I hate to get ahead of myself....

... but my jaw was not especially sore today, nor did I have a headache! Usually Tuesdays are my worst days for jaw pain and headaches due to my 2 hour rehearsals on my clarinet on Monday nights.

The funny thing now? I don't know what is actually giving me relief. I didn't play as much as usual last night (nightmares of migraines), I am trying acupuncture, I have those new muscle relaxers AND new day-time pain medications (sodium naproxen).

Still, I have a glimmer of hope [again]. Hopefully it's not a fluke this time.

more mirgaine fun!

I ended up in the Urgent Care on Thursday because the migraine had surpassed all migraines before it. It actually ran out of room to inflict pain on my [normal] left side, and began aching and pulling on the right. I couldn't hold food down, I couldn't see straight, I was sleeping for the entire day (we're talking, I'd wake up, moan, turn, cry a little bit, and finally fall asleep because the pain was so bad I couldn't see myself getting out of bed).

At the urgent care, they gave me an anti-nausea shot in the hip and a hardcore painkiller shot in the hip, along with some prescriptions to try for the jaw (a muscle relaxant for at night, a painkiller for the day, and a super-pain-killer for days like the last few). Hopefully something works!

I missed 3 days of school. Unheard of.

Acupuncture today with a crazy needle configuration on my left side (the ouchy migraine jaw pain side).... I again feel less tension already. Hopefully tomorrow I'll be pain free for a while!

He says that a week between visits is optimal. I'm seeing him again next Friday. Hopefully no record-breaking migraines before then.

acupuncture and adjustment

Acupuncture was this past Friday. I had needles. In my FACE (and neck, shoulders, hands, and feet). It was a bit scary. The acupuncturist was very good - he made me feel very relaxed, asked me a lot of questions, told me he thought acupuncture would help (and he can also fix my I'm-suddenly-getting-old-or-something weird stuff going on like my hip being weird). The needles stung a little bit going in on my face, but nothing more than a pinch and a sting and it was over. He left Nick and I in a nice warm room to hang out for maybe 20-25 minutes with the needles in (good picture time). I didn't feel any immediate relief, which was a bummer because I was coming off of a doozy of a migraine, but the next day I woke up to no pain. Not even a little. In fact, I didn't really notice anything was different until I went to yawn and I winced and grabbed for my jaw joints like I usually do and realized it didn't hurt. It didn't last long, maybe an hour, but I now have confidence that it can work. He says that the relief will be more immediate and more long lasting as treatment progresses.

Then the next day I got the worst migraine I've had in a long time. Hopefully not connected... I still have it now and I'm contemplating missing school tomorrow it hurts so bad.

Adjustment was today. They x-rayed my teeth and took off a maybe 7-8 brackets on my lowers and 1 on my uppers for replacement. She put the same wire back in and I was originally disappointed (no pain no gain!) but immediately I felt the results.... and 8 hours later my teeth are singing Wagner. Whoo-eee! I was sad, he made a comment on my teeth getting a little discolored. I drink coffee. I LOVE coffee. I'm not sure how I'm going to give coffee up, but he's right. My teeth aren't as lovely as they once were. Any ideas?

Oh, and progress pictures. The gums keep swelling (the splints make it worse, I think), the overbite keeps growing, and the gaps keep closing. On and on.

great news! (maybe)

Over the past few months Nick (the husband) has been getting lots of conflicting information about his school dates for the Natl Guard. At first it looked like he would leave in January and not really come back until both schools were finished (which would total a bit over a year).

NOW, we have a tentative date from early February to July 2nd! If I scheduled my surgery for the 5th or 6th, I could have Nick take care of me instead of my mom! I hate having to make my mom take time off of work - plus it's a hassle for my brother Jake at home, who'd have to take care of things while Mom is gone. (Did I mention how grateful I am to have people to take care of me?)

I'm REALLY crossing my fingers. The problem is, is it's the army. And the army is full of schedule changes and setbacks. Since I'm not scheduling my surgery until March, we'll know whether or not he is gone and when he'll be back.

benefits

Even though my district is now offering a "basic" plan, it will still be financially wise for me to chose the more expensive plan. This coming year, it is $267.00 a month for health and $20.00 a month for dental.

