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Disturbing...

2/26/2015

http://www.matthoover.com/misc/AnimatedXrayComparisons/index.html

Disturbing... it's all I can really call this. My case is going ass over head thanks to our expert witness doing a complete 180 about face in terms of his stance on how gross the errors were, and how they could have been caught/corrected. He's now saying the standard of care was followed and it's protocol to send somebody in my shoes back to the ortho to fix it; that it wasn't immediately obvious that surgical intervention was required. This is totally opposite of what he said during my consult with him back in August. He's mentioned now after reviewing my records as an expert witness that post op swelling, being wired shut, etc could have made it difficult for them to recognize any error and it's typical to be sent back to your ortho for correction. Sorry buddy, but xrays have nothing to do with post op swelling and being wired shut. I'm no doc and it's even very obvious to me in this animation of my xrays that the bones are moved in the wrong places. BONES CAN NOT BE FIXED WITH ORTHO!!!!! Seriously, I am just a measly meteorologist who has no medical training and it's very obvious even to me on these xrays. So, I would really like to hear how he will explain this one away. If he tap dances and pulls something out of his butt to refute it, then I know we are done with him. Something happened, and I'm not sure what. I hate to put on a tinfoil hat and say Kaiser or my surgeon somehow got to him, but I have to think that could be a possibility. I've heard rule of thumb is you don't use an expert witness who practices in the same area as the surgeon you're suing. Maybe he decided he didn't want to step on his neighbors lawn and/or shit where he eats. But if that is the case, at least do me the courtesy of stating you have a conflict of interest and can no longer be the witness for our case instead of taking my $2400 to review my records and pull some bullshit out of your ass.

In other medical news - I am still on the hunt for answers for my knees. I booked a flight out to see one of the top patella femoral specialists in CT. Then I have one more opinion in San Fran as well as the follow up with the one surgeon I've already seen there who sent me for the 6 weeks of PT. I am just over 3 weeks in, and it's hard to say if it's making a significant difference. I can feel my legs are already much stronger. I'm trying to take notice if I feel less aches/pains and clicking. I think I am clicking a tad less, and almost want to say I am a little less achy too, but I have to wonder if this is my brain trying to convince myself that I am feeling better because I so badly want to feel better and avoid surgery. Even if I did feel better, they say PT is not going to untwist and untilt my knee cap, so despite feeling better for the time being, am I still grinding down on cartilage further? The answer is probably yes, which is why they said this is a surgery only case. So, none of this probably is going to matter in the end anyway, which I knew going in to it, but it's still discouraging to think I am doing this for nothing. I guess if anything I am just making my legs stronger going in to surgery.

So much going on. I hope everything levels out soon, because lately I am just so overwhelmed. I see my ortho on March 5th for my next wire change. Lets hope that he can start closing the space in the front of my lower arch where they took that tooth out. So annoying going on day to day with that there.

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It's Never Ending This Week

2/14/2015

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The past couple of weeks have been pretty rough. I pinched a nerve in my back/neck, so it's been back and forth to the chiropractor for that. Then I found out about a serious issue with not one, but both knees, and I've been all over the Bay Area for consults and care for that. The jaw/teeth woes continue, and now I just got dealt a blow by my lawyers saying that our expert witness has changed his tune and is now saying he can't really say that my care was below the standard of care. Wwwhhhaaatttt?? (PS-- yes, I have been working with a lawyer the last few months to talk about putting a case together against my surgeon and Kaiser. I have not mentioned it in the blog thus far since I didn't want to drag that part in here with the medical part, but I've decided to talk about it now.) I have no clue what sparked that change when he was so critical and adamant about everything being so shoddy and the lack of care (and quality care at that) that I got post op after my first surgery. I've had a few days to process it now, and I still can not fathom what happened for him to do a complete 180 with his opinion on my case. My lawyer is pretty confused and dissapointed too. I mean, if the care I got (especially post op when I needed it most and instead my surgeon ignored me, wouldn't grant me an appointment, and shoved me off to my orthodontist, and was never heard from again) is the standard of care, then I am not sure I could ever let another doctor touch me again for anything. I am sorry, but what was done to me is not only below the standard of care, but it's down right unethical and negligent. I would never in a million years treat somebody like that, and I wouldn't expect others to be treated like that. So, the reality of all of this is my case is probably dead in the water now. I have less than 60 days until my statute of limitations runs out in April. There is not enough time to get with another legal team and get an expert witness on board. It took so much out of me just getting the first case put together with the current team. Both emotionally and financially. I spent $2400 just to have the expert witness review my records and then pull a 180 on me. Now with the knee issues coming up unexpectedly, I need to reserve what I have left (both emotionally and financially) to deal with that. I'm almost at a point where I am ready to emotionally process what has happened here and try to find a way to deal with it and move on. I will need to find another way to get some closure about what happened to me since it won't come through giving my surgeon a wrist slap legally. Hopefully I can find some peace somehow. I am afraid that even if I do, I will never really have complete closure over it and it will be something I think about and bothers me, even if just a hint of it in the back of my mind, for the rest of my life.

