Patience

Ok so I may have gotten a little ahead of myself. I got a call from Kim at Dr.Tawfilis' office and she basically said that my proposed surgery date is rather unrealistic. They're looking at another 3-4 weeks to get insurance approval and another 3-4 weeks for a hospital opening. Granted, I knew setting up my ortho appointments was a bit on the rash side but I was hoping for the best. I guess I just got excited because if everything went according to my plan it would fit perfectly into my work schedule and this and that...

And now I know that surgery is an awful mistress who will do as she pleases, when she pleases.

So I guess I'll just keep my spacers in for awhile so I don't have to get re-used to them. I'll postpone the cementing of the I-make-food-impossible-to-eat device and wait.

At least I won't be stressing about it on my trip.

Getting There

Nothing exciting but I did go in to Dr.Styrt's this morning. Kira took out my spacers and fit the bands for my RPE. I was kind of hoping to actually get to try the whole device in my mouth for a second just to see what I'll be in for but no, the bands around the teeth get fitted separately and then get sent to RPE's-R-Us to be built into the expanding part. Makes sense now that I think about it. And while I was prepared for the rank smell that is food stuck in the spacers it doesn't cease to amaze me how much smell a little piece of whatever foodstuffs can cause. I didn't feel bad about it though because 1) Kira is smart enough to wear a mask and 2) they tell you specifically not to floss near the spacers. So there. You want rotting chicken pieces? You got it.

She gave me some more extras in case I have another escaping bandy while I'm away. I'm getting a touch nervous about the surgery date because I still haven't heard back from The Chainsaw's office. I think he's waiting for me to be approved by the insurance people before he schedules me. I just hope it happens before I get on a plane so I can tell my family what's happening when exactly.

Well How About That.

A mere 6 hours after leaving Dr.Styrts yesterday a spacer came out. Hmm. Seemed to go back in without much hassle but it was curious, I never lost one from the first time around. Whatevs. Yeah they're a little sore but I've found I'm adopting a slightly aggressive point of view towards the ordeal. "I know this is going to hurt to bite into but the more I get used to it the better off I'll be. Bring It!!"

Surprise!

After looking at my schedule to figure out when I want to start this saga I found a good week after I get back from holiday and called Wonderful Jessica to set something up. I want to do everything I can to be ready to hit the ground running when I come back. As I figured, getting the RPE cemented will take a few appointments. One to get some spacers in, a second to fit the RPE and a third to actually plant it in there. She had time this afternoon to get the spacers in. I didn't have anything better to do and the sooner I get used to them the less annoying they'll be in Chile. Next week I'll get fitted. Then I'll fly 15 hours for some snowboarding and wine. Then on the 20th of August I'll get geared up for a hopeful surgery on the 22nd or shortly thereafter. Things have been going swimmingly so far. I'm keeping my fingers crossed. It's good to be good, it's better to be lucky.

So it has begun. I've got spacers on my upper 6's and I'm ready to rumble.

Meeting with The Chainsaw

Dr. Tawfilis is great. He went to USC and is an honored lecturer at UCSD. I like his style and I'm feeling pretty good about him. I think for the purposes of this blog I might keep calling him The Chainsaw though because that's how nicknames work. Sometimes they just stick and you get no say in the matter.

So Dr. Styrt wanted a consult for a Lefort I expansion and posterior impaction in addition to lower mandibular advancement. Three things happening there: Upper jaw gets cut vertically and is spread apart, Upper jaw gets tilted forward, and Lower jaw slides forward. Dr. Tawfilis said he prefers to be minimalist when it comes to surgery and believes that the lower advancement won't be necessary but if the chin deficiency is a problem for me that he recommends just a genioplasty. (He showed me some pictures of other genio patients and I'm not sure how I feel about it but I've got plenty of time to ponder.) He also said he isn't sure that the Lefort expansion will be necessary and that seemed to think that SARPE (surgically assisted rapid palette expansion)would do the trick. This confused me a little bit. I guess by Lefort I expansion they mean like a three piece expansion? Anyone have any insight? And the prize indeed goes to Erin for calling the wisdom teeth extraction. He said we could do it at the same time as the SARPE since I'd be under anyway. As for the implant down the line, the bone grafting will happen at the same time as the Lefort I and the actual implanting will happen around the time I get the braces off. The great news is he said I can save some money by doing the grafting at the same time because implants aren't usually covered.

Speaking of coverage. He said my insurance is usually really good about approving this type of treatment and that yes indeed, we're talking 100%. Sweetness.

So we talked a little bit about timeline and here's the big rundown:

1. Make an appointment with Dr.Styrt to get the hyrax (hirax?) cemented in, meanwhile Dr.Tawfilis will put in the request to insurance for the SARPE.
2. Have SARPE, remove wisdom teeth, and start clicking. (For those of you out there who've had this done, how long post-op until the braces go on?)
3. Get braces on and start closing "the gap"
4. 12-18 months later, have a Lefort I and bone grafting and perhaps a genio (I really think I'm going to decide against it though.)
5. 6 months later, get braces off and install implant post.
6. Then whatever the timeline for the implant is, I didn't see any need to go into it in detail since it's so far away yet.
7. Fin!

As I'm writing this I got a call from Dr.Tawfilis who had a chance to speak with Dr.Styrt. They're in agreement about The Chainsaw's plan and now I need to get that awful thing cemented in. Here's the rub. I'm going on vacation to Chile in a couple weeks and think I'd like to wait until I get back to get everything started. I'd hate for something to go wrong while I'm there or have to deal with that thing any longer than I have to, especially when I'm supposed to be enjoying myself.

The only bad part of the appointment was with the confirmation of the SARPE means I'll have to stop playing hockey 12 months sooner than I was hoping. *shrug* I guess that's the way it'll have to be then.

I Am a Retard

Yup. Friday the 13th. I was supposed to go meet my OS but the fates had another plan for me. I had to run around for work and thought I'd be able to make it back in time to head to my appointment. I would have made it just in the nick of time had I not forgotten to grab my models and x-rays. Bloody hell. So as a penance I had to reschedule for Monday and have the whole weekend to think about what I had done. Lucky for you my readers often times my curiosity gets the best of me and an entire weekend with a box of cement teeth on my desk is too much to go without a peek. So here are some photos to tide you over until tomorrow. You can really see two distinct occlusal planes (I've been reading.) My wisdom teeth are also visible now and Erin I think you're right. There seem to be good odds they're gonna get the axe.

List

Questions/Issues to Ask Dr.Tawfilis Tomorrow:

-Will I need to have my wisdom teeth pulled?
-Will I need a palette expander?
-Will I need SARPE?
-What will the timeline for the implant be like?

I saw Wonderful Jessica today when I picked up my files and models for tomorrow and she said he's really cool and that I'd like him a lot. Perfect. I'm not used to letting people I don't like peel my face back and break my skull apart.

Moving Right Along

I have an appointment to meet my would-be Oral Surgeon. Dr. Tawfilis will be checking me out next Friday, the 13th. Aw hell. I was a little disappointed when I got the call from his secretary yesterday. There's another surgeon that I've heard good things about from a guy I work with and from my ENT that I was hoping insurance would send me to. Well we'll see how I like Dr.Tawfilis and if he's really terrible ("Oh you got Dr.Tawfilis, 'The Chainsaw'? Yeah he's been in and out of court all year. Who knew a wooden mallet and a bottle of whiskey aren't considered standard practice any more,") then I'll see what I can do to get the other fellow.