Now, it's looking like
Health Insurance Total: $3204
Hospital Co-pay: $300
Out-of-Pocket Max: $500-$2000 (depending on in-network status)
Surgery Downpayment: $1000
Genioplasty: $500.00

My husband and I just got out from under 4.5 years of major credit card debt. As of yesterday, we are debt free (well, except for my student loans)! But now, looking at all this money I'm going to spend in the next year, things are looking down. Because this doesn't include co-payments for visits ($20 each), co-payments for prescriptions ($10-$30 each), or the stuff I'll need to buy - blender, zip-n-squeeze bags, etc.

I know I need this surgery (after two more days of migraines while teaching band and orchestra, believe me I know), but at the same time I can't stand that it's so expensive. And I don't know that I'll even be covered when it comes down to it.

This is all so frustrating. I was really hoping the basic plan would help me out.

acupuncture, part two

I didn't realize that I had a mandatory district laptop training on Monday (my district is giving me a laptop to use though! Hurray!).... and the next appointment open is on Friday. So a week from today, I'll know about the acupuncture. While I'm scared out of my wits about it (I really don't like needles), it seems like a last resort - I mean, what else can I do? I don't see very many options.

The past few weeks I was wondering what was going on with my splints - it seemed as if they weren't working as well, and I was wondering if my jaw had perhaps adjusted somehow to them.

Well, I fell asleep during a movie last night and didn't put my splint in - and I would rate my jaw pain today at an 8. Edging higher and higher as the day progresses. Luckily it was an inservice day, not a teaching day - but I went out to lunch with my staff, ordered a bowl of tortilla soup and only was able to drink the broth. Thank God I didn't have to teach - I mean, I can't really talk.

Hey, but it's probably for the best - now I can't eat any of the yummy Halloween candy sitting in a bowl by my front door. Heh.

Happy Halloween, everyone!

acupuncture

I'm biting the bullet (not really, it would probably hurt my jaw too much). I've been complaining about this stupid jaw pain for weeks now. Despite massive amounts of tylenol and ibuprofen, massages from my talented husband, eating only soup and very soft foods, AND my amazing splint, nothing is changing for the good.

I was talking to two friends a few weeks back, and they discouraged me from getting surgery, saying that acupuncture fixed all of Mishka's TMJ problems. They even recommended a clinic here in Tacoma. I've been putting off making an appointment, though, mostly due to fear of the unknown.

But today I had another puking migraine at school today and am being forced to skip my band rehearsal tonight. I have shooting pains that are making my eyes water through my left jaw joints. Enough is enough.

My appointment is Monday at 4:30.

jaw pain

The pain from my jaw has been continuing to worsen over time. I'm keeping daily track of it in a notebook (hoping to build evidence for the appeal process). In the last 30 days, I have only had two days where the pain has been a 3 or less (on a scale of 1-10). I've had 18 days where the pain has been a 6 or more. We're talking, some days I can't chew food. I can't open my mouth (or close it once it's finally open). I've had 12 migraines.

At some point, if this continues, it won't bother me at all to be on a no-chew diet. I'm getting closer and closer every day.

This sucks.

Oh! But good news! In an update from my school district (insurance provider), they have decided to cut the UHC plan completely and to offer a less-expensive, more basic plan from the "good" insurance company that I have to go with to possibly cover my surgery/surgeon. I don't know how much it will cost yet (in fact, they're re-evaluating all costs before open enrollment starts next month), but it gives me a shimmer of hope. Hurray!

and...

My insurance has to be the insurance that costs 237.00 a month. To save me some money, I am able to use the "normal" 45.00 a month insurance until January - because I can change to the expensive insurance during open enrollment in November. But I'm stuck with that expensive insurance for an entire year.

Bummer, to say the least. But I called my oral surgeon and she said that I can schedule my surgery in March. Wahoo!

Does anyone know - is that enough time for the appeal process? Or should I start appealing come January?

decisions, decisions

I have to make my insurance decision by Monday.... I think, though, that if things go terribly wrong I have the chance to change them when open enrollment comes in November. I called the other insurance choice, and they have a similar policy for orthognathic surgery - it is simply not covered except for in specific cases, but you can appeal.

Now that THAT is over (finding out that surgery could possibly be covered in two of my insurance choices), now I need to figure out which one covers the hospital and Dr. Lee. Hopefully in-network.

I left (another) message for Dr. Lee's patient coordinator, and I'm sure I'll talk to her tomorrow.

Keep your fingers crossed that the UHC insurance covers the hospital/ surgeon - because it's only 45 dollars a month, as opposed to 237 dollars a month. With everything else, coverage wise, being pretty much the same.

