Nothing really

Its been a while since I posted. Nothing has really been going on. My surgeon was very please with the almost 10mm space in the front of my mouth. I can't wait until January when my orthodontist starts to close my gap. I hope my teeth move quickly. I know that this takes time but I really miss being able to speak to clients, co-workers, vendors, friends and family members without repeating myself 2 or 3 times. I have meetings all week and I feel really self conscience in most meetings. I am a project manager/engineer and can't sit quietly through most of my meetings. I am getting better each day at communicating.

For those who had SARPE how long did it take your teeth to move in and close your gap? How big was your gap?

Thanks

17 days Post Op, 18 activations and 1st OMS and Ortho visit Post Op

So I had my first follow up with my surgeon on Sept 22. According to him everything went well and looks good. Now it was time for me to activate my expander. The desired gap is about 7mm. To achieve this spacing I need to turn/activate the expander twice a day. I like to do one in the morning and the other in the evening. I really am not experiencing any pain, no bruising and very little swelling. I have been lucky enough to loss 8lbs and I am down a dress size! :)

I had my first Ortho visit today which I was not looking forward too. They did not change my wire, I was happy not to have to top ones changed but I thought the bottom wire should have been changed; but what do I know?? The Orthodontist and my surgeon don't really speak that often. At my last Ortho appointment they asked me if the OMS told me how many activations of the expander I would do per day. Sad to say I didn't know until my visit on Sept 22. This time the Orthodontist asked when I would stop the expansion of my pallet. I let him know that the OMS said I should continue 2 turns per day until my visit on Oct 22. I don't think he liked this reply because immediately after I said Oct 22 he said I needed to come back in 2 weeks.

I have a question - how many turns or activations of the expander is required to achieve 7 to 8 mm?

So my tongue is finding its way into my new found gap. I have a tongue thrust and am on the edge of starting therapy / treatment for it. At this point i think the only reason I have not started is because the sessions are costly $150/hour. I would be looking at 2 hours per session, 2 sessions per week for an unknown duration. I looked into the number of sessions I would need and the answer that I was give was "it depends on how sever my case was and how well I responded to therapy. But I should expect 3 months minimum."


That is all for this week. I will leave you with a photos of my gap.

36 Hours Post Op w/Photos

So It has been 36 hours since surgery and I feel a lot better. I have full feeling on the left side of my mouth and lips. The right side still feels numb and tingly. I do not have nay bruising which is nice. I am going to venture into the world today. I think it would be the best time since my husband goes back to work tomorrow and I am still on vicidin and will not be able to drive tomorrow. I am a little swollen but I am sure that very few people will even notice it.
The first photo was taken 2 hour Pre OP.


The second is 18 hours Post OP. This photo is to show how my teeth have already moved. In the past the 3rd and 4th teeth use to be behind the 1st and 2nd teeth. I can't believe how much they moved already.


The 3rd is 36 hours Post OP. I do have swelling and don't look that good at 10 am but I could look alot worse.

18 hours Post Op

It has been 18 hours since my surgery. Everything went well. I have am not groggy but I am very sleepy. My surgery was scheduled for 1:00pm but it was 3 hours late which meant that I did not eat or drink from 11:40 pm Sept 13 until 6:00 pm Sept 14. I am now on a liquids only diet for the next week.
Last night sucked. My husband is really trying but he wanted to wait 6 hours instead of 4 to give me my first dose of drugs at home; that hurt. I don't have to take then every 4 hours but my body wakes me out of my sleep promptly when it is time. I have some swelling and can't close my mouth all the way. I feel a lot of pressure in my sinuses when I swallow or have my eye glasses on as I do to write this blog. I should be able to go back to work in 5 days which is really fast. I booked 2 weeks off but am thinking of returning on Monday to work. I like having my vacations 1 week at a time and since I don't get sick leave this is cutting into my vacation.

I can't wait to be able to sleep on my side. I was so tired from sleeping on my back that I chose to sleep on the couch for a couple of hours.

well my head is starting to hurt so I will go.

Good night.

14 hours until my SARPE surgery

There are only 14 hours until my SARPE surgery. I am a little nervous. I really don't like pain. I have picked up some items that I should be able to blend up and eat with no problem.

I can't eat anything after midnight and my surgery is not until 1 pm. I am going to be soooooooo hungry; the one consultation get to drink water and apple juice until 6:00 am. So my husband has come up with this great plan of staying up all night and sleeping in as long as possible. Hope it works. I usually get up at 5am to go to work. Sleeping in for me is 7am.


Talk to you after surgery.

Scheduling

So I don't really have much to say about having braces other then its strange. My lips are stretched over my braces. My teeth feel like they are going to wiggle out of place like they did when I was a child.

So I have the SARPE surgery Sept 14th but I need to leave the country and renew my work visa. I am having some problems scheduling as I have waited so long. I was going to go 8 or 9 days after surgery but That really is not aloud according to the surgeon. I am just going to have to squeeze in a weekend flight to Canada.

