Stuff You Should Know - How Cleft Lips and Palates Work

Episode Date: May 25, 2021

Cleft lips and palates are common birth defects, but for the kids who have them (and their parents), its no small matter: Years of surgeries, therapy, and possibly lifelong health issues, not to mention the teasing that comes along with looking different. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

I'm Munga Shatikler and it turns out astrology is way more widespread than any of us want to believe. You can find it in Major League Baseball, international banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed. Whether you're a skeptic or a believer, give me a few minutes because I think your ideas are about to change too.

Just a Skyline drive on the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. Here's to the great American settlers. The millions of you have settled for unsatisfying jobs because they pay the bills. Of course, there is something else you could do if you got something to say. Start a podcast with Spreaker from iHeart and unleash your creative freedom. Maybe even earn enough money to one day tell your old boss, hey, I'm no settler. I'm an explorer. Spreaker.com, S-P-R-E-A-K-E-R.

That's a lot over today. Welcome to Stuff You Should Know, a production of iHeart Radio. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Chuck Bryant and Jerry is literally right there. And Chuck, I want to start something. I'm going to get, I actually have a jar at my studio at home. Swear jar?

Kind of, but it's a use of the word literally jar. I'm trying to break myself of that, except when it really truly makes sense, when it literally makes sense to use that word. Like in this instance, Jerry is literally sitting right here. So do you have a problem with misusing that word like so many people? It's not, yeah, no, not necessarily. It's overuse. That's what bothers me.

Yumi, is she donating to the jar at all? Or is she just like, this is literally the dumbest idea. I don't think she has an opinion on this one. Okay. Yeah. She just spends the money. Well, I keep the jar at home. I can't get money out of it when I need to.

It's more just the ritual of like punishing myself, calling out that I'm doing something stupid. Once a Catholic, always a Catholic. Basically, yeah. So, oh yeah, this is Stuff You Should Know. And we are talking, Chuck, today. How are you doing, by the way? I'm great.

Good. We're in the same room. It's still a little weird. Getting used to it still. Yeah. I went to a baseball game last night. Oh my God. And that was weird.

I mean, it was great. And once we got on our seats, we were actually, I mean, they're fully just selling seats, but where we bought seats, there just happened to be no one kind of around us, which was good. Oh, nice. Yeah. So you're at a Braves game? Yeah.

I went to a Braves game. We were playing, you know, unless you're in your seats eating and drinking, you should be wearing a mask. And so we, the four of us wore masks, you know, in and out in the bathrooms, in the food lines and all that stuff. But nobody else was. Well, I mean, we're in Atlanta. There's a lot of jerks in Atlanta.

Yeah. It is what it is. We took care of ourselves. And it's fun. Yeah. No, I've noticed. But it was fun. Well, that's good.

I'm glad you had a good time. Yeah. Walk Off Homer. Oh, yeah. It was like one of those in my life. Wow. It was amazing. It was a great game.

Yeah. It was cool. Who'd we play? We played the Mets and our star player, Acunia, blasted one in the bottom of the ninth first pitch. It was just great. I thought Freddie Freeman was our star player. They're, I mean, they're one and two.

They're neck and neck. On any given day. I got you. Yeah. I wouldn't want to be number two. You know what I'm saying? But yes. No, of course not.

That's why I'm number two. No, that's not true. You, me, Jerry, all tied for number one. But anyway, it was a little just, it's just a little jarring to be among a lot of people again, but it also comes back quickly like, oh wait, I spent the first 49 years of my life among people, took a year off and I'm back in the swing. That's good. That's good.

I'm hoping to get back there myself. Yeah. You should. At any rate, this is still a little weird. So we're talking today about clefs and most people, when they think about clefs, they think about cleft lips, but there's a lot more to that. Or treble clefs. Sure.

That's a little different. There's an extra letter in this one that I'm talking about at the end. How is that spelled? Is that just treble cleft? No, C-L-E-F. Oh, there's no T? Treble clef? Clef.

I didn't take piano. That's okay. All right. But no, that's a clef. This is a cleft. Okay. A cleft in this case is, it's a division, it's a trench, it's a void, I guess you could say.

