Moving my newly cleaned teeth

I saw my surgeon last week and went for a cleaning this week, just to round out the excitement, I have the orthodontist next week.

Dr. S's next plan is to move one of my teeth.  It is the tooth next to the gap in my mouth, he wants to move it forward to help close up the gums.  By moving it (using the braces), the gums  (which haven't closed up right with my last 2 surgeries) should close up better.  I can't wait, I love moving teeth!

The other thing he said is that it looks like I will lose my front tooth, he said the bone just isn't there and he thinks it's part of the reason that the gums aren't closing up right.  It doesn't sound like something they're doing for a little while.  My dentist, LF, also agreed that the tooth didn't have good bone structure and it's not in good shape internally anyway.  But LF is as always, excited about my progress.  She however was not too excited that I have been using perodex since my surgery, it's been staining my teeth and I will agree they were looking pretty gross.

1st Doctors Visit

I had my first Doctor's visit today.  I saw an associate of Dr. S.  He didn't do too much, did make me properly brush my teeth though.  Said that things were healing appropriately.  Moved me up to mushy foods - pasta, mashed potatoes, eggs...  Originally I thought I would be much more up on my feet at this point, but I'm not.  It didn't sound like they wanted me to return to work next week like I had originally planned, so I wont be.

I see Dr. S next Monday, I suspect I will learn a lot more then.

I also saw Dr. F, who basically did nothing.  The surgeon doesn't want to have my teeth put in for another 2 weeks until the swelling goes down more.  Dr. F decided not to bother putting the wire back in until then as it's not needed.

It seems like they're taking things very conservatively at this point, which is ok.  I'm not sure if after the bone loss last time they're feeling more conservative or if there were any issues with the surgery where they are feeling a need to be more conservative.  

I will say that today I have had a bit more pain then I have had in the past few days and I'm taking the same amount and types of pain killers.

Oh, and laughing hurts, no more funny sitcoms for a few more days.

Not much going on...

I haven't written lately, because there just isn't much going on.  I'm just waiting for the next surgery in November.  I did go away to England and Scotland for 2 weeks, the food wasn't great, but I was able to eat it and that made me very happy!

This week I did go to see Dr. S, but there wasn't much to report from that.  He told me to keep doing what I'm doing.  That this sometimes happens with adults and he was confident the bone stimulating proteins would help.  I did keep some of the bone, so that's good.

One other good thing is that my primary care physician has opted not to have me come into the office for a pre-surgical clearance, he feels that I'm in good health and he can clear me without seeing me.  I think since he did one back in July too helped.  So I have one less thing to do before the surgery.

Back to the surgeon

I saw Dr. S again this week and got some good news.  My wound around the bone graft is healing now, similar to how a scab heals over a cut.

I no longer have to rise with peroxide and water, instead I have to use one of those liquid syringe things and clean out the wound with that.  I think it's a bit better, but I'm not sure how much better that is.

My first visit to the doctor

My surgeon is on vacation this week so I saw a different one and I didn't really care for him much.  I felt like I got berated for blowing my nose, which apparently i'm not allowed to do, even though my doctor said I could do it very very softly. 

He irrigated my mouth and cleaned out the wound which felt weird.  

He said I could eat some more foods.  But I can't bite into anything with my front teeth, but can eat stuff that needs just a little chewing in the back of my mouth.  I'm not sure how much more food that is, but I'm sure I'll come up with some new ideas.

I have to say my gums look really weird though.  Before I just had a gap in my gums up to the roof of my mouth.  Now it looks kinda like a hook or an O with a hole on the edge.  It looks like the gums behind my tooth line need to grow forward and that the hook needs to grow to connect to the other side of my gums, which it doesn't really do.  It's weird, I thought the gums would look much more complete.

So what's the deal with the bone graft?

I went to Dr. S today primarily to discuss when I would have my bone graft surgery. He said that Dr. F was being very conservative and I had to wait 4 months since the date of my last surgery. February 23 + 4 months = July (I'm guessing that Dr. S is going on vacation in early July so no late June or early July). I scheduled for July 27, but nothing is that easy since that is cutting it close to some vacations I have planned. I'll get back to that in a minute...