Other then a little trouble scheduling a flight I am all set with my Husband coming along.

Got them on!!!

So I got my braces and the rapid palatal expander apparatus ( I believe it is a Hyrax) installed. this is really strange. The expander apparatus is close to the roof of my mouth; food gets trapped in it and I have problems saying many words. The separators hurt sooooooooooooo much I was really happy when they where removed. My co-workers keep telling me that the brace will hurt, not as much as the separator, but they will hurt. I am on day 3 and no pain just a little irritation on the back of my lips. I think the braces don't hurt is because the top only have a split wire (only the front 6 teeth have a wire through them). The bottom however has wire all the way around.

I had a meeting on Thursday and that was hard. I had to talk and could not pronounce many word. Hopefully I will over come most of that this weekend.

The rapid palatal expander apparatus that I have in, by the way this is not being tightened until my 1st surgery Sept 14) can be seen here: www.drstich.com/images/diagram_expander.jpg
You can also check out these sites to get more infomration to the sugically assisted rapid palatal expansion (SARPE) I wll have.
http://www.srt-psc.com/10case98.html
http://ejo.oxfordjournals.org/cgi/content/full/29/1/31
http://www.angle.org/anglonline/?request=get-document&issn=0003-3219&volume=072&issue=04&page=0362
http://ejo.oxfordjournals.org/cgi/reprint/26/4/403.pdf

Time off work

How much time should I expect to take off work for each of the following?
- I am tentatively having rapid palatal expansion September 14
- and in about 1.5 years I will have upper jaw surgery (one cut to move my entire upper jaw down)

I am a project engineer and my current projects are both in construction. They will be in construction until the end of 2009. The engineer that I keep in the loop has planned his vacation for the last week of September until the 2nd week of October. This is my dilemma. I know the project will go on without me but unexpected challenges always arise when I am not in the office. I also feel that these projects are my babies and I don't want to leave then with just anyone.

Also my 1st wedding anniversary is Oct 1 this year and I would like to be able to enjoy it.

Thanks for your comments.

Starting again

So it's been a long time since I have posted. Here is my update. I had separators once, they where removed and metal bands where added to my bottom teeth. I had to wait for an approval for my surgery before I could have the upper expander or braces in. My OMS finally applied. This time my surgery has been approved. This wed I get the separators for my upper teeth. The wed after that I get my braces. My tentative at surgery date for the pallet expansion is Sept 14th. I had a trip planned for then but I have rescheduled it.
I am so excited and nervous. What advice do you have for me? Was there any receipts that where quick, easy, and really good?


So that is everything in a quick short package.

2nd Try

So I went to an OMS, Dr. P within my network today. This was at the UCSF hospital which is a teaching facility. The surgeon didn't really do much. He walked in didn't say hello or introduce himself, even though this was the first time I'd seen him. He started talking to the observing students. I tried to interject and offer up some useful information but he continued to cut me off. When I was able to get a word in I let the surgeon know that I had an approval for the same reason I was there and I was seeing him because I wanted to stay within my network. He got on me and said that this was information that I needed to share with him right away. I was a little taken back as he didn't really even talk to me or want to hear what I was trying to say earlier. Moving forward from that point the resident surgeon, Dr. J took over. He did all photos and measurements.

Even thought Dr. P was distant and possibly insulting I like the fact that his experience plus the eyes of many students is what I would be getting. Students work really had to impress their professors. The surgery would be completed by the Dr. P and not a student.
I have a followup appointment April 23, 2009. This whole process is taking a really long time.

On another note, I called the Texas Department of Insurance (TDI) about my insurance company not suppling the benefit booklet so I find out what the allowable maximum would be for my treatement. TDI was not that helpful over the phone. All they said is that I should file a complaint which would take 4-6 weeks before I got any results. I did file a complaint. Now I just have to sit and wait for their reply. I feel kind of like a rat/ whistle blow. I know that I should not feel that way but I do. I also feel ripped off because I have to spend a lot time that could be spend on other things.

Insurance - in network or out of network

So last time I was excited to be approved for my surgery. Well there is always a ketch 21 with insurance companies. So my coverage is "Bluecross Blueshield of Texas PPO". Which is pretty simple to understand if you live outside California. In the state California Bluecross and Blueshield are different medical providers/companies. I of corse live in California. I apparently am a member of Bluecross PPO or Blue card PPO. Which would have been good to know months ago when I went to see my OMS. The OMS office didn't know until I told them last week that they where out of my network. The OMS didn't know because they are covered by Blueshield but has to send their claims to Bluecross Blueshield of Texas PPO for processing. This so very odd, how do people trust or understand what they are covered by or for when things like this happen? I am pretty sure that I am not the only one experiencing this confusion, unrest and distrust of insurance companies.

Back to the letter of approval. The letter indicated that they I would have to reach my min deductible then they would pay 90% of the allowable max. After I met my max deductible they would pay 100% of the allowable maximum, if the doctor was in the network. If the surgeon is out of my network they'll pay 75% of the allowable max once I reach the min deductible. Once I reach my max deductible they will pay 100% of the allowable max.

