
their body is now able to rest and repair the way it's intended to when we're sleeping.
Yep. And I will tell parents that don't think it's real. As somebody that has been through this
process because I do have an airway disease, which even page in the term disease, I know,
has been an airway issue for 20 years, but it's an issue. These changes, the little things,
make impacts. There's meds I'm not on anymore. I actually do sleep six to seven hours a night,
which is phenomenal. That's great. I'm not tired during the day. And yeah, I do still have the
airway issue, but just these little changes, it does matter. Right? So, yeah. And take advantage
of something as simple as your phone, you can mute it at night. You can set it up to where it goes
into hibernation at night and only certain people can get through. My people are away at school,
because they're older, but if they need me, I will hear that, but I won't hear anything else at night.
And you think, oh, that's not a big deal, but these tiny little sounds and every time your phone
goes off, the light comes on. You don't realize it and it does make an impact. So just do your
research and check out these books and these websites and you're going to learn so much.
And no, you really are. And even if you can just find a sleep hygiene handout, there's some great
picture ones too. And just give it to your kiddo if they're at the reading age or understanding age
and say, okay, what are some of these things that maybe we can all do as a family and make it like
a full of that? Yeah, do it as it is. Yeah, let them be involved. Is that then when they're empowered
and they feel like they're involved, they're going to buy into it. And then they see mom and dad
doing it, their siblings doing it, they're doing it. And like I said, it's just going to improve
everybody's quality of life, well-being, happiness, health, yeah, everything. It's just, it makes
everybody feel better when you sleep because when you don't sleep, you feel like crap and you know,
feel good and you don't have the energy or motivation and then you can get into this kind
of cycle of sadness or frustration or guilt, anxiety, there's everything because of it.
Yes, of all of these things. Yeah, which is crazy because you don't realize it. So, and I know we've
touched on some of this because that's just kind of how it went, but I am still going to ask the
question because I always ask it at the end of every episode. What are some of your final thoughts
that you would want to leave with parents when it comes to sleep studies or sleep hygiene?
I think the most important thing is to remember, you may go in and they may not find anything
going on just because they order a sleep study doesn't necessarily mean there's something going
on. It could just be, okay, we need to narrow down or figure out what is going on and that could
just be sleep hygiene changes or a medication change because they're on this medication that's
causing them to have some sleep issues or you go in and you may get a diagnosis of something
and that's okay because you're going in, you're trying to find the help and support for your child
and so if they have to wear a CPAP mask or have some sort of support throughout the night, that's
okay. It doesn't necessarily mean it's going to be forever either. It could be they grow out of it or
hey, we're going to do this in the meantime and make some changes and see if that helps support them.
So many times people, especially in the adult world, I don't want to wear that mask the rest of
my life. I don't want to wear this the rest of my life. Okay, but why is it after having you wear
this? Because you're not breathing for at least 10 seconds, more than five times an hour if you're
an adult, that's a lot. It's hard to even hold your breath for that long, that often. And so
understanding there's a reason for the treatment plan and that it doesn't have to be forever and
the more you can educate yourself and ask those questions, the more you're informed and can make
the decision that you feel is best for your child. And so in letting the kids know that there's
nothing necessarily wrong with them, if they have to wear it at night, it's just helping them breathe,
helping keep that airway open so they can grow and be big and strong and be good at school and be
able to do whatever they enjoy to do. They're going to want to do it because they're going to feel
better. So I think it's just important for parents because it's easy to be like, oh my gosh, this
is another thing, right? Or they're going to be on this the rest of their life, well, not necessarily.
Maybe as they get older, they won't need it. Maybe just a short-term thing or maybe they
took their tonsils and adenoids out and they still need some support. But as they grow and their
airway gets bigger, they won't need that support. And so just asking the questions, don't be afraid
to ask the questions. It can be scary. If it's not working, freaking out why is your math isn't it
working? Don't feel like, oh, I'm just going to throw it in the corner and not use it anymore.
There's other masks out there. There's other options out there. Sleep is so new in terms of
health care that there's so many things coming out. I was just at the Texas Sleep Society meeting
and just to see all of the new things coming out and hear all of the things coming out,
it's amazing. And so, 10 years, I think sleep's going to look very different in terms of treatment
options for patients and long-term options for patients. So I think just take it one day at a
time. It's okay. If something's not working, talk to your doctor about it. Get a new mask. Say, hey,
I don't know what I'm supposed to be doing with this. That's okay. They don't expect every parent
to know exactly what they need to be doing. It's daunting. Having your kids help you with it.