I asked Dr. S what the recovery was like after the bone graft - he said for 2 weeks I'll be on really soft food, ugh, I'm sick of soft food already! He said he was going to take the bone from my tibia (shin just below my knee) and that I would be a little sore 7-10 days and wont be jogging for a little while. But he said that if he had to take from my hip then the recover is a lot slower, possibly a couple months to get fully back up and running. He seemed to play that down, but the fact that he mentioned it indicates that it's a possibility. I also looked online, though it's hard to tell what type of bone grafts people are reporting about. Sounds like I'll be fairly sore for at least 2 weeks and the roof of my mouth will be easily irritated and tender for 2 weeks. And I saw that there might be an issue with flying (the whole pressurized cabin thing.)

After talking to Mom, who seemed a little concerned about the time frame and confused as to why I couldn't do it earlier I decided to call Dr. S's office. He said 2-3 weeks to fly, so I'm good, but I'm on the border with that time frame and that stressed me a bit. I asked if there was any possibility of getting the surgery the week before and was told that they are waiting for more surgical space and she'll see next week if they get more room. If they do she'll call me and give me a spot the week before. I would feel much more comfortable with that. While the trip to Las Vegas with my family is pretty relaxing I feel like 3 weeks will be cutting it close, 4 weeks I feel MUCH better with.

The other thing I asked about was my front tooth that I've been having trouble with - it's been sore for a couple years now and finally had a root canal in the fall. It's very close to the cleft but Dr. S thinks there is enough bone. However, he wont know for sure until he cuts open my mouth. Ackk!

I also have a vacation that I'm planning for mid September with Contiki. I think I'm fine with mid to late July and the recovery. Unless, they take the bone from my hip, my solution is to carefully research the reasons I can cancel my tour with travel insurance companies.

Felling a little better

I went to the Oral Surgeon on Monday afternoon. He said everything looked good and that I don't need to come up for follow up. However, he said to keep my appt that's in 2 weeks so we can work out a date for the bone graft. He did think that late June or early July was quite possible for that surgery.
He asked if I would be interested in a fake tooth with some sort of device that would cover up my hole and prevent fluid from going up my nose. I said yes, and he called Dr. F. He didn't speak to him, but plans to. I was so happy I nearly cried, I felt very cared for by Dr. S. He also anticipates that Dr. F will allow my palate to close up a bit before the surgery and said that my teeth are slanted out a bit, which I hear is common with the Surgically Assisted Rapid Palate Expander.

I asked where he gets the skin from for the palate and he said there is always plenty of skin in the cleft (remember it's two separate pieces of palate that are covered. He cuts that skin strategically so that there is enough for my base of my sinuses/nose and enough for the roof of my mouth. That's kinda what I thought, but now I know for sure.

The mean post-op nurse

Well from the subject you might have guessed that I had the surgery, and if you didn't guess - well I did. On Tuesday morning I went in at 6am and had the surgically assisted rapid palate expander surgery and it sucked. The morning went ok, got to the hospital ok and did all my processing fine. The doctor was a little late, something about a tractor trailer slowing him down. The nurse anesthetist was a girl I went to High School with.

After surgery I woke up and my whole entire head hurt! I asked for my mommy (it's times like these when we revert to childhood) and was told I couldn't see her until I left post-op but I don't remember what I had to do. But she gave me meds and I went back to sleep. Then I woke up again looking for mommy again and was again told I couldn't see her. She was tough, I was pathetic. Finally the pain killers were making me ill and I was actually sitting up when the Dr. S came by who berated the nurse for not having ice on my face. After that I pulled myself together so that I could leave post op and see my Mom and Dad. Probably 2 hours had passed. Then in the get ready to leave area I was still in quite a bit of pain and constantly in and out of sleep. It's all a bit of a blur but once I decided I was ready to go I got a last bit of medicine and then mom helped me get ready to go. I think it was close to 2pm by the time we left. I did get a bit of a chuckle when I was riding through the hospital in the wheel chair with ice packs on my face and people would almost walk into me.

I'm writing this on Friday and am doing ok all things considered. I'll write some more about the experience in the next few days but wanted to give a bit of an update about the surgery and the mean post-op nurse.

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.