And that is what we're talking about, is a very common, actually, fairly common birth defect. That's right. It occurs in the embryonic stage and a child is born with part of their lip and or part of their palate, the roof of their mouth is another way to put it. Right. Missing. It's just not there.

Unjoined. Yep. And we should probably say right at the beginning, this is a birth defect, but it is a visual difference. Yes. Is what we call things like this. It is not a disability, although there are many complications we'll go over, but it's a visual difference and it is also, the term hair lip is not something you should use.

It was used for many, many years, even by doctors to describe this condition, but it is not a good, nice term. So just stop saying it. Yeah. I don't know anybody who says it. I don't think so. But some people just may not know. Sure.

I thought that's what it was called. Even doctors use a term, you can sort of understand, you know, like somebody falling into that trap. Sure. But it's not a term that we use anymore. No. And I think that was a good thing to say. All right.

So the COA is finished. So like we're saying, it is, like you said, it is a birth defect, but it is just a visible difference. And there's, I mean, that's, that's it. I mean, it is tied in with some syndrome, some genetic syndromes, but plenty of people, I think in the United States, somewhere between one and every 700 births comes with some sort of cleft, either a cleft lip, a cleft palate, or both. And there's, that's it.

That can be it. That's the only thing that is different about that child. There's no developmental problems. There's no, like you said, it's not disability. There's nothing else. That's it. And what's fascinating to me, I had no idea about this, but I never really thought about it is that the, the, the kid with the cleft lip or the cleft palate, their, their palate

or their lip just never finished forming. Yeah. They never, you know, there's a symmetry generally running down the center of your nose and the, the two sides of the lip, you know, the stuff forms when you're in the, in the womb very early on, actually, I think the lip is first and then the palate. But you know, they joined together. And in this case, they just don't join. Yeah.

You know, the little, the little bit under your nose and joining the, the, the bottom of your nose to your top lip. Yeah. That's called a philtrum. Oh, okay. And that is where your lips join together, your upper lip joins together. Right. And that is where your mustache can part.

Yeah. Yeah. You got a little mustache part. I have a mustache part because mine, but you know, some guys, you shave yours in just for looks or is it growing naturally? It just kind of parts naturally. Your hair doesn't quite grow right there. But you know, if you're like a Burt Reynolds type or a Wilford Brimley, you can just grow

it over the, the whole, what's it called, philtrum, philtrum, P-H-I-L-T-R-U-M, philtrum, which would be a really great nerdy boy's name. Filtrum. Yeah. Yeah. And his brother Baxter. On second thought though, don't name your son, Phil, so when you are in the embryonic stage, like you said very early on, the lip forms in like the fourth to seventh week and

very frequently, a woman might not even know she's pregnant at that time. And that lips forming. Yes. Already. I saw a really cool BBC documentary sequence basically where they took 3D images of a baby in utero and basically turned it into a flip book video showing the face forming. Your nostrils are giant when you're forming and they're like on the top of your forehead. They move down and each nostril is part of a tissue plate.

And then the bottom jaw and your bottom lip are part of a third tissue plate. So you have three forming and coming together and as they form new cells, form new skin and they just kind of move into place. If you have a cleft lip or cleft palate, again, that final meeting in the middle just never happens. Yes. So when you watch something like that, are you amazed at the miracle of life or are you disgusted?

Amazed at the miracle of life. Okay. Yeah. For sure. Because when you think of nostrils on the top of the head. It's nothing. I just feel like that's the most. It's neat.

Actually, it is. Oh, it is super cool. Yeah. For sure. So miracle of life is what I'm going with. So there are different ways this can happen. Your palate on the top of your mouth is in a couple of sections. The one closer to the front is the hard palate and the rear, it's a soft palate.

And if you have a cleft palate, it can be in the soft part, the hard part, it can split both. Yeah. Because if you rub your tongue. Don't do that. On the top of your mouth. Don't do that. The front part is bony.

That's your hard palate. If you go further back, it's really kind of tough to do, but you can just, you got to stop that. You don't like that? No. I don't think anyone does. I really. You think some people like hearing that?

