Dr. Cara Riek – 2024 Kumar Patel Prize Recipient

2024 Kumar Patel Prize Recipient for outstanding contributions to laser frenectomy education

Cara J. Riek DNP, RN, FNP-BC, IBCLC, FAANP

My journey into educating and supporting families started sixteen years ago with the birth of my son, Benjamin. Reading every book and article possible, listening to podcasts, and scouring the internet does not prepare one for the life-changing moment of becoming a parent. For me, breastfeeding was my top priority, and I knew that I would go to the ends of the earth to meet this goal. Breastfeeding was one of the single most difficult and daunting journeys of my life: painful latch, bleeding damaged nipples, unhappy fussy infant, and an impactful lack of sleep. Little did I know that this journey in pursuit of breastfeeding my children would change the trajectory of my life forever.

When my firstborn became six months of age, I felt that it was my calling to help other women on their breastfeeding journeys. I decided to completely change the direction of my career. I quit my job as a high school math teacher and enrolled in nursing school with the sole intent of helping mothers successfully breastfeed their babies.

As my son grew, so did the challenges. We were able to breastfeed for 2.5 years but experienced further challenges, such as his speech not developing properly, grinding his teeth in his sleep, and often waking at night. His sister was born and we were met with similar challenges. It was not until I began attending La Leche League meetings that the light bulb went off; my son was 4.5 years old, and I had a 2-year-old daughter and a newborn daughter. I was slowly introduced to the world of tethered oral tissue by the group moderator, Rene Moore. At this point, I was nearly finished with my nursing degree and applying to graduate school.

At my graduate school interview, when asked why I wanted to pursue a degree and career as a family nurse practitioner, my reply was simply: “To help breastfeeding families and treat tethered oral tissue.” From a very competitive field, I was selected, and my journey to releasing ties began. Upon graduation, I had some trepidation about offering releases at my clinic, mostly because I had not heard of nurse practitioners performing releases. I was introduced to Kittie Frantz RN, CPNP-PC, at a breastfeeding conference, who said that she had been performing scissor releases since the early 90s. Her advice was prudent: “See one, do some, teach the rest of them.” Until this point, I had only seen releases with scissors and electrocautery. However, I felt knowledgeable enough to give it a go, as I had observed many releases by pediatricians and dentists. I placed an order for a hemostat, blunt surgical scissors, a grooved director, and hurricane gel. Rene Moore volunteered to be my first patient. We set a date of September 25, 2016, to release Rene’s tongue tie with scissors.

Two nights before our scheduled release, Rene called me while she was at a laser dentistry conference in Tucson to ask if I was open to trying out a CO2 laser to release her tie. Of course, I agreed! I had read about CO2 lasers and had seen the beautiful outcomes of said releases. On a Sunday morning, Peter Vitruk traveled from Tucson to my office in Scottsdale with his CO2 laser. He spent over 4 hours at my office explaining the science of the CO2 laser and nuances of tissue interaction of the CO2 versus scissors, electrocautery, and diodes. It fascinated me and blew my mind all at once! How could this science not be readily discussed in school? How could practitioners not understand these distinctions in tool methodology? It was at this moment that I knew that I could not perform releases with any other tool. It became my mission to collaborate and educate fellow healthcare providers on the science of laser physics and tethered oral tissues.

Shortly after Peter’s visit, I traveled with my team to Tufts University to attend one of the first comprehensive Infant laser courses from Marty Kaplan, DDS. I was the first Nurse Practitioner to take this course. I went back to my clinic with new knowledge at hand. Our clinic developed a comprehensive methodology for providing a collaborative approach to releasing tethered oral tissues. Dr Stevanie Bahnerth, DC, and I worked together to optimize a triad approach (bodyworker, release provider, and lactation support/feeding support) within our community.

Sharing this knowledge with other providers (and more so Nurse Practitioners) to provide a holistic approach to releasing tethered oral tissues has become a passion and a mission for me. Teaching courses, presenting at conferences, and welcoming all practitioners into my clinic helps to grow our body of knowledge, gain more understanding, and ultimately improve patient outcomes. As we know better, we do better. As we share our experiences and unite our differences, not only do we improve the lives of our patients, but we also provide a stronger foundation within the medical community for the work that we do.

In my progression of education and experience, I have utilized the CO2 laser in my clinic for more than just infant frenectomies. I will commonly remove skin tags, ablate warts, remove lipomas, excise moles (especially from the face), etc. I am able to minimize scar tissue with the CO2 laser and, in many cases, improve the self-confidence of my adult patients.

Collaboration, observation, inquisitive curiosity, and constant reevaluation drive me to continue to evolve my skills, techniques, and procedures. I am grateful to have the opportunity to travel to educate and mentor nurse practitioners to open up new clinics around the country. I strongly welcome and open my arms to any and all providers who walk through our door to learn in our clinic. I remain consistently open-minded to change and improving proficiency for release. It is my hope that the CO2 laser will become the standard of care for a multitude of procedures, but especially for frenectomies.

I appreciate Dr. Kumar Patel’s ingenuity, inquisitive nature, creativity, and tenacity. I strive to carry these same tenets of thought in the work I do. This award is such a great honor. I am inspired to continue to collaborate toward innovation and ameliorate patient care.

Dr. Riek Biographical Highlights

Dr. Cara graduated from Arizona State University with a Doctor of Nursing Practice degree. She is a board-certified Family Nurse Practitioner in addition to having her IBCLC certification. Dr. Cara is also a diplomate of the American Board of Laser Surgery, specializing in “Oral Surgery in Infants, Toddlers, and Adults.” She has earned her certification as a Certified Specialist in Orofacial Myology (CSOM).

Dr. Cara describes her career as a diversifying adventure: research, teaching, nursing, and now breastfeeding medicine specialist. She strives to provide meaningful, evidence-based care to mother-baby dyads. Her mission is to support mothers where they are and help them journey into the breastfeeding relationship they desire. She strives to make sure that each patient can reach their desired goal and have an amazing breastfeeding relationship.