PS. Ran in to get some more splints today because mine are all wearing through - ended up getting a 20 minute appointment where my two orthodontists chatted with me about what's going on! I love my orthodontists. They are also trying to get me off of the splints and onto something different that isnt' so expensive OR so chewable. We'll see how it works, although it doesn't seem promising to me. I'll post pictures soon.

short quip

True story: Dancing in San Francisco last weekend, I ran into someone I had met in the summer of 2005 dancing in California. The first thing she says to me when she realizes it's me? "Ohh, you didn't have braces then!" like they were a permanent fixture on my teeth.

No kidding, super sleuth.

blogger is a pain!

Blogger issues = I didn't post the picture of the splint itself yet can't put it in there now, after the fact. So here it is, in it's splint-y glory:

And for the heck of it, a picture of my friend Heidi and I after running our first 10k! :) (In all of our sweat-y glory, ah hah hah!)

splint and new progress

Progress pictures! My front teeth are finally starting to look straight! A few nights ago I looked in the mirror while I was brushing my teeth and I realized that my front tooth was no longer sticking out at such an angle. Hooray! My overbite doesn't seem to be getting much worse this time (thank goodness... it's awful).

As I get further into teaching, my jaw is getting less and less mobile. Today during my beginning band class, the last class of the day I teach, my jaw actually locked closed for a little bit. Luckily, the kids were working on note reading, so I didn't need to talk. OUCH! The headache of tonight is incredible.... today was also probably due to the fact that I played my clarinet last night for band rehearsal, the first one since the spring.

I wish you could see it in this picture of my bottom teeth, but my front teeth are starting to get slight gaps in between them. Crazy! The big gaps from my extractions are closing up with a quickness... which is good, but they are becoming quite good at trapping food. Ugh. No more rice cakes for me at lunch. ;)

Anyway, tomorrow during my lunch time I'm going to try to call my oral surgeon's office so they can help me make my decision about insurance. Hopefully they know what kind of a time frame I'm looking at for appeal processes, how likely or unlikely each company was to accept the appeals, etc. Two insurance choices cost me around 250 dollars a month (OUCH, especially when last year it was free), one insurance costs me overall around 50 dollars, and one 30. I'm voting for the lower cost ones, of course, but I'll do whatever it takes to get my surgery to happen. Money might get really tight, but that's okay. We'll manage.

And last but not least.... my beloved splint. It's got water in the pads that go between my back teeth at night, and it rests itself on my upper gums right above my braces - my braces kind of anchor it in place. It's impossible to talk while wearing it, so wearing it while teaching is out. It makes me sleep with my mouth wide open (well, just forces my mouth to be wide open, and if I try to force my lips over it for long periods of time I get worse headaches than I had before the splint). So I have to have water around while I'm wearing it, or I get sore throats. The last negative thing is it's irritating my gums something fierce - which my orthodontist warned me it might. I switch it from upper to lower jaws, but it works best when it's on my uppers. I LOVE it. When I'm wearing it, it feels like my jaw just settles into where it's supposed to be, and instantly I lose tension all the way from the top of my skull into my shoulders. It's amazing. I'm in heaven.

Apologies for the fairly disjointed post... My mind is swimming with an upcoming dancing trip to San Francisco (Friday), missing instruments, teaching stuff, staff stuff, teeth and insurance stuff.... I decided I'd come home tonight and go to bed at eight :) Yay.

feeling better

We haven't gotten internet in our new apartment yet, hence the sudden lack of updating. I am appreciative about all of your lovely notes and comments.

Between you guys and one of my good friend's sister (who is a lawyer, and tells me she'll help me appeal once the time comes), I am feeling much better. While I don't technically qualify at this point, I feel that I can medically prove I need this surgery.

The splints at night really are improving my headaches, too - even during the day. Once we get internet again (end of the week or so), I'll post pictures of them. While I still have headaches almost every night, at least it's not during the day when I'm teaching middle school band and orchestra :)

And speaking of middle school band and orchestra, while I got quite a few questions about the braces from teachers and adults, not ONE student even really payed any attention to them. Gotta love middle schoolers :)

I'm breathing :)

"extreme cases"

Here's the lowdown on extreme cases. I don't qualify, by the way.