Yeah. It's kind of pleasant. Anybody who liked that, shout out. I want to hear you. I think there's some kind of a pressure point in your soft palate too for, is it migraines or something? I remember hearing about like pressing your thumb into your soft palate to do something. Ice cream headache.

No, it wasn't that. It was something else. Oh, well you can cure an ice cream headache with putting your tongue against the roof. It may be multi-functional. Anyway, in the very back, you have just a muscle, like your hard palate is bony with some skin covering it. After back, it's like muscle with skin covering, and that's your soft palate. It feels like a little rib cage up there.

And you can have this division, this cleft in either part or both, right? That's correct. Yeah. That's what I said. So an incomplete cleft is missing, it's a little notch, and it's missing from the middle of the upper left. A complete cleft is all the way through into the nose, and then with the lip, it's always the upper lip, but it's usually off to one side or the other, I think, because of that

symmetry and how it forms. Yes. And it's always the upper lip because it only affects the two top plates of flesh that are forming that form your upper lip and your face, and those forehead nostrils that come back down to your nostril area. That's right. God, it's just like old times. Cherry's literally dropping food out of her mouth onto the table.

Is she eating me so easily? This is amazing, no, but it's so funny. I don't know. I think there might be a little bit. Got all day, and she chooses to eat when she's in here. I think she should take a break. I think so too. All right.

That's a good opening salvo, so we'll be back after this. All right. I'm Mangesh Atikular, and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get secondhand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention, because maybe there is magic in the stars if you're willing to look for

it. So I rounded up some friends and we dove in, and let me tell you, it got weird fast. Tantric curses, Major League Baseball teams, canceled marriages, K-pop, but just when I thought I had a handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed.

Whether you're a skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. I think I might have missed you, Salvo, did I? I don't think so. Was that right? Yeah, I associate that with like a timpani or a cannon going off. Oh, sure.

Fanfare. Yeah. All right. I think you used it correctly. All right. It was a clef that you got wrong. It was a clef. They are developmental defects, like we said, very early.

And what causes them, you know, genetics can play a part. I think if you're a parent, you have, with a cleft, either palate or lip, you have like a two to 8% chance that your kid may, if you have a biological child. And then that goes up if you have siblings or if you have your parents, and it's sort of passed down. I think that number can go up to like 20 or 30%. Yeah, it can. If your parent has a sibling that has a cleft as well, the chance of your kid having a cleft

is definitely increased. And then it can keep going up depending on whether or not your parent has a genetic syndrome that they're passing along. I think there's something like 300 to 400 different genetic syndromes that are associated with cleft lip or cleft palate. And together we should say they're both called orophacial clefts. Oh yeah. We didn't say that, did we?

And I've also, no. And I've also seen it abbreviated as CL slash P, cleft lip slash palate. That seems to be kind of like the shorthand for it. Because doctors don't like to write full words. No, they don't. And their handwriting is just terrible. And then I've also seen them called affectionately as clefties. Oh, that's nice.

So and, you know, we'll talk about the, you know, acceptance of facial differences if you have a cleft or have friends or family members and that's a big, big part of it. And I think something like clefties might be, but we have embracing that. So there are some other things that could be risk factors and increase the risk of all kinds of birth defects, certainly including clefts. And one of them is if you're smoking and drinking booze while you're pregnant, one of the reasons alcohol affects any kind of birth defect is because it disrupts the absorption of folic acid.

And that's another reason you might, if you don't have enough folic acid, that's why pregnant women take extra. It's a natural form of B9. It's a vitamin. And I think in the late nineties, the FDA said, you got to start putting extra folic acid in like all kinds of common foods. I remember that sort your recyclables, start taking folic acid. Yeah.

And, and just like put it in bread and pasta and grains and cereals and things that people eat a lot of it's naturally found in sunflower seeds and fruits and beans and peanuts and stuff like that. So you want the folic acid. I think if you're pregnant, they recommend you take at least 600 milligrams per day. And if you're just a regular old non-pregnant human, 400 milligrams a day. Yeah. If you are in your reproductive stage or age.

