I can now touch the roof of my mouth

On Friday I went to Dr. F and had the palate expander taken out.  I cannot tell you how happy that made me!  The roof of my mouth was so soft and tender, it felt so good to be able to touch it again.

Taking the palate expander out wasn't an easy feat for Dr. F, though it seemed to go fairly smoothly.  It did hurt me though, not so much the teeth that held the palate expander, but Dr. F kept leaning on my front tooth that always hurts and really hurt after having the wire taken out.  I actually had to complain about it, and I usually don't complain unless something really hurts.

Dr. F gave me the option of having my fake tooth put back in, but I would have to come back on Monday afternoon to have it taken out again.  I decided to save myself the trouble of going back on Monday and go without the tooth, I didn't have any real plans this weekend anyway where I would have felt funny without the tooth.  I did ask if it would be back in by the time I went away in September and Dr. F sounded sure it would be.  I do have to wait until Dr. S gives the ok for that though.

After taking out the palate expander Dr. F put new bracket rings on the teeth that were holding the palate expander.  One of those rings feels a little off, I'm not sure if it's the way it sits on the tooth that it feels funny or if it's just hitting my teeth differently making it feel like it's off.

Since Friday my teeth have been quite sore on the top, especially my two front teeth.  When they take the wire out my teeth always feel a little sore and loose, like the teeth are just sorda floating within in the bone and aren't really solid in the bone.  It makes me wonder how different the damon braces system is to the old way and if part of it has to do with them keeping your teeth from setting into the bones, making them easier and quicker to move.

On another note, last weekend the chain that was moving my tooth on the bottom right fell off and I ate it.  I only noticed when I was eating and the tooth felt funny, I looked and the chain was gone.  Grrrr.  Of course it was a Saturday afternoon and the office was closed.  By Sunday morning the tooth had moved back totally.  Grrrr.  Dr. F did not replace the chain on the last visit.

Surgery is Tuesday!

Another painful experience

Last week I was back at Dr. F's office and left feeling slightly irritated...

Apparently my wire on the top shifted a bit and had to be moved back.  Also, he did fix the wire that was attached to the palate expander, I think I left him wondering how I did that.  Also, one of the girls put a shorter chain on the lower right tooth that they've been trying to rotate.  It has hurt a fair bit since then so I think the tooth might have actually moved.  Looking at it though sometime I think it did move, other times I don't think so. 

We also had a conversation about my surgery on the 27th, he's not sure how Dr. S wants to handle it.  Then he started to almost think out loud to me about how they usually wait 5-6 months from the time the palate expander finishes expanding - that would acutally be Aug 17.  This is the first I've heard the wait time this way.  I was originally told by Dr. F 4-6 months and the same by Dr. S, no one added in the rest about after the palate expander finishes expanding.  This irritated me quite a bit since it was 3 weeks before my surgery and he decides to bring it up then.  At this point I'm pretty much committed mentally to July 27th.  But once or twice Dr. S has made comments about Dr. F being conservative, which fits well with my perception of him.  But at this point I'm sticking with the July 27th date.  My theory is that if the surgeon thinks this is enough time then it probably is.  If it was an orthodontic issue then I would defer to the orthodontist. 

Two other things that I have thought of/ noticed since that visit.  The numbness in my gums has gone away on the right side of my mouth.  I'm still dumb a bit on the left side, but being as the tooth on the left side of the cleft hurts I know that the area there isn't still numb.  The other thing I thought is that when Dr. F gets me ready for the surgery he's probably going to take the wire out of my braces and it probably wont go back in for a few weeks.  My fake tooth is held in with the wires.  3 weeks after the surgery I'm going away with the family for a few days, I can deal with a gap for that trip.  However, in the middle of September I'm going away on a 2 week tour and I do not want to have a gap there.  I feel funny meeting new people and having to explain the lack of tooth, but even worse is that every picture from that trip will have me missing a tooth and that will drive me crazy for the rest of my life.

A cleaning and good news

Last week I went for a dental cleaning. LF was excited to see me and my mouth. She's always so positive and happy - she thought everything looked good to her. But she did find 2 cavities starting so I'll be seeing her again next week.

Yesterday I went for an adjustment with Dr. F, he didn't do much other then change the chain on teeth on the lower right. The tooth that is sideways doesn't seem to be moving, but what do I know? But I did get good news. Dr. F will take the palate expander out before my surgery and it probably wont have to go back in - oh happy day!!!!

Days 1 and 2 - Post-Op

I'm finally back to report on days 1 and 2 post surgery. They were relatively quiet days, I would take medication every 4-6 hours (I took a total of 5 on top of any medication I was already taking) and was in and out of sleep most of the time. I missed some good parts of the olympics in these in and out of sleep fazes. There was a fair amount of pain, but nothing crazy as long as I was taking pain killers (Tylenol with codeine). The pain was primarily in the area just below my cheek bones, but also a bit in my temples.

Eating was difficult since my mouth didn't open much. Primarily I just had broth, jello and maybe an egg. Eating was slow and I wasn't terribly hungry. I stuck with mostly apple juice to drink.