If you need a therapist's support in the meantime to maybe help with some
acclimation therapy or anything like that, don't be afraid to reach out and see what kind of
resources are available, especially if your kid's going to be on CPAP. And maybe they're
really having a hard time with it. School counselors are really great too. So my friend was just
diagnosed with a lot of allergy issues and has to do some allergy shots and he was
devastated. He's eight and he's like, why? This is not fair. My brother doesn't have to do this.
And I reached out to his school counselor and she talked to him and he felt so much better.
And that's like, that's a free resource, right? That's their friend.
Yeah, that's true.
If you're feeling kind of stuck or your kiddos maybe having a hard time understanding
what's going on with them, reach out to those resources because if they
understand what's going on with them, they're going to want to do the therapy, right? Whether
that be some little changes here and there or where that or anything like that. And they know,
hey, mom and dad are on board too with what's going on. I likely to do it and to buy into it.
And that's big. You've got to get them to buy in or it's going to be a struggle for everybody.
It gives you a struggle and you need to ask for another one from your DME company so their
bear can have a mask on too or their stuff. The animal can have a mask on too or little things
like that. Finding communities, there's so many ways to connect with people.
Truly now, forums or support group, anything like that so that you feel supported and you're not
alone because you're not alone as a parent. You're not alone either. They're not the only one in the
world with this. It's very common. And so letting them know that, hey, yeah, it doesn't mean that
there's anything wrong with you. It's just we want your body to be able to grow and sleep and support
and all of those things you learned at school. We want to stay in your brain. And so that,
when we're sleeping, we're processing all of those things and it's storing it.
And so we're just wanting to support you while you're sleeping.
Yep, I agree. And it's so funny because some of these groups, we have the airway huddle,
for example, is our parents support group, but there's others out there. And there's even some
stuff I've seen people lost on Pinterest. And if you're a crafty person, the funniest one I saw,
and there is a little thing on there about how careful they had to be, but it's only on the
outside. They painted a bit of the mask. So they could be Darth Vader. And I just thought, first
of all, that parent and I need to be best friends. But second of all, that's brilliant because you're
making it. I don't know what kid's not going to love that with smoke. Manel, I'm thinking it's the
greatest thing. I mean, I love that. So these are, you can find a way. You've got to put it out there.
And like after the Top Gun movie came out, you saw all those things on the air and the men with their
CPAP masks, looking like they're all of those kinds of things. Find pictures of fighter pilots or
whatever wearing the mask. All are cooler and see through and all of those things that help them buy
in and realize, this is kind of cool. It'll be okay. It's totally fine. And it's, I always tell my kids,
I'm not doing anything to be mean or to hurt you. It's to support you and to make sure that you have
everything that you can and everything available to you so that I feel like, okay, you're supported
in your health journey, whatever that may be and whatever I can do to support them. And so letting
the parents know that by getting them to the sleep study, that's the biggest hurdle because you relate
some concerns that you had and you're wanting to help your child and figure out what's going on with
them. And so that's the biggest step is just getting there and showing up. And everything after that,
we can figure out and work through and there's tons of support for you and that you're doing
the right thing for your child too. Yeah, you're doing these short-term things for a long-term goal.
Exactly. Exactly. Yeah. Thank you so much, Jordan, for being here and for really kind of bringing it
all together and just building on some of the things we learned in the other two episodes.
Thank you so much. Thank you for having me. I appreciate it.
Thanks again to today's guests, Jordan Russ, for being on our show and to each of you for listening.
You can stay connected with the Children's Airway First Foundation by following us on Instagram,
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or have an idea for an upcoming show, shoot us a note via the contact page on our website or
send us an email directly at infoatchildrensairwayfirst.org. Today's episode was written and
directed by Rebecca St. James, video editing and promotion by Ryan Drone and guest outreach by
Christy Bochinkian. And finally, thanks to all the parents and medical professionals out there
that are working hard to help make the lives of kids around the globe just a little bit better.
Take care, stay safe, and happy breathing, everyone.