Sorry, Should have said February 2014 surgery buddies

[redwine]

Got a little too excited, I suppose?

[redwine]

So here are my major questions so far:
1. What should I get now that the zip-n-squeeze bags are no longer available? Do I really need them? I will be banded after my BSSO, but will not have a splint.
2. Has anyone had experience with the "re-absorbing" type of plates/screws as opposed to the titanium?

BSSO scheduled for Feb 11, 2014.

[boodles8]

I can't offer advice on a specific product to purchase for getting food in. I used the syringes and tubes from the hospital, which worked really well. You want a 60mL syringe. Tell the nurses it's the kind they use with feeding tubes (the technical name could be irrigation syringe, but I might have that wrong; they'll know what you mean if you say the feeding tube bit). You want the piston kind, not the bulb kind, and get several because they do wear out.

For the tube, you want a 14 or 16 (larger number is larger diameter tube, and you don't want too large of one or it's hard to keep it in your mouth) french red rubber catheter with the end cut off so that you can thread it back to your back teeth. The larger end of it fits perfectly on the syringe so you can squeeze the food in. Get a couple, but these are expensive so if you don't have good insurance, keep that in mind. Yes, it's a catheter, but they're sterile, so no fear there.

To make the syringes last, DO NOT pull the piston out of the tube. The food doesn't get between the black plunger and the side of the syringe anyway, so although it's tempting, you don't need to pull them apart to clean them well. They WILL be worn out after the first time or two you pull them apart. Eventually, they do still wear out. At this point, you can pull out the plunger and extend their life somewhat by applying vegetable oil to the rubber each time you use it. Trouble is they get hard to control the rate of flow after you do this.

Sorry can't help with the absorbable screw question, I have the titanium sort.

[redwine]

So the hospital will probably provide (and bill insurance, I suppose)? I hope so, although I'll look for catheter tubing. And the syringe. I'm going to Johns Hopkins and you'd think they would be on top of everything, right? When I went in for SARPE, they couldn't even locate ice for me. Everyone was very nice and on top of their game, but supplies were in, um, short supply.

[boodles8]

Yeah, they couldn't find ice for me when I had BSSO, either. I guess it's hard to come by? I dunno. My mom tracked it down eventually.

The hospital "should" provide supplies, and if they do, you can rest assured they will bill insurance. However, I've heard some hospitals are stingy, not wanting to give out more than one syringe. Locate a home health care supply store. They should carry all of those things. The only catch is you probably can't bill insurance if you go that route. But you WILL have the peace of mind of having what you need.

[samoorelaw]

Checking in here.

Thought I would post my pic of how my teeth look now: do you think they look fully aligned and ready for surgery? I'm due to have a LeFort I to fix my Class 3 malocclusion. Surgery date is also 2/11/14.

I'm also including an earlier picture to compare.

[redwine]

No clue here. I'm taking the word of the ortho and the surgeon. I look at my teeth and while they're a lot better than before, they obviously still need plenty of work. So much, that I'm still not ready to post photos.

[samoorelaw]

It's official: I'm ready for surgery and had my surgery hooks installed today! Oh my goodness, in 3 weeks, 1 day, I'll be having jaw surgery. Thankfully, ortho still recommends just upper jaw surgery, but he said my upper jaw has to be moved forward as well as expanded to fit my lower jaw. I haven't seen anyone's experiences about maxillary expansion so I'm hopeful someone on this message board will chime in about his/her experience.

[redwine]

Yay, Samoorelaw! Congratulations on getting the surgery "for sure" scheduled! Is it really only three weeks? So much to do to prepare!
I had SARPE (upper max. expansion) a bit over a year ago. Is that what you're getting? The hardest part for me I think, was the difficulty eating with the expander in. It was messy, and of course it was much more difficult to clean teeth and appliance after. Speaking wasn't easy either, although for the first couple of days of having the expander in (prior to surgery), I sang a lot, especially in the car. The gap isn't fun, but that's mostly aesthetics. My gap closed pretty quickly and is only a distant memory now. There wasn't as much pain as I had expected, but the swelling and bruising were pretty bad. I had no ice for the first 24 hrs and the bruising was actually quite horrific. I had to stay overnight due to some unexpected bleeding and believe that had I been allowed to go home sooner and been packed in ice, it would have gone a bit easier. That said, it seems the mind tends to block unpleasant times so the whole ordeal doesn't seem so bad now. I do remember thinking a couple of times "why did I agree to this?". Now I know why. My breathing is much easier, I get fewer sinus headaches, and I can now use normal sized eating utensils! How much are you going to be expanded?

[samoorelaw]

Thanks! Yes, definitely only 3 weeks away...yikes, I need to figure out what I need to do.

I don't think it's SARPE because they will first be expanding my upper jaw surgically and then they will advance it forward approximately 3-4 mm. I'm not sure how much they will have to widen it. My pre-op appointment is on 2/4/14 so I will be sure to ask all those questions then.

I'm glad to hear that you still think the expansion was worth it! I thought my main problem was my upper jaw having to be brought forward a lot but 3-4 mm seems so small of a movement, so it appears my main problem is my upper jaw is just not wide enough to fit over my lower jaw. I am still so relieved that my ortho still agrees with my surgeon in that I don't need lower jaw surgery. I honestly can't afford lower jaw surgery and I can't afford a hospital: this whole thing will be done entirely outpatient, and only then is it barely affordable (costing me around $7,800 and I will be putting that on a Care Credit medical credit card, with no interest for 2 years; my braces cost me $6,895, which my insurance also didn't cover).

[samoorelaw]

I just had to share because I'm super psyched and amazed: after having denied my appeal for coverage of my surgery, I received a revised appeal decision from my insurance company stating they have reconsidered their decision and will cover it! I had given up and here I receive this. What a great way to end the night.

[redwine]

Wow, great news Samoorelaw! That's a big relief to know that insurance is doing what they're supposed to do! It will make the healing go faster since you won't have to worry about the stupid big bills coming in. Braces are bad enough on their own.
I got good news today - my surgeon says that since I'm such a "fast healer" (his words!), he may be able to use just screws, no plate, to hold the jaw together. Which would mean that my jaws won't have to be banded so tightly together. He'll just place bands to guide my teeth into proper alignment. I guess they'll still be pretty snug, but he said using a spoon won't be a problem. Well, I'll be totally numb for awhile so I'll need to wear a bib - actually he said it would be easier to use the whole syringe/tubing thing for eating, at least at first. But, I'll be able to talk! Sort of. I had a list of questions written out and he took the time to answer them all. I have concerns about anesthesia - I'm difficult to knock out and he remembered that from the last time and said he would consult with the anesthesiologist ahead of time. Apparently last time I moved around so much that I yanked the IV out of my arm!
So, Sam (may I call you Sam?) we're on our way! And the results will be fantastic!

[samoorelaw]

Thank you! While my doctor is out of network and I'll be paying a higher deductible and have less of the procedure paid for (50% will be covered after I meet my $2,000 deductible + $250 co-pay), it's still better than paying for the whole thing myself and after I had long since given up hope! I had previously been denied in December 2012, and then I re-submitted it in December 2013 and then filed an appeal, which was still initially denied but now will be covered.

I still don't know why they are covering it because the language of my plan states it will only be covered if you have either acute trauma, TMJ, or obstructive sleep apnea, non of which apply. I'm not going to question it too much, though: goes to show that persistence is key.

That is awesome that you won't need the plate! That will most likely result in less pain and/or swelling/stiffness, I would imagine.

Yikes about the anesthesia! I personally am terrified of the anesthesia part more than anything because despite my having countless procedures over the years involving anesthesia, the feeling of the anesthesia running up my arm still scares me (that tingling, burning/freezing sensation that runs up your arm - that's the best way I can describe it).

Yes, you can call me either SAM or Sherry; either works.

[redwine]

Can't decide which part scares me the most. Anesthesia/pain meds (and my weird reactions to them), swelling and bruising, or the mild depression that shows up after 2-3 weeks and I'm not completely healed. I know in my brain that it takes a lot longer that 2-3 weeks to heal and for the swelling and bruising to go away, but last time I was sure I'd never have a "normal" face again. I know it will all pass pretty quickly, but I'm still scared. And excited at the same time. What are or have been others biggest fears? And how did you get past them? Sam, what do they call your surgery? A Lefort?

[samoorelaw]

Mine is called "Reconstruction midface, LeFort I; 2 pieces and splint" and "maxillary expansion."

I filed a Gap Exception with my insurance company yesterday in the hopes of trying to get my surgery covered at in-network rates (if in-network, the deductible is $1,000 instead of $2,000, and 70% of the surgery would be covered instead of 50%). I doubt I will win, though, because the Gap Exception is usually only covered if you can prove there is no available surgeon within a 30-mile radius who can do this procedure, and there IS an in-network doctor available: only 1. I had them add notes about the in-network doctor about how he recommended I have 2 separate surgeries, each time with a mandatory hospital stay, which would cost in excess of $50,000! It makes no sense why they would not want to cover my out of network doctor who along with my ortho recommends only one jaw surgery and can do it in his own office suite sans a hospital stay. Gotta love insurance companies.