I slept on my parents recliner/couch, it allowed me to keep my head up without fighting pillows. This was a particular issue since the night before surgery I tried to sleep kinda upright so I wouldn't get too congested and had a terrible time sleeping and had a little bit of a stiff neck in the morning.

On Wednesday I had to use my key to open the expander once. Being the only one who knew how to use the expander I had to do it myself. I got the key in the hole pretty quickly and did it. It didn't hurt much, though I did feel some pressure in my head.

Ready to expand

I went on Wednesday and had the palate expander put in my mouth. I'm not a fan. I spent the first couple minutes trying to figure out how to swallow and in the end needed a tip from the girl in the office. slurp. I've gotten much better at swallowing though it still something that I sometimes have to pay attention to.

Talking has been another issue. I took off of work on Thursday but went in on Friday. I'm pretty self conscious about my speech, though it is steadily improving. Thursday I had to call tech support for my Tivo, then Cable, then Tivo again. I did manage to be understood.

I figure when I finally get this thing out I'll have finally mastered it.

I was taught how to expand it, but will not start expanding until after surgery on Tuesday. A couple teeth are a little sore from either the expander or from the bite being a little off. That will all change as I expand, I think and hope.

But a greater challenge has been that on and off all week I've had a cold threatening me. Earlier in the week I was just tired and a touch of sinus congesting, then I was feeling ok and the sinus congestion didn't seem as bad. I'll never know if I was actually getting better or just wishful thinking. Saturday I woke up with my ear bothering me from congestion. I've continued to baby myself hoping that this will all clear up. I'm feeling better today then yesterday but am quite concerned. On top of all of it I might be starving to death. The first 2 days I was having some real issues with eating, and although doing better I am still having issues which have left me eating less then I should be. Yesterday I really started to feel the affects of starvation. I seriously wonder how the people on Survivor survive with so little food. I've had headaches, fatigue, dizzy spells. I've been doing better at eating today.

Here's hoping I feel better tomorrow and the Doctor says I can continue with the surgery this week.

A fitting of sorts

This week I was back to Dr. F. He he fitted me for my palate expander. He took out the spacer and fitted my two (one in from the back) molars with rings and took a mold of my upper teeth. It would seem those rings will be attached to the palate expander. Then in an evil twist of fate he put new spacers in. My teeth have been a little tender, though not too bad, but now one of the spacers digs into my gums whenever I bite into it. I suppose that wont seem so bad when I get the palate expander in... That's just a week and a half away.

Wide Open Spaces...

Ok, Dr. F added some spacers in on the top. It wasn't an easy process, it seems I have some very stubborn teeth, they take after me. The little plastic ones wouldn't go in on the right side of my mouth and I got jabbed a couple times on the roof of my mouth with the several attempts. Dr. F ended up putting in a different type of spacer in the right side.

Up next?

First week of February I am getting fitted for bands, I think. I overheard Dr. F talking to the secretary he didn't actually say it to me. Then the Wednesday before my surgery I go for the palate expander, I can't wait! They really do need to make a sarcasm font.

Did I mention that my surgery was approved by my health insurance? It was and I now know I made the right decision regarding that, I'm thankful that something is working out and not stressing me out.

Stuff they don't put in the brochure

First, my wire on the bottom of my braces shifted last weekend so I was back at Dr. F's this week to have it moved back, it seems to be staying place now.

More importantly I was at Dr. S (Oral Surgeon) on Wednesday. The good news - my surgery is approved! The bad news, the stuff they don't say at the first consultation... I'm scheduled for late February. Dr. S went through his whole thing on how he cuts into my gums on the outside side of the teeth at the root line and cuts into the bones to break them - I'm almost adjusting to the concept of this though it's one of those things I think I would rather not know. After the surgery I'll apparently be very swollen and will have to ice my face all day and night and overnight. I'll be in pain for about 3 days, but I'll have pain killers for at night. I'll have to sleep upright the first night. The swelling will last 2-3 weeks and there may be some bruising. I'll start on a liquid diet the first day and then add foods over that next week, but mostly soup, and ice cream types of stuff. Ugh, this was not in the brochure!

I always knew I would be miserable, but this is sounding way worse then I thought. I'm actually considering going to either my parents house or my sisters house that first day and night. But I did place an order with mom for her homemade soup, I'm going to add an order of her apple sauce too. I'll make my own pea soup before hand.

Back to the oral surgeon

I went back to the oral surgeon to discuss how to progress, the plan, and insurance.

First we went over the dental plan. First a surgically assisted palate expander would be placed in my mouth by Dr. F. Then I would go to Dr. S and he would cut into my gums to break some bones in my mouth. I didn't ask too many questions about this since the thought of it grosses me out, this is why they have anesthesia. But this is a necessary step since my bones are fused and wont move the way the palate expander would make them. The recovery time for this is about a week and I will be swollen. Dr. S didn't tell me if I would have any pain, but I read a bit about this on the internet and there isn't any real pain. Then I would have to crank the palate expander twice a day for around 2 weeks - how long will depend on how much Dr. F wants to expand. Once I'm expanded I will have gaps in my teeth, Dr. F told me he would put on some temporary fake teeth so things look good in the meantime.