Right. But you need folic acid anyway, right? Why not? Just as a person. Sure. Yeah. I eat a lot of bread. I get a lot of folic acid.

So smoking and drinking is one, diabetes is another, right? Yeah. That's a really big risk factor. Diabetes and obesity both seem to be correlated to increased risk of clefts. I'm not sure what the incidence is for women with diabetes, but it is an increased risk. And then there's also a couple of epilepsy medications that increase your risk. The thing about all this is there is no definitive understanding or explanation of why clefts form.

Right. Of what it is that causes some children's lips just not to join together or their palates did not fuse together at that last final stage. It seems to be multifactorial is what they call it, where there's just a bunch of different factors. And also, in addition to genetics, like your parents having one or your parents having a sibling with one, depending on your race, actually, your risk is increased. Apparently, it's far more common among Asian people and Native Americans.

I think it's the highest among Native Americans. Something like 3.6 out of every 1,000 births, I believe, to two among Asian people. It's the lowest among African Americans. Yeah. I think Chinese babies are more commonly diagnosed as a diagnosis or just what do you even call that? No, you're diagnosed. Okay.

But I mean, it's like very easy diagnosis. Right. It's like, oh, okay. Your child has a cleft lip. What's interesting, Chuck, is with the cleft palate, you can have a cleft palate, but it not be visible. It can actually be hidden. Yeah.

That's called a submucosis cleft palate, and you might never be diagnosed with it because there may be no problem with it or that arise from it, like with other clefts like we'll talk about. Yeah. But that's kind of great from what I understand. Right. And the palate is less visible anyway as opposed to the lip. Right.

And if you see any kind of photo image of cleft palate, it's usually a doctor taking a picture of someone with their mouth wide open, kind of tilting their head back so you can get a good angle on it. Right. Health problems that are associated with clefts are, they can be numerous. It's not, it seems like everything is something that can be overcome, but they are challenges nonetheless, and they are challenges that especially can just make a kid when they're growing up feel not so great about themselves.

So that's a big, big part of overcoming these challenges, but to be sure there are some physical things that happen, like it can interfere with how your teeth are forming and growing in. Yeah. Sometimes you might have to get bone grafts on the upper portion of your gums. Especially if you have a cleft lip. Yeah, cleft lips, it seems like it's usually where the teeth problems come from. And then one of the first things, you know, if you're nursing your baby, then if your

baby has a cleft lip or, and or a cleft palate, they may have trouble latching on and getting a good, like a good suck is what they call it. Yes. And if you, luckily there are different methods for improving that, there are certain types of bottles which can help with that. So again, that's a problem that can be overcome pretty routinely. It's the easiest to overcome and to nurse a child with a cleft lip because you can set the baby up and as usual, chuck them in the air and you can just after they latch on,

you just kind of put your finger over their cleft lip. Oh, and just like close the gap. Basically. Yeah. It's easy as pie. If you have a cleft palate, it can be much more difficult because we use our palate to create suction, use your tongue and your palate, your soft palate in particular to create suction. So there's specialized bottles for feeding babies with cleft palates.

And in particular, if the baby is just not able to latch on for breastfeeding, they still say, well, just pump your breast milk and feed your baby the bottle milk because unfortunately, because of that gap in their palate, there's basically a passage into their nose and sometimes their ears so breast milk can get in there and they found it's far less irritating breast milk is than formula when it does get in the little baby's ears and nose. That's right. And because of that same gap there, I think throughout, we'll talk about the surgeries, but throughout childhood, babies and children with cleft palates and lips have higher incidences

of ear infections, sometimes chronic, sometimes they might have trouble hearing and learning how to talk. But again, these are all early challenges that it's such a common birth defect that they really, really know a lot about how to overcome this stuff. That's exactly right, fortunately, especially in the developed world, there's a lot of services available that are pretty routine. And if you're fortunate enough to live in a country with socialized medicine, you get it all for free.

And if you're not, you're going to be dropping some money on surgery. I think the statistic is a $200,000 average for medical procedures over the course of your life. And I don't know if that's figuring in insurance, if that's a $200,000 sort of total and you pay a portion of that if you're insured. I get that that's out of pocket. Oh, you think so? I think so.

