Thursday, January 29, 2009

migraine part 1,000,938,822

I'm beginning to believe that every time I have an orthodontist adjustment, I should just prepare lesson plans for the next day so I don't have to worry about it the morning of. That's right, I'm home with a migraine AGAIN.

The only bright side is that I have an amazing husband who brought home two giant bags of indian food (all slow-cooked and delicious and mushy and doesn't need to be chewed). So I just had an amazing meal that I didn't have to chew once.

I am ready to be done.

Wednesday, January 28, 2009

metal mouth extreme

I had an hour long orthodontist appointment today. And it wasn't one of those chat for a half hour before the real appointment begins appointment... it was an hour of people with their hands in my mouth and adding pounds of metal onto my teeth. Looky looky: if you look closely, my front 6 or 7 teeth are all connected by a wire that is twisted and criss-crossed around each bracket. Then I've got huge hooks on the top and the bottom. There are two huge springs on the bottom, working on closing those gaps, and there are "tie backs" on the top teeth - rubber bands hooked from the top hook to the back that I don't change. The archwire is a thick stainless steel wire. So. Much. Metal. I'm a tad worried about playing the clarinet with all of these things inside of my face! On the right is a better picture of the spring and the dreaded gap... there is a matching one on the other side. Oh, hey, and there's food stuck under the top hook already. Lovely. Already the extra stuff is rubbing against my lips and making my teeth sing more Wagner arias. Despite taking an extra-large dose of ibuprofen, my teeth are pretending themselves sopranos - singing the high notes!

Other than that, not a ton of change... My orthodontist seems really pleased with the overbite, which is sure a different reaction than my own. This new set of wires, along with closing the dreaded gaps, is trying to spread out my arches. My next appointment is in April, and that should be my last major appointment prior to surgery - perhaps some minor tweaking appointments after that. WHOA! I am more excited than I can possibly tell you that surgery is coming, but all of a sudden it seems like it's rushing at me at 100 miles an hour.

Tuesday, January 27, 2009

letter number 1!

"To whom it may concern:

Stephanie has been seen to determine the feasibility of surgically correcting the unsatisfactory functional relationship which exists between her upper and lower jaw. Clinical examination and review of records demonstrates the patient to have maxillary hyperplasia and mandibular hypoplasia. I have outlined to the patient a plan of treatment, which will involve surgical realignment of the maxilla and mandible. This will entail a 2-piece Lefort I Maxillary Osteotomy and Bilateral Saggital Osteotomy, with Impressions and Custom Preperation of TWO surgical splints PRIOR to the date of surgery. This form of major surgery is performed in an outpatient 23-hour observation facility using nasoendotracheal anesthesia. It should aslo be stressed that the proposed surgical procedure is a functional correction; it is not cosmetic or dental in nature, nor is it TMJ-related surgery.

The above procedure is medically necessary. The American Association of Oral and Maxillofacial Surgeons defines "medical necessity" as (1) appropriate for the symptoms and diagnosis, care and treatment of the patient's condition, disease or injury; (2) provided for the diagnosis, care and treatment of the patient's condition, disease or injury; and (3) in accordance with standards of good oral and maxiollfacial surgery practice. Stephanie has a facial skeletal deformity. The orthognathic surgery which is recommended would be done to establish normal functional relationships between osseous, muscular and contiguous structures. I feel that medical necessity is established by the diagnosis of a musculoskeletal deformity, which is by itself, pathologic, and constitutes a medical condition which requires surgical correction. I would cite corrective surgeries that are routinely allowable, such as scoliosis of the spine, cleft palate, and club foot, and would request that Stephanie's orthognathic surgery be considered in the same context of medical necessity.

In outlining the details of surgery, hospitalization, and anesthesia to the Sheppards, they raised the question regarding insurance coverage that might be expected. I have mentioned the importance of obtaining a predetermination so that she might better understand her financial obligations. Two points should be stressed. First, the diagnosis mentioned above refers to a skeletal deformity. Second, the singular objective of treatment is to establish and maintain an acceptable functional relationship between the upper and lower jaw. Pending your review and response, we will advise the Sheppards accordingly.



Ahhhh!! :)

Wednesday, January 21, 2009


Alright, I tried to be clever after a run and it didn't work. Regardless, my braces anniversary is tomorrow! I think I'll celebrate by eating soup. And more soup. Ooooh... and oatmeal!

A year ago tomorrow morning, I was waking up and late... which ended in only getting half my braces on. While my jaw and teeth were not functional at the time, I never really had a problem with a tight jaw (unless I chewed gum for too long or chewed a big piece of steak), I never got migraines from my jaw, and while it clicked and popped a lot, it didn't really bother me, per se. I decided to get braces because my bottom teeth were so crooked that it affected my clarinet playing (plus, I hated the look of my crooked teeth).

What a year. And what a year ahead of me... Maybe at this time next year we'll be looking at de-bracing dates! Whoa.

Oh... and I decided to do the half-marathon, but I think I'll postpone my surgery into the first full week of July. I'll run, I'll work a bit at Starbucks, I'll chair shop, I'll blend and make soup (blegh) and be nice and prepared. I'm sure that I COULD do it and have surgery two days later, but I want to make sure my body only has to worry about my bones, not the rest of my body, too.

Tuesday, January 20, 2009

here we go!

I finally called my insurance company to get this show on the road today - and get this. I explained the surgery I needed (had the surgery codes and everything) and wanted to know when was an acceptable time to start my appeals process, as P*remera does not cover orthognathic surgery for teachers in Washington State.

Lots of confusion later, the woman on the other line tells me that I can't appeal something that hasn't happened already. I have to have the surgery and then appeal if they deny covering the bills. I explain that the surgery and hospital stay may be upwards of 10,000 dollars and that wasn't something I was willing to do, and that I needed it pre-authorized. I pretty much get no where.

So I called Tami, my wonderful amazing patient coordinator, who simply asks me for my subscriber ID numbers and group number, and tells me that she'll send a letter off tomorrow explaining that surgery is medically necessary, and they will deny it from there - and then the real appeal process begins.

Here we go!

Tuesday, January 13, 2009

half marathon + surgery?

I'm not sure what's happening... but I got a doozy of a migraine on Sunday and it hasn't left, missed yet another day of work on Monday. Today I spent the day wearing earplugs which resulted in mildly offended middle schoolers. (Not fun. Not fun).

My jaw is also intensely tired... but I haven't been working it out, I swear! I have stuck to my rigid chew-as-little-as-possible regimen, eating oatmeal and soup and smoothies instead of "real" food. It is spasming left and right, and I can not find a comfortable resting position to save my life.

On another note, I've been considering running a half marathon for a while now and my friend wants to do the Seattle Rock and Roll Half Marathon with me... however, it's June 27th. School is already going to be delayed getting out by at least two days (we've had a bit of snow this December in Western WA) which places us out of school on the 19th. If I had my perfect date, I would choose June 29th for a surgery date.... but I'm wondering about putting my body through the stress of a half marathon only to have major surgery two days later. What do you guys think?

Sunday, January 4, 2009

appeals, here we come

It is after January 1st! I have new health insurance. I'm going to call Dr. Lee's office this week to learn about when I should start the appeal process. I will NOT have my surgery delayed because of insurance snafus.

Ooh, am I scared, though. Moment[s] of truth.