Second surgical consultation

It’s been a two weeks since my consult with a second surgeon in Charleston (also named Dr. T, go figure). I needed some time after the shock of that appointment to process everything. I felt like tiny sand crystal along a wide beach. Poor directions, an impolite receptionist, a thirty minute wait, several bewildered residents, then a stoic resident, and finally…the attending surgeon. There was some kind of confusion about who had my chart, but once they found it, and all four surgeons were in the examination room, we were in business!

On a positive note, the team spent twice the time with me as the private practice Dr. T.

Here are some of the more memorable quotes:
*** “Look, see this? And this? She’s a classic long face syndrome”
*** “I saw it as soon as I walked in…” (I sat at the end of a long, narrow room that did look like a storage closet)
*** “yeah, yeah, these things usually go together” (during a discussion of my large tonsils, constant state of minor congestion, headaches, underdeveloped lower jaw, and overdeveloped upper jaw).

My primary goals for the appointment were to receive a second opinion, to decide whether to not to have my upper jaw moved, and to select a surgeon. The first two questions have been addressed. I’ve decided to definitely go for the BSSO, to move my mandible forward. Dr. T also recommended a Lefort to address the gumminess in my smile. My initial consult recommended the Lefort, and now that the initial shock has passed, I am more receptive to the idea. If I am going to go for surgery, why not fix it all at once?

Now I need to choose who will perform the surgery.

Both surgeons are located 100 miles from my city. Because Dr. T in Charleston bills through an in-network teaching hospital, my out-of-pocket costs would be low. While I am confident in Dr. M.T’s technical ability, my patient experience at the teaching hospital was mediocre at best. How important is a good bedside manner? Is it worth paying more out of pocket? How did y’all decide which surgeon to go with?

I must not have sounded very confident about surgery because Dr. T. spent a lot of time explaining that I must decide about surgery in order that my orthodontist could develop a course of action. I said I had, rather it was deciding whether or not to move my maxilla that distressed me. At this point my goals are to create a normal, balanced profile, to protect my teeth from the rough wear & tear of misalignment, and to improve my breathing. Aesthetics motivate me, too. Now that I understand the important role of a good bite and good breathing, I am ready to do take action on a long-standing to desire to “fix my profile”.

Thankfully, I brought copies of Dr.T in Charlotte’s assessment, and the Charleston team of surgeons agreed 100% with his diagnosis. Good news, sort of. I think I was still hoping at this point someone might convince me I didn’t really need surgery. Anyway, the team was utterly confused why I was there if I’d already seen Dr.T; It is his textbook that these guys all studied.

So, I explained how my husband and I wanted more children, and how our medical insurance factored into that decision. Every one of those residents thought I was loony to want more children, and seemed totally confused why this would be a factor. Umph. By this point, I was upset. I was not just some “long face syndrome” case study in the chair, but an individual.

The last five minutes of the appointment were pretty interesting. The team decided to take fresh x-rays, and the incoming chief resident showed me how to bite while relaxing my jaw/facial muscles. Wow…this was really hard to do. I had no idea I tense so many muscles in order to bite, smile, talk, etc. Anyway, when the attending surgeon and chief resident examined the films in front of me, I noticed just how far apart my lips are when my face is truly relaxed. Wow again….it was hard to fight back my tears at that point. You know, the awareness that I had worked for so long to make my lips meet – the whole time thinking, “If only I tried harder…!

You may be thinking, ok, what’s the big deal? Well, two thoughts struck me then. First, no matter how hard I had been trying to modify my behavior, my lips were not going to meet on their own. I am kinda sensitive about being a mouth breather. I mean, for years I have believed this to be a huge personal weakness. Look around the room sometime, and yep, almost everyone else can close their mouth naturally. Not me. Second, I am now aware that all those “strange smile” photos over the years were actually snapped with me trying to pull my lips over my teeth! This also makes me want to cry because it means that while I thought the facial expression was an occasional thing, if I am constantly pulling my lips, then it is actually a constant expression. Yikes!

I looked over some photo albums and found a sample shots. Easier than I thought...

Lip incompetence is not a huge hardship, I know. :)

The closing hymn this morning was von Schlegel’s 1752 hit, Be Still My Soul, a beautiful hymn that brought me much comfort. Here is the poetic beginning:

Be still, my soul: the Lord is on thy side.

Bear patiently the cross of grief or pain.

Leave to thy God to order and provide;

In every change, He faithful will remain.

Be still, my soul: thy best, thy heavenly Friend

Through thorny ways leads to a joyful end.