"WHAT IS THE ALLOWABLE MAXIMUM?"

I called the medical insurance company to see what the amount of the maximum allowable would be for my procedure. Guess what not one person could tell me that information. I called a total of 4 times and got the same answer each time. The customer service agents did not have this information . They said to go to the benefit booklet which you have to get from your companies admin office as they did not have any copies and could not order you one. The admin office only had the"summary of benefits" This indicated the percentages that would be covered but was only a summary and did not have $ figures.

The OMS office finally got a $ figure form one agent the would not send a written copy. The dollar amount for a $75,000 for my 3 treatment procedures is $4705.98. That's right they said they would pay less then 7% of my surgery.

I have decided to try a doctor within my network. The only ones that specialized in adult orthognathic surgery and within 30 miles of my home are at UCSF. I did some research on this Oral Maxillofacial office has a record for keeping bad records, keeping people waiting for 1 hour before seeing them and they don't have real communication between the student doctors and the residents. I called UCSF yesterday to schedule and appointment with one of the doctors in-my-network. The schedular pushed me into taking an appointment with Dr. C... for March 13, 2009 saying that this sergeon usually has the same contracts as dr. Bast (even though that is who I asked for). Dr C... was not covered by my insurance so now I have to wait till April 7.

I really want to get the finances in order without owing a sports car at the end of this but the way this health care system is designed my wish seems impossible.

By the way if I didn't mention this before I am Canadian and really miss my public health care system where the costs of medical treatment are reasonable.

How it began

So I have never had a blog before but felt the need to tell my story and document my journey.

I have never had anything near a perfect smile. As I got older I could never afford braces until now. I am 28 today and will turn 29 in the next month. While in post secondary school my jaw started causing me trouble. My jaw started clicking and would not open completely. The pain was not constant when that started, but as the years past the pain was constant and brought headaches with the pain.
I have now completed school and can afford braces to correct alignment of my teeth. I have so long wanted braces but my parents didn't have the knowledge that I needed braces as a child. I now have dental insurance that will pay for a portion of the braces.

In Dec/08 I made an appointment with an Orthodontist, selected by the dental insurance company. The office I went to was dirty and unpleasant. The orthodontist looked at my teeth for 5 min max; I don't even think it was that long. He told me that I would have to to wear braces for 24 to 30 months, and that he could not correct all of the issues with my mouth without surgery but he would try. He told the insurance company that braces where needed; for me this meant I would not have to pay for the complete cost of braces.

When I was at that office I really felt like I was at the poor mans office and the orthodontist was working more for the insurance company then for me. So what I did was select another orthodontist that was covered by my dental. I really didn't know who to select especially since I recently moved to the bay area and didn't know anyone in my area to help with this selection. So what I did was choose an orthodontist based on the area that was known for better everything. I went to one in Berkeley.
The orthodontist that I saw, Dr. O took the time to record what he saw and what he thought the treatment needed was. This made me feel a lot better in comparison to the first orthodontist.

So the results where both expected and disappointing. I would need braces and orthognatic (jaw) surgery. Dr. O would not put braces on me if I did not get the surgery. I went for the Oral and Maxillofacial surgeon (OMS) consultation. According to the OMS if I got braces without this surgery I would be back to see him but to get my front teeth removed because the braces would pull the roots of my teeth. I really want to keep my own teeth.

So I had the OMS submit an request for approval. On Feb 2, 2009 the medical insurance company sent their first letter of denial saying that orthognatic surgery was only covered for people 19 years and under. That doesn't make sense, many people get this surgery done. I did not wake up one day and say " hey I'll put myself though 3 surgeries for the fun of it."

What I need done are 1st surgery - I will have my pallet suture split, the 2nd surgery - the upper and lower jaw need cut in to 2 or more pieces and movement and bracing of those pieces.

I called the medical insurance company to find out how they came to the conclusion that my age excluded me from coverage. The first person I spoke with indicated that there where no age restriction on the treatment codes supplied by the OMS office.
I called a second time and that person sent my file for second review.
I called a third time to find out if I could do anything else to be approved. Person 3 indicated that I needed to get the benefit booklet and submit an appeal to the medical insurance company.
I called a fourth time just to get more information as my husbands admin office did not have a copy of the benefit booklet (they only had the summery which tells you nothing). I spent over an hour with this person. I am sooooo glad that I called the fourth time because on February 10th another letter was complied indicating that I was approved for the 3 surgeries.

When I thought I would have to pay for the surgeries myself, I found out that some hospitals will give a discount to cash patients. So, if you think you will have to pay out of pocket, call your local hospital's accounting department and see what they'll do for you. You can also check out teaching hospitals, I heard that they will give a discount on the surgery. If you went this way I would see if you could get the professor to do your surgery. I also found out that there are a couple options for financing. Medical financing is suppose to be different then any other financing, the OMS office will let you know which ones are available in your area.
I gave this information because I had to go to soooo many websites and blogs to find those 3 financing options.