"Orthognathic surgery involves the surgical manipulation of the facial skeleton, particularly the maxilla and mandible, to restore the proper anatomic and functional relationship in patients with dentofacial skeletal anomalies, which may be caused by congenital or developmental anomalies or by traumatic injury. (1)

Note: This policy does not address surgical treatment of temporomandibular joint dysfunction or the surgical management of sleep apnea; discussion of these conditions may be found in Medical Policies, Surgery Nos. 49, 122 and 142.

Policy/Criteria
Orthognathic surgery for the treatment of obstructive sleep apnea may be considered medically necessary when the criteria in Surgery, Policy No. 49 are met.

Orthognathic surgery may be considered medically necessary to correct jaw and craniofacial deformities in the absence of obstructive sleep apnea when all of the following criteria (1-3) are met: Significant functional impairment is documented as a result of illness, injury, congenital anomaly, or developmental anomaly.

Significant functional impairment must be directly attributable to jaw and craniofacial deformities and must include one or more of the following:

• Chewing-induced trauma secondary to malocclusion
• Significantly impaired swallowing and/or choking due to inadequate mastication secondary to malocclusion
• Significant speech abnormalities (e.g., sibilant distortions or velopharyngeal distortion) which have not responded to speech therapy and are secondary to malocclusion
• Loss of masticatory or incisive function due to malocclusion or skeletal abnormality
• Airway restriction

Significant over- or underjet as documented by one of the following:

• In mandibular excess or maxillary deficiency, a reverse overjet of 3mm or greater
• In mandibular deficiency, an overjet of 5mm or greater
• Open bite of 4mm or greater
• Deep bite of 7mm or greater
• Less than six posterior teeth in functional opposition to other teeth secondary to a developmental or congenital growth abnormality (as opposed to a consequence of the loss of teeth)
• The functional impairment and over- or underjet are not correctable with non-surgical treatment modalities.

Orthognathic surgery in the absence of significant physical functional impairment is considered cosmetic, including but not limited to when used for altering or improving bite or for improvement of appearance.

The following documentation is required to determine medical necessity for orthognathic surgery:

• Current study models with the appropriate bite registration and/or the back of the models trimmed such that they represent the patient's current pre-surgical centric occlusion and/or centric relation bite
• Intra-oral and extra-oral photographs
• Cephalometric x-rays
• Diagnostic report
• Panorex x-ray

okay, freak out now.

None of the available insurance plans cover orthognathic surgery except for in extreme cases. I can go through a lengthy appeal process with my school district, but even then I'm not sure what my chances are about getting it approved.

So.... a lot of random crying going on. I think I'll just have to have my orthodontist put me back together again, fix my bite as much as possible, and remove the braces - I can't afford this surgery without insurance, and I can't afford to have my bite get any worse. I have shooting pains in my jaws all the time now, and I'm getting migraines every other day or so.

And it's considered "cosmetic." What a bunch of shit.

do. not. freak. out. (yet).

While I was initally pleased (understatement of the year, right there) about my new teaching job, now I am freaking out. I just got back from my new hire orientation, where I learned that my new school district has a really messed up version of insurance. And instead of getting a plan for free in my old school district that would pay for 95% of my jaw surgery, I don't know if it can get covered at all. Two of the five plans cost me 237.00 a month, one costs 25.00 a month, and one costs 45.00 a month (the final is group health, which isn't an option). Now, don't get me wrong, it'd be pretty darned good insurance... if I didn't already have a surgeon that I love and that is working with my orthodontist.

I don't know what to do with myself. I called the patient coordinator to HELP, but they were already out of the office. I'll call again tomorrow. And since my husband is doing the whole army thing come January, his current insurance can't help me even if it did cover more than my own does.

If that weren't bad enough, my new dental insurance doesn't have any coverage for braces. So I owe an additional 400 dollars at the end of my contract now. I asked the benefits coordinator why, and he explained that through their other dental plan (Willamette), braces only cost 400 dollars. Yeah, but they only offer traditional braces, and they have terrible service.

So, I'm panicked. In the next week I have to set up my classroom, get prepared for the first week of classes, pack up my entire apartment, move to a new apartment (possibly unpack?), get my insurance stuff worked out, and.... breathe.

(just breathe).

adjustment today

As I said in my post yesterday, I had a lot of questions going into this appointment. But my orthodontist is so great - he read my mind before I could even ask them!