Oh, interesting. So, do you want to talk specifically about some of the treatment for clefts? Yeah. So, the diagnosis of cleft often happens through ultrasounds. So you'll know your baby is going to be born with a cleft lip, especially, but cleft palate is probably diagnosed after birth, but shortly after birth, usually upon the first examination by the doctor. And they'll say, okay, well, your child has a cleft palate, don't panic, there's a lot

of stuff in place, we know exactly what to do, we know exactly when to do it. Yeah. But it's going to be really tough for you and your family because your baby, before your baby turns one year old, and as actually as early as maybe three months old, they might be, they will undergo a surgery, like a major surgery where they are given general anesthesia and basically it's a form of cosmetic surgery to repair, is what they call it, their cleft lip or their cleft palate or both. And it's basically the first in a very long line of surgeries that will take up their

first 18 years pretty easily. Yeah. It's called, the first one is called chyloplasty, C-H-E-I-L-O, and this is, it can be a few surgeries, like I said, about the teeth, it can include bone grafts. And I think the cleft palate surgery is a little bit later, that's only for cleft lip and cleft palate though, is still before they're 18 months old. And you know, even though it's routine, it is, like you said, it's stressful for a parent to see that little baby go under general anesthesia and go under the knife.

Yeah. And when they come out, I mean, you know, they're in pain, they're not very happy, they're pretty uncomfortable. Sure. It's no fun. Fortunately, they've actually come up with a procedure called nasal alveolar molding or N-A-M, thank God, where this reduces the number of follow-up surgeries, because they don't always get it on the first surgery.

Right. It might just kind of be like, well, this is the first step, and we're going to let this heal and kind of fuse a little more closer together, and then we're going to try it again and again, and we'll finally get there after a couple of surgeries or a few. N-A-M kind of does that follow-up surgery ahead of time by molding the little baby's astoundingly malleable features ahead of time before the surgery. Yeah. It almost sounded like braces for your...

Faces. That's right. It's a clear plastic retainer inside the mouth, and like you said, it helps mold it as they grow, and then like braces, they adjust it as they grow and maybe like tighten it down. I think for cleft lips, they add a little, if it's a small one, they add a little plastic post that's up in the nose to lift that up, because it can also affect the shape of your nose early on too. Yeah.

I'm not sure if we mentioned that. So, it's all sort of tied in together developmentally, and it sounds like this NAM retainer device sort of just limits, like you said, what's going to happen in the future. Yeah, and it just brings the cleft closer together so that when they actually do go in to do the surgery, there's far less trauma, and it's far more successful at bringing it together. The palate surgery is called the palatoplasty, and it actually, because especially if it's going through the bony part of your hard palate, they may use bone grafts to kind of

fuse that, or they may just basically cut the gums along the roof of your mouth and bring it together and just basically cover it up. And for all intents and purposes, the palate has been fixed. There's not milk going in their ear canal any longer, or up their nose. They're going to be able to speak clearly, because they'll have that soft palate, which we use to basically make almost every sound we make phonetically. We use our soft palate to close the airway. I'm doing it right now, literally right now, I'm doing it.

So if you could just kind of cover that cleft palate with gum tissue, I mean, you've fixed a lot of the issues that arise from having a cleft palate. Yeah. I mean, in addition to that speech surgery, there may be speech therapy that your kid might undergo early on. There rhinoplasty sometimes, because I did mention the nose. Sometimes rhinoplasty comes into play. And then there's also ortho, oh man, ortho-nathnic-nathic, ortho-nathic, that G's got to be silent.

Don't you think? I don't know, man. All right. You take a stab. Ortho-nathic? Yeah, I think that was it. Really? Yeah, I think so.

