an update on surgery

Here is an update on my surgery timeline. Thank y’all for your encouragement regarding a previous post. I’m beginning to embrace the idea of orthognathic surgery. This post is focused on the practical side of things, but I also have some thoughts on how my decision affects my family. I think a lot of us struggle with this. More on this later.

After each uncomfortable adjustment, I yearn more for an established timeline. It seems like so many decisions in my near future hinge on surgery plans.

· Another baby - my husband and I are ready to welcome another child into our family. The longer I postpone surgery, the longer we wait on this. I really like the spacing between my first two children (21 months). My body has finally recovered fully and other family items are in order.
· Family vacations – there are some neat opportunities to meet up with extended family this summer. Until we have a better idea about surgery, we can’t commit to spending savings or vacation days. My husband has offered to stay at home with me & the children post surgery for two weeks.
· A new car - we’re ready to purchase a family car, though I think we can delay this purchase until our next child is on the way. With each month that passes, I have to adjust my formula for investing in our current automobiles, planning trips, etc.
· Remodeling our house – like most folks, we have a long list of “someday…” house projects. :)

The good news is that my teeth should be ready by late July/early August. Remember how excited I was to be classified as medically necessary? Well, because there are not any oral surgeons in my insurance carrier’s network, I discovered I’d have to pay about 85-100% of surgery services out of pocket. Ouch! There is one oral surgeon in the state who bills through a hospital, which means I could cap out my expenses at the hospital max. This fee is more reasonable but would still require a significant sacrifice.

I have an appt with Dr. T in SC in late April. I feel like I’m cheating on Dr T in NC. I am finally comfortable with the idea of him performing surgery. And his office staff is great, too. If necessary, I’ll consider working with an oral surgeon in a nearby state. We’ll see. Open enrollment for insurance plans is mid-November. By then I will have reached a decision. In the meantime, my husband has most graciously listened to me evaluate the possible scenarios ad nauseum, listed here in my preferred ranking:

**have surgery in mid August, try for baby #3 in the November, buy a family car in January
change ins. plans in November,
**have surgery in spring ’09, try for baby #3 in summer ’09
try for baby #3 now, buy family car in fall
**change plans in November, have surgery in summer ’09 (though this might mean weaning baby #3 early…)
**don’t have surgery

It is an excellent opportunity to for me to rely on God. Perhaps I'll be blessed with an open door/closed door moment. Even if I don’t have a clear answer on a decision, I know that I can trust His character. If I keep my heart focused on Him, then I'm confident I will act within His will.

spacers

My ortho put in spacers about 10 days ago. They were as annoying as I’d feared, but after a week the discomfort disappeared. Then bands were put on my two crowns and one large amalgam. Oooh, they feel strange. My teeth shifted from touching on my right side to the left side. Overall, I’m pleased with the improvements.

This is my lower arch at 3 months in braces. The bend in the midline has smoothed out and spaces are closing up. My lower incisors feel like they need to rotate a bit more.

This is my loweer arch right after my braces were banded.

I never imagined that getting braces would improve my figure. My thoughts had been so focused on changes to my teeth that I forgot that not being able to chew *could* be a good thing. Before anyone reading this grows alarmed, I am not developing a disorder. Rather, I am enjoying the one plus of constant teeth aches – weight loss!

I am learning some new recipes here, but I find that during most meals, I loose interest in struggling to chew and stop eating. Oh, and snacking with my toddler has lost its appeal too. Making fruit shakes in the afternoon does seem to help. And my 2 1/2 year old "sweetpea" still thinks it's a treat when I spike our shakes with good-for-her cod liver oil. :)

What does this really mean to me? I ordered this swimsuit from Lands end. The built in under wire and swim skirt make me immensely happy. For the last three summers, I’ve worn really ill-fitting suits because I couldn’t find a decent suit. Why do maternity suits scream hoochie mama? Anyway, now that “buttercup” is 10 months old, I can finally pack away my frumpy clothes. Besides the wonders of braces, my swimsuit ready person would like to thank my exercise instructor, Anna Benson. Anna teaches a fabulous fusion class at my church. For the first time in many years, I am looking forward to wearing a bathing suit.

**p.s. - at my banding appintment, I was able to brush sans ligs, wires and all. Such a great feeling!

the original diagnosis

Thank you Google! I discovered my scanner stopped working because I updated IE to v.7 last week. A few downloads later and we're back in business. Here is my original x-ray and diagnosis from Oct 2000. Sorry the scan quality is not better.

Xray pics

For inquiring minds and to help me record my progress, I decided to post my head scan and panarex shots. If I can fix my broken scanner, I'll post a panarex pic from 2000. It's pretty cool to see these side by side.

"It's medically necessary"

...the official word from my health insurance. This is wonderful news!


To prepare myself for the idea of surgery, I have been utterly immersed in orthognathic blogs and adult braces websites. Thank you to everyone who's shared their experiences.