Approximately 4 months later I will be ready for the bone graft. The bone graft would likely be taken from my shin just below the knee. Some fancy synthetic bone growing stuff thing would also be used to help the bone grow in. Dr. S estimated that the recovery time for this would be closer to 2 weeks because of the grafting from the leg, I would probably have a limp for a good week. The palate expander could be taken off at this time since the bone will fill in the gap created. After another 4 months they'll do some x-rays to see how the bone graft set, if it has set then I will be ready to start with the implants.

At this point no one knows how many implants I will need, there are currently 3 teeth that are candidates and the gap would create a spot for my missing lateral incisor, which would be a 4th. My left canine, which is part of the two tooth cap/bridge with the bicuspid, may not (and it sounds like wont) be salvaged because of the lack of bone in the area of the tooth's root. That will be decided at the time of the bone graft. The bicuspid, which is set back in my mouth, is also an unknown. As I recall the tooth was in good condition before it was capped, but may have broken down since then, that tooth is an unknown until the cap is removed. My front tooth is another tooth that may have to be removed. About a year and a half ago I had the tooth capped, ever since then the tooth has been a little loose and it occasionally hurts, particularly if I bite into harder foods. It could be from the tooth having to deal with a cap, or from lack of bone, though Dr. S thinks there is good bone (though not perfect) to hold the tooth. A decision will be made about that tooth prior to the bone graft.

Then we talked about prices and insurance. As I previously stated Dr. S does not take my health insurance and my insurance does not provide out of network coverage. I have 2 options: pay out of pocket or change my insurance. Dr. S said that if I opted to pay out of pocket he would discount me and he would charge $3000, I would also have to pay around $1500 for an anesthesiologist. This would be done in the office, but this would only cover the palate expander. The insurance girl did say that I would still have out of pocket expenses of around $3000 with insurance, that sounded high but she also didn't know what exactly was being planned and what surgeries would be done so I'm not going to get stuck on that amount. But with insurance I wouldn't be paying for the anesthesiologist. I'm sure I'll be in contact with her again.

Changing my insurance is slightly more complicated and will delay things until next year. My insurance change period is in the fall and the change takes effect for January 1. Then they would still have to get approval for surgery which will take another 6-8 weeks. I wouldn't get started with things until late February. If I did wait though I would be able to set up a flex-spending account, where you put pre-tax money into an account to pay for medical expenses and then get reimbursed as you pay out. This could save me a bit of money, especially when looking at $9000 for braces and the out of pocket expenses for the 2 surgeries.

The other issue is that even if I decide to pay for the palate expander I still have to have the bone graft. I'm not independently wealthy, I can't afford another $5000 for that, assuming it would only cost $5000. I suspect it will cost more because it is a more complex procedure. So, I would still need to change my health insurance no matter what.

If I opt to pay out of pocket for the palate expander and change insurance for 2009 to cover the bone graft then I should probably wait until October or November to do the palate expander. That's assuming 4 or 5 months after the palate expander until I could get the bone graft. And I would also need to allow another 2 months to get approval for the bone graft. So paying out of pocket for the palate expander would only save me 3 or 4 months of a delay.

The other factor is that if I pay out of pocket then I would have the palate expander done at the office, if I wait and use health insurance then it would be done in the hospital.

The Oral Surgeon

On the recommendation of LF I made an appointment with Dr. S, an Oral Surgeon, for November of 2008. At this appointment Dr. S took pictures and molds of my mouth, he was able to scan the x-rays that I had from my appointment with LF. I really liked Dr. S he was nice and knowledgeable about Clefts.

The first week of December I went back to meet with Dr. S, this time I took my mom with me since I knew that at this visit Dr. S would be explaining options to me. First he spoke to my mom and I about the state of my teeth. I am missing a tooth on the top where the cleft palate is (my left side) it's the one that should be next to my middle teeth - the lateral incisor. The bridge/crown was adjusted to make the the left canine look like that missing tooth. He showed how my dental line has more of a V shape instead of a rounded shape and spoke about the mobility of the bridge/crown. We also discussed my goals: not to necessarily have a prefect mouth, but to have a more permanent solution to my bridge/crown.

He then went to discuss what I could do with my teeth. He explained to me that he did not think that I needed a palate expander and that the same goal could be reached by getting braces. He said at some point a bone graft would be needed as the bone graft that was done when I was younger was no longer there. Apparently, with a bone graft the bone that isn't used basically dissolves, you can now, on an x-ray, see a gap in my bone where my cleft palate is. Depending on the plan that was developed I might need at least 1 implant. I was a little taken back by all this work, when I walked in to see LF in July I never thought about the idea of getting braces, a palate expander or a bone graft. But ever the trooper since I was born, I went with it and started to really think about doing these things.

My next step was to meet with an orthodontist, Dr. G was recommended.