All right. Well, this is jaw alignment surgery, and this is something that happens later on, because your jaw has to stop growing. It's sort of similar, I think, to my issues with my cross-bite, and it's all sort of orthodontic related in a way as well. Right. And that ridge that's at the, like, right behind your teeth, that your adult teeth actually grow out of that, and if you have a cleft lip in particular, like you were saying, you

might need a bone graft that's another surgery that you were talking about. I know all about those same implants. So that, like, for your front teeth in particular. So that's a pretty decent amount of surgeries, and that's not necessarily one and done for any of them, especially I think rhinoplasty can be, can take multiple surgeries to kind of get the nose back where you want it to. But again, like, this is the doctors who handle this stuff at children's hospitals around the country and basically everywhere in the global north just know exactly what they're

doing and what to do and when to do it. Yeah. That outcome is usually very good. The prognosis of a baby born with a cleft lip is, you know, is pretty good. Yeah, it's great. There can be scarring, obviously, especially with that first surgery. There's sort of a signature scar from a cleft lip surgical procedure, and kids can be very self-conscious about that stuff, but I think, you know, they encourage parents to try and

be open about that stuff and get them to own that as a facial difference and as a visible difference and to really drive home to the kid, like, this is not going to, you know, you can still be an athlete. You can still, it doesn't affect any kind of learning or anything like that in school. So it's really up to the parents and then through the help of, like, friends and family hopefully to get that kid on the right track. That's a huge one too. And supposedly, like, parents who are given, especially with an ultrasound, a diagnosis

of a child with a cleft lip, they can take the news pretty hard. I was reading, I don't remember why I read it, but it was basically like a first person account of having a child with a cleft lip, and the woman was saying she was really worried that she was going to have trouble bonding with her baby. Remember our cute episode in the Kinden Schema, she was basically worried about that. And then she said the moment she saw her baby, she just fell totally in love and it was just like having any other baby. It was her baby, so of course she loved it, no matter whether she had a cleft lip or not.

But that is a common concern among parents when they're first, you know, getting their feet wet with this. But I was reading some studies and they found that there are basically no bonding issues that differentiate parents and children of kids with cleft palates or lips from kids without cleft lips. They basically, the outcome is the same. One of the things that you do have to be careful with though is it's very easy for you to become an overprotective parent.

Because you're dealing with a baby that you're sending off for surgery, you don't want any harm to come to it. You've now seen your baby with like a heart monitor, like IV tubes sticking out of them and it's just not a sight you want to see. It can really make you even more protective of your baby than before. And then when they come home and they're being teased because of their facial difference, which they cannot help and they're not guilty of anything, they don't deserve any of that kind of bullying or teasing.

I'm sure it makes you want to go kill those little kids who are doing that. So you kind of have to approach it. It's a process for everyone, you know. It's a definite crucible for parents that you have to, it's an additional challenge that you would have to take on. But parents do it all the time and their kids turn out totally normal. All the time. All right, well let's take another break, or another break and we'll come back and finish

up right after this. I'm Mangesh Atikular and to be honest, I don't believe in astrology, but from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get secondhand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention. Because maybe there is magic in the stars, if you're willing to look for it.

So I rounded up some friends and we dove in and let me tell you, it got weird fast. Tantric curses, Major League Baseball teams, canceled marriages, K-pop. But just when I thought I had a handle on this sweet and curious show about astrology, my whole world came crashing down. The situation doesn't look good, there is risk to father. And my whole view on astrology? It changed. Whether you're a skeptic or a believer, I think your ideas are going to change too.

Find the Skyline Drive and the I Heart Radio app or wherever you get your podcasts. All right, so we should talk about some of the great things that are going on around the world, but we first have to talk about some of the not so great things. We've been talking about this from the perspective of someone in the United States where it is very common and very treatable and outcomes are great. Unfortunately in developing countries, there are a lot more challenges, of course. There is a lot of stigma attached to this anywhere, but especially in developing countries, you might come into a situation where like a father might blame the mother and say you

were to blame because you didn't do whatever right that my child looks like this. And there can be a lot of shame involved. I think there was a study in Kenya where mothers of babies were blamed by their husband and extended families for that. And they interviewed some of these women and some had contemplated taking the baby's life or their own life or both. And that is just unspeakably tragic, of course. Their access to medical care is different, obviously.