The library nerd has struck again! I checked out my surgeon's oral surgery textbook. Much appreciation goes to Diane at our local library who helped me track down a copy. The book contained an immense amount of information. The photographs were shocking, though not at all what I had expected. For instance, a Lefort surgery depicted a man who had his face attacked by a chainsaw. Ouch! My own possible surgery pales in comparison.

I do wish it weren't such a complicated decision. Deciding to buy our first home was so much easier. Though I'll need to re-certify every 90 days, I am thrilled with the good news this week.

More thoughts on orthognathic surgery

One day I am all for it and the next plagued by doubt. I’m still waiting to her back from my insurance company. Many hours spent on the phone this week. The oral surgeon’s office has been extremely helpful (as you’d expect) and has resubmitted my pre-certification request as an inpatient operation after insurance denied the outpatient procedure. The fees are truly mind boggling.

I am frustrated by the well-intentioned people who tell me I am fine just the way I am. If I felt fine about my teeth, I wouldn’t be spending so much money and volunteering for daily pain. About 99% of them wore braces as children. Their bite is healthy, their teeth are straight, and they don’t get headaches and such. Their lips touch when they close their mouth. I’m struggling to find a good analogy when this topic arises. Orthognathic surgery is different than having my tummy tucked. I asked someone recently to imagine if they were still “wearing” the teeth they were born with. That kind of helped them see my point!

This question woke me up today: if I correct my jaw alignment and our daughters inherit the very same recessed chin and gummy smile, will they grow to think I don’t accept them as they are? They are lovely girls. I hope they won't need to go through all this. As I type, it's 5:30 am and my two year old daughter, who rises early, sings hymns next to me and reads her little children’s Bible. It reminds me what’s really important. I’ll continue to pray about the decision.

First adjustment

It was very anticlimactic. I had been a little concerned about having spacers put in; this was postponed until next month. Several metal ties were placed to close in gaps created after my initial banding. Ouch, I felt like my teeth were twisting out of my mouth. Let me just say how wonderful braces have been for my flossing routine – now there is enough space to actually clean between my teeth. Oh, and new ligatures rock. Yeah!

My orthodontist, Dr. B, looked at my mouth for about 30 seconds. Then I spoke up and said, “Wait, I have a few questions!” I wanted to discuss the oral surgeon’s notes, to talk about Dr. T’s textbook (which I tracked down through inter library loan), and get a sense of my timeline. Well, everyone was pleasant but I could tell they were ready to go home. My entire appointment lasted about 10 minutes. I hope the rushed treatment was due to the time of day and not to the fact that I was now locked into treatment. Everyone was so accommodating during my previous two appointments. My mouth is sore enough that it woke me up this morning but not nearly as bad as before. Thank goodness.

initial surgical consultation

The visit to Dr. T’s office was great. I live about 100 miles south of his office, so getting there took some real effort. My dear husband offered to take a half day off to stay at home with our children. This was especially nice for them – the baby really needs her long morning nap and our toddler loved the extra time with her “Papa”.

I was terribly nervous throughout the entire visit. I arrived about 30 minutes early and flipped through the pages of People magazine. This was a terrible idea! My usual magazines are the Economist, National Review, House Beautiful and when I can find it, Southern Accents. I don’t usually read People or US. That day reminded me why. It was difficult to feel confident when it seemed like everyone in the office was examining my teeth. Seeing glamorous stars with perfect everything just made it all worse.

When Dr. T asked me what I wanted to correct, I tried to describe the complex feelings I have about my mouth. His bedside manner was delightful. He asked clarifying questions without prying. Next, he took some photographs of my teeth & jaw profile. We had to take several…it turns out I subconsciously pull my lips over my overbite. My lips don't really meet! I’ ve since read other bloggers who say they do the same things. It’s good to know I am not the only one. A special thanks are in order to all of you who have posted pics of your “before” photos. They have really encouraged me.

After much discussion, Dr. T recommended I have upper and lower surgery. Next, we discussed these two procedures in more detail. He merged my photo with the software – my “new” face stared back at me. When I kinda freaked out about the upper surgery, he said something like, “well, I think we can achieve about 90% of the results with about 60 % of the surgery…doing lower surgery only is okay.” He remarked that as my face ages, my upper lip will cover some of my upper gums. I guess this is good news? So far, my chin is okay. No need to do genio.

The most interesting thing I learned is that my panoramic x-ray revealed my jaw bones had shifted “significantly” in the past few years. It is so good to know what I see in the mirror is not just a figment of my imagination. Maybe my two pregnancies exacerbated the asymmetry? You hear how your pelvis joints relax. I also learned I have arthritis in my jaw. A few other bloggers have mentioned this too. I am eager to learn more about this aspect. Is there something specific that causes this? Does my asymmetric bite create constant friction on my joints or something? Not sure.

I am now waiting to hear back from my insurance company. Thank you to everyone who has shared their experiences so far. I found Stephanie’s blog especially helpful. Dr. T said my mouth should be ready for surgery in 6-9 months.