Yesterday afternoon was all about me and my damn face! I had a visit with my therapist, my follow up consult with Dr P, followed by a chiropractic treatment. When I finally got home in the evening, I was feeling relieved and at peace with my situation. Here's how my Dr P consult went.
I had my initial consultation with Dr. P in November, where he had reviewed my xrays, cone beam CT scan and reports from my dentist. This visit was tough, it was in the evening and my husband and 3 year old son came with me. I wanted my husband to be present for Dr P's thoughts and recommendations, but after our son almost broke some dental molds in his office, he ended up in the waiting room with a busy little boy.
Dr P gave me the news that day that he was recommending a total bilateral TMJ replacement with custom prosthetic joints. He obviously ran through all the reasons he was recommending this, the treatment plan, complications, costs, timeline and answered the limited number of questions I had for him at the time. My husband didn't hear any of this, and had a really hard time accepting this as my only option. So this time I wanted the hubs present. And he was.
Dr P reviewed my recent symptoms and took a look at my "bite". You could loosely identify it as a bite. The thing that struck me most about him this time is his confidence and assuredness that he can help me. He managed to say, in the most compassionate but not condescending way, "Don't worry, we're going to fix this for you." I am so pleased with his demeanor and the confidence he inspires in me that he can help. It truly seems like no question is beneath him to answer, and that he really cares for you and your well being. It's sad to say, but if only all doctors could convey that.
Anyways, we discussed the fact that my anterior fracture site is lacking in bone, and that I was concerned about trying to move teeth around in that area. Again, he wasn't concerned. He said it shouldn't be a problem, and that yes, I might lose a tooth or two in that region but then implants just become part of the ultimate treatment. Again, making me feel like I needn't worry....he's got this.
My husband wisely asked him about my tooth pain, specifically that every time one of my teeth starts to hurt I worry that it means I'm going to lose them. He reassured me that, no, that's not the case. My teeth have had root canals, but the nerves around them are all damaged and it could take a long time for them to settle down. He feels good that in the long run it will subside. He mentioned he even has one patient with persistent pain, but all the xrays of her teeth show normal pathology. Since the teeth look fine, he is keeping them in her head and managing the pain for her. I like the sounds of that.
The MRI results that he received just confirmed what he already knew or suspected. Both discs in my TMJ's are displaced, meaning they are no longer cushioning the bones of the joint. I don't know if they are forward or backward, but they're not where they're supposed to be. The rest just confirmed that my joints are messed. The report did confirm that I have a normal brain, and for some reason he just laughed when I requested a copy of the report saying so. Weird.
We discussed medication, which I have not been taking, for some personal reasons. After being reassured by my doctor that it wouldn't be a problem to take Vimovo (an enterically-coated NSAID anti-inflammatory) and Flexeril (a muscle relaxant for bedtime) I finally relented to trying them. Dr P thinks I'm being silly and just told me "take your pills!" This should also help with the tooth pain, and I have to say that he's right. I took my first Vimovo last night and one this morning (the dosage is 2 pills per day) and I can feel a difference in my overall pain level. My joints are still quite sore, but it's not as bad as it was.
The Flexeril is another beast altogether. He recommended starting with 1/2 a pill at first, and I took one last night. Boy did it knock me out! I remember waking up when my husband got into bed last night and being so incredibly dopey. I also needed a strong cup of coffee before even hitting the shower this morning to wake up. It was strange. I don't know if I'll take those every night. I don't want to take anything that can cause a dependency, and I'm not sure about those guys.
We also discussed what I think is a misunderstood aspect of TJR (total joint replacement), which is ultimate pain relief. The research I have done online (admittedly, not the most reliable source!) told me that this surgery is not primarily intended for pain relief. The intended goal is to restore function, and patients should not expect complete pain elimination as a result. This is concerning! I have spent months now worrying that I wasn't in enough pain to warrant this, and wondering if the surgery could cause me to be in more pain afterward with the implants than I am now.
I now believe that I'm not a great judge of my pain levels in the moment. I've had tremendous, debilitating and horrific pain post-accident, and any pain I feel now seems so insignificant in comparison. However, any time I've experienced further pain reduction, I look back and see how much pain I have actually been in without acknowledging it.
In any case, Dr P explained that no, the surgery cannot guarantee complete elimination of pain. However, the studies that have been done show a marked decrease in pain levels for most patients. In fact, the numbers show that 85% of patients who have undergone TJR experience pain level reductions from 8-9 on the pain scale (out of 10) to 2-3. Interviewed about their satisfaction with their results, most say that they would choose to do the surgery all over again. I've joined a jaw surgery support group on Facebook, and had a chance to speak directly with some ladies who have gone through it, and they say the same - their pain is way less or gone, and they're so happy they did it. What reassurance!
What else? Dr P is just waiting for Dr O (my orthodontist) to get my teeth straightened and let him know when he might be able to schedule surgery. I'm sure this is a long way off, considering I only get my lower braces on next week, so I'm certainly not holding my breath yet.
I will go back for another follow up visit in 4 months, and hopefully there will be some good progress toward the end goal!
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