I will be surgery ready in.... are you ready???? APRIL! However, I can't take time off of school, so surgery will have to wait until June. But what a relief! He also explained what will happen in my next few appointments - the next appointment is a long one, repositioning brackets and getting my first set of stainless steel wires. After that, the focus will be on closing my lower gaps and achieving as much width in my lower arches as possible. He says that while they are working on my upper jaw, it's not as big a priority because it's going to be widened in surgery.

School gets out on June 16th with the 17th-20th being possible snow makeup days. I will probably shoot for the last week in June to give me time to prepare. My mom has a ton of vacaction time, luckily, so she'll be able to come up and take care of me the first week or two (my husband leaves for National Guard training in January, and will be gone for a year to two years in California... with no way to take time off). Thank goodness she'll be able to help - otherwise, things would be scary.

He also gave me a few splints, hoping to curb some of the severe migraines I've been getting lately from my jaw. They're pretty neat - I'll post pictures when I get a chance, and let you know how they work out.

Oh, and the gums? Looking fine. Whatever.

the almost waterpik and why I hate my husband....

Big things are happening in life - in the last week, I got a new job teaching band and orchestra, with a continuing contract to boot so I don't have to interview for jobs next summer with my jaw banded shut and swollen like a cartoon. I think I found us a new apartment (we'll move in next weekend) and we are possibly buying a new car this weekend... Which of course, results in us needing to save our cash flow and not being able to buy a waterpik!!

The gums are still doing terribly... but I have an appointment tomorrow in the early AM so I'm going to talk with them about it. I also need to talk with them about making sure my surgery date is as soon as school gets out, and to talk with them about insurance stuff, since I've got the new job and I don't know how that'll work out.

My husband went into the orthodontist a few weeks ago. We've been noticing that his teeth have been moving quite rapidly, and I noticed his midlines being extremely off - he had braces for a very long time as a teenager, and he wanted to talk with an orthodontist. Just like I suspected, he has a severe cross-bite and needs braces and lower jaw surgery. He doesn't want braces, but the orthodontist is worried about his front teeth shortening because they are hitting together every time he closes his mouth. (P.S. If we ever decide to have kids, poor them. Or poor us, having to shell out all that money for orthodontics).

All things aside, he was able to skip the braces and jaw surgery for now, and got to get these:

I must say I'm jealous. Aren't they pretty? Can't wait to have my own some day.

why I love braces

You know? Seven-ish months into this journey, I love my braces. Here's why.

• They are always a conversation piece.
• They are an excuse to not try a food or a drink I don't want to at a party or social gathering (oh... no thanks, you know, I'd have to go brush afterwards again. thanks anyway!
• They are an excuse to eat frozen yogurt whenever my teeth hurt.
• They are working so quickly and efficiently!
• I have met a whole host of wonderful blogging friends.
• At the end of all of this, I will have a beautiful smile and an even-more beautiful bite!

In other words, while I'm not seeing any changes, I know that they're working in there. My teeth have been hurting quite a bit (randomly) for the past week or two, now. My jaw is very tired all of the time, and it's been giving me vicious headaches. Stupid bite.

Just two weeks ago I had a PERFECT placement to chew food - it was beautiful! I wanted to eat all of the time because so many teeth met together! However, now we're back into a more normal placement - only the outside of my rear-most molars on my right side touch when I bite, and my incisiors on my left side touch at the same time. Well, that's the bite that I chew with, not the bite that has unsurfaced itself. I'm developing quite the overbite! It's really attractive with the large gummy smile and huge braces, let me tell you :) I'm workin it!

Progress picture time! (It's too bad that it's not easier to upload photos. I really have a tough time with it sometimes!)

Look at my overbite! I'll give you two shots of it (one sideways because my photo editor is being a pain in the rear end). It is large. Very, very large. And seeming to keep growing (great). In fact, when I position my jaw where it should be (versus where I'm posturing it to be) I can stick my tounge out at people. Fun times, huh? It doesn't seem like my open bite is getting any worse, though... In fact, it seems to be getting better!!

The arch on my lowers is continuing to widen. It's really a spacious home now for my tounge! My gaps from my extraction are still there - but the one on my right side seems to be closing up quickly lately - hopefully the left one follows suit!

Finally, the uppers. They seem to be doing NOTHING! I was a bit upset at the last wire's lack of teeth moving - especially in the area of my front teeth. I assumed that this wire would kick some butt, though - and it just hasn't. It's changed a little, my arch seems a bit wider, but what I really want to happen is for those front teeth to straighten out. And they're just not. Maybe the next wire will do it - my next appointment is in just a few weeks.

Until next time!