Speaking of the knees, I got a 4th opinion. My husband forgot that he has an uncle that is a orthopedic surgeon (well, he didn't forget about his uncle, but he did forget that he was an ortho). So, we tapped him for his opinion. At first he didn't have any of my records and was just going off of hearing a few details from Matt. I emailed him and chatted a bit more and planned on sending my records that night. I would have to snail mail him the xrays since they are actual films and not digitals. I was so appreciative of him taking his time to look at all of this for me. I was able to quick send him the screen grab of the MRI that I posted from my last blog update. He responded immediately, and his tone changed drastically. I think he was thinking I was a simple case of malalignment and we were going to talk mostly PT and if anything a simple lateral release that is done. He even mentioned taking my time and I didn't have to feel rushed to get the surgery. I don't blame him for his initial response like that as 85% of patients who present with this problem are treated with conservative general treatment like that. His response now was grim. He said I didn't even need to send him the rest of the records, MRI, or xrays anymore. Just that one screen shot from the MRI tells it all. He said the amount of tilt and displacement of my patella isn't even severe, it's quite extreme. He's surprised I am still getting around as well as I am and not experiencing complete dislocations of my knee cap. He switched from being pretty casual and a 'no rush,' approach, to now more serious, suggesting I shouldn't put this off too long. Every day I am causing more and more damage on the cartilage rubbing together in the wrong spots, just from something as simple as walking and sitting at my desk with my knees bent 90 degree. He said without a doubt I would develop severe arthritis in the not too distant future if the problem isn't corrected. I believe him, because the pain I am in now is the first signs of my cartilage starting to wear through and hurt me, and it's only going to keep going downhill from here. He's pretty certain I am going to need the more invasive tibial tubercle osteotomy to fix this problem due to how severe it is. Sucks, because my shred of hope so far in all of this was that the doctor I am seeing in San Francisco does an all inside arthroscopic fix, but it's soft tissue only, which sometimes isn't enough when the malalignment is this far off. Could I go for the less invasive procedure first? Sure, but if it fails, then they are just going to have to open me up anyway, cut more tissue/muscle and cause more scar tissue issues, and do the tibial tubercle transfer anyway.

What's the worst that can happen? I could end up again on the other side of a surgery where it's gone completely wrong and I am left worse off and in deep regret. Or I could not do the surgery, let it go and within the next 3-5 years probably be in the same spot in terms of non-activity because the pain/instability has become that severe and keeps me from activity. So, I risk loosing the next 3-5 years (maybe 6-8 years at best if I had to guess) of doing all of my activities (with pain getting worse and worse as time goes on) vs. being restricted immediately if the surgery goes wrong like my jaw surgery did. Either way, I come out restricted. But, if the surgery turns out great for me, then that could buy me a life time of future activity on healthy cartilage and knee structure. On the downside, I end up in the same boat whether I do the surgery or not. So, why not do the surgery and at least have a chance at this being great for me? It's like the only thing I have to lose trying is those couple of years where I would have been active still had I not done the surgery. I think that is a fair gamble and the risk of losing those few years is worth the reward of a lifetime of better knees that will allow me stay active.

I don't want to feel like I am in a position to be forced in to surgery "or else." In this case it's or else my cartilage gets worn down to bone and I end up with severe arthritis. It was similar "or elses" for my jaw surgery. So, if I have to take the risk, then at least I've learned some things through my botched jaw surgery experience to hopefully minimize those risks and give me the best options. I already sought out not only orthopedic surgeons, but ones that are patellafemoral specialists. They are hard to come by. Luckily it seems I found a good one in San Fran. The more invasive procedure I would need is called a Fulkerson osteotomy (the general procedure is a tibial tubercle osteotomy or tibial tubercle transfer), named after the doctor that took the osteotomy precedure and perfected it to a point where that is how it's mostly done all over the world now. So.... why not go see Dr. Fulkerson? He's in CT, a 3 hour drive from my parents place in NJ. He's rated in the top 1% of all US orthopedic surgeons, and he's founder of the patellafemoral specialist group. It's only a handful of doctors, and luckily for me I found out my doctor I am seeing in San Fran is on it! SWEET! So, I am going to go out and go straight to the source for a consult. I don't mess around now. ha! Hopefully the doctor here in SