My 3rd Opinion

Hi Friends,

I've been trying to get up the energy to post again this week, but to be honest I didn't really have much great to say.  It's been a bit of a rough week for me, and not in terms of my health or jaw situation. But I've received my final report from Best Doctors Canada, and I thought that would be a great reason to write.

To start, I'll just talk about what's been going on.  I work for a large company in the Oil & Gas industry in Canada.  So does my husband, although at a different location.  You might be aware that oil prices have fallen sharply in the last six months, from over $100/barrel to under $45 in the first quarter of this year.  As a result of the poor short to long-term outlook for oil prices (not to be confused with gas prices!) our company announced in January that they would be reducing our workforce by 1,000 people.  While this number seems huge, consider that we also have a lot of contract workers in the upstream business (oil sands, in particular) and we didn't really know how many of those 1,000 would be from full time employees, and if so, who and where.  Well this week we lost 4 people from our relatively small team, one of which was my work husband (..not real husband).  I've been deeply affected by the unfortunate circumstances for everyone, but this loss was really personal for me, and I'm quite sad.  Another person who is leaving is my boss, who is being asked to retire at the end of April.  He's been the only one allowed to stay beyond the end of the day of hearing the news.  Our new boss is moving here from Calgary, and I don't know anything about him except for his name.  It's a sad and stressful time.

On top of that, my dog Roxy took ill last weekend and by Wednesday had to go see the vet.  I had been consulting with my best friend who actually IS a vet, but she lives out of town.  Upon her recommendation, I brought Roxy in.  It turned out that Roxy was so ill that she needed to be hospitalized, and stayed there overnight for 2 nights on IV fluids, antibiotics and anti-nausea/diarrhea medications.  Only today has she started eating again after 3 full days of not eating at all.   I am to pick her up soon, and I can't wait to get her home for some love and rest.

So...it's been a stressful week, y'all.

But in GOOD news, today I received my final report from the Best Doctors Canada service.   If you don't know about this service, it's a company that offers help finding doctors,  getting second opinions and referring you to specialists.  It's often a part of your benefits package at work, but most people don't know about it.  I had seen it on my benefits before, but it wasn't until my mom told me about someone she knew who had used it that I found out what they really do.

I engaged them, and they took my history, assigned me a nurse and a case manager and went about gathering all of my physician's notes, test results, images and the like.  They then had their internal physician review the information, and sought out a specialist (in my case an Oral MaxilloFacial Surgeon - OMFS) for their opinion on my treatment and diagnosis.

In my case, my information was sent to Dr. Bonnie Padwa at the Children's Hospital Boston.  Essentially Dr Padwa confirmed that my condyles are indeed broken and shortened.  They are not dislocated, but they are shortened which has resulted in a downwards and backwards rotation of my jaw, and an open bite. The limitation in opening of my jaw could be due to muscle spasming, and could be improved with aggressive physical therapy (PT).

Dr Padwa did agree that my condyles should have been treated with internal fixation (surgically fixing the broken condyles with pins/plates), and that it is too late for that now that so much time has passed.  She thinks that I should get a new CT scan to confirm if there is ankylosis in my joints and to confirm that my mandibular fracture has healed.  Ankylosis basically means joint stiffness. If there is ankylosis, she recommends the joint replacement surgery.  

If there's no ankylosis, she suggests that PT could improve my mouth opening and that a less complicated LeFort 1 osteotomy surgery could be performed to move my upper jaw into alignment with my lower jaw.   Um, how about no thanks??

So my feelings about this report are essentially that Dr P (my original Dr P) is correct in his diagnosis and treatment plan.  Even if there is no ankylosis in my joints, I'm not really interested in surgically moving my upper teeth to a screwed up position to match the already F'd up lower jaw.  (Pardon my language, I just don't see this as an actual option).  I'd still end up with a messed up jaw, but I'd be able to bite.  Great, but I'm not interested in creating more deformity. 

To be honest, though I might sound upset in this post, I'm not.  I was deeply convinced that this 2nd (or 3rd) opinion was going to confirm the TJR (total joint replacement) and I was right! (Who doesn't love saying that?!)