The further they are away from good care and the more expensive it is, the harder it becomes to overcome these challenges. But there is great news because there are some great organizations. One's called Smile Train, one's called Operation Smile. And what they do, instead of sending in doctors, they try and go in and train up doctors in these places to deal with this better, to teach them how to perform these surgeries and to help educate the public at large about facial differences and that it's okay. Yeah.

I was looking at Charity Navigator. You ever go on there? Sure. Man, they're great. It turns out Operation Smile has like a 75%, which is fine. But Smile Train has a 100% on Charity Navigator. Wow. Are they brand new?

No. No, they've been around for a while. No, that's amazing. It's like they're spending tens and tens of millions of dollars a year on providing these services for children around the world, so 75 or 100 hats off to both of them for that. That's great. I think Operation Smile has 31 medical centers in 16 countries and they have these international medical missions every year, like over 100 of them that they, like I said, they just

go in. They teach the doctors instead of bringing in doctors and I think the whole teach a person to fish thing comes into play. Teach a person to fix a cleft lip and they'll be doing it again and again. That's the old saying. So there are actually like since it's, I think, one out of every 750 births in the United States alone, that might even be like a European statistic too. There's a lot of famous people who have cleft lips because like you said, if you have a

cleft lip or a cleft palate, it doesn't prevent you from doing anything. Sure. So you could excel at, say, acting as maybe my camera if you wanted to. Stacey Keach? Yeah. Is that what you're talking about? Sure. Yeah, Stacey Keach has that cleft palate or I guess cleft lip surgery scar for surgeries,

actually that Stacey Keach had. Cheech Marin? Sure. So I guess you can still smoke tons of weed. I was going to say he's got the suction thing down. Maybe so. Yeah. Who else?

Joaquin Phoenix actually is widely considered to have like a cleft scar. It has what looks like that cleft scar like he had a cleft lip repair, a keeloplasty. But he doesn't. He has a microform cleft that was, it's looked like that since birth. And apparently Wendy Williams, the talk show host, got just jumped all over last year because she was talking about how cute she thought it was and then was like basically pulling her. Oh, really?

Yeah. She didn't do it right at all. I know she was ultimately trying to give him a compliment, but she did not do it in the right way and definitely suffered for it. And then Peyton Manning is another one. Yeah. I think his was a palate, right? He had, I think, a lip, too.

No, I guess it says palate. I thought he had a cleft lip because I feel like I've seen him, he has a scar or like his lip. Oh, really? Looks turned up a little bit, but maybe it was just a cleft palate. So he had a couple of surgeries and he had, I think he had braces for like 11 years. Yeah, from like age four. Yeah, man.

That's four to 15 having braces. I mean, I had braces twice and that was bad. That's the Jolly Rancher years and Peyton Manning missed out on those. I can assure you. He did. Did you like the individual candies or the sticks? The sticks, that was just too much, man. It was over the top.

Was it? The I for me. I kind of liked them because the more you licked on them and sucked on them, you can make them into a little knife, basically. Right. Like a poop knife, but Jolly Rancher. It was very sharp. What was your flavor?

I was always green apple. Same here. Love those. Watermelon are good, too. It's okay. It gets old fast. Don't come at me with grape. I had no problem with grapes.

What about the blue, I think blue raspberry one? It might have been after your time. I don't remember that maybe, but boy, those green apple. Yeah, they were good. I haven't had one of those in 40 years. I think I still have, I haven't either. I still have some stuck to my molars. Wow.

Dennis never, just couldn't even get it out. They try. They try and they fail every single one of them. So Peyton Manning, he, like I said, has done a lot with his money over the years. In addition to throwing lots of touchdowns, a lot of philanthropy and I think even the St. Vincent's Children's Hospital in Indiana, they renamed that Peyton Manning Children's Hospital at St. Vincent because they have the leading or one of the leading pediatric craniofacial centers in the country and he has shoveled a lot of money their way.

There's also one other thing we were talking about how other kids in other countries don't have access to a lot of the services. And apparently a lot of people have said, I want to adopt a child from a developing country and I am going to just basically go ahead and go right on to the canonization track and adopt a child from a developing country who has what's called an unrepaired cleft. And like you know this going into it. Yes.

You sign up for it. There's actually a group by the way called Rainbow Kids that connects people to adopt of parents to children with developmental or other kinds of special needs and that includes kids with cleft lips, cleft palate, that kind of thing which I think is pretty great. That is great and that's one of the stressors of the many stressors of adopting a kid period I can say from experience in that you are oftentimes dealing with a birth mother that may not have practiced great prenatal care, had access to it, smoking and drugs and alcohol could play a part and you sign up for this and they ask you these questions beforehand.

They're like, what would you do if you are in the birth room and the baby comes out with a cleft lip or a cleft palate? What's your reaction? Oh really? They ask you that? Yeah. I mean it's just called your tolerance list. What if this happens?

What if this happens? Right. What if you go in there and the baby comes out that's an unexpected race? And you're like, oh okay, well could that happen? Yeah. Yeah, sure it can, so how are you going to... That's one interesting list. And then they tap on their clipboard and look at you and they're like, what would you do?

So you just got to fill out all this stuff and it's really interesting and it makes you do two things. It makes you really take a hard look at what matters and also take a hard look at your own family and genetics and eventually probably end up saying like, hey, we're no prize either. So let's just do this. That's fantastic. That's really cool. Do an adoption podcast one day.

I agree. Jerry could even maybe say a few words. She just thumbed up and then shook her head. She's a little sleepy right now. Now she's blowing her nose. She just finished lunch. We'll see. So you got anything else?

I got nothing else. Okay. Well if you want to know more about cleft lips and cleft palettes and craniofacial clefts then you can go do some more research online. As I said, go do more research online. It's time for Listener Mail. I'm going to call this, I inadvertently said something and I didn't even know what it meant.

I don't think we did this one yet. Did we about Netflix and chill? No, I don't think so. So I said Netflix and chill. I've heard it's an expression. There's a Ben and Jerry's flavor that I love. What's in it? Oh, I can't even remember.

It's just really good. It's got a lot of good, delicious, crunchy sweet things going on. It's one of my favorite flavors. I'll check it out. But let me just read this. Welcome back, Stuff You Should Know Team, listening to your appendix episode. At a good laugh during the podcast, Chuck said our immune system is not good at Netflix and chill.

And I really started laughing. Did you know what this meant? Yes. Why didn't you say something when I said it? I don't know. I must have been thinking of my next joke or something because I don't know how I missed that. Did you know, Jerry?

You know what? Man, I'm an idiot. I'll have to go back and listen if I snorted. Last week, my 30-year-old daughter was visiting, and I said to her, let's Netflix and chill. And she probably told me, Mom, that is code for having sex. What? Who knew? Obviously, Stuff You Should Know did not get the slang decoder memo either, and we should

say Chuck did not. Okay. I'm absolving you and Jerry. Thank you. But thanks for making me laugh. And that's from Rosie. And Rosie said that I could read this, and her daughter would get a good laugh about it. But I feel like a rube.

I had no idea. And it makes sense now, like I could see some kid being like, what did you guys do last night? Well, just Netflix and chill, when in fact they were doing unspeakable things. But now I know. Netflix and chill. Yeah. I don't know how I let that one pass.

Maybe it was purposeful. That's right. Well, thanks for that one. Who was that again? Rosie. Rosie, appreciate that. And I'll bet that was a really great conversation you had with your mom. I'm glad we're clearing this up though, because there's probably a lot of people that were

like, what is, is Chuck that dumb? Right. Or maybe they thought like you had just gotten bone dry in your sense of humor. Oh, maybe. And timing and delivery. Well, if you want to get in touch with us like Rosie did, we want to hear from you. You can email to us directly at stuffpodcastatihartradio.com. Stuff you should know is a production of I Heart Radio.

For more podcasts, my heart radio, visit the I Heart Radio app, Apple podcasts, or wherever you listen to your favorite shows. I'm Munga Chauticular, and it turns out astrology is way more widespread than any of us want to believe. You can find it in Major League Baseball, international banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me, and my whole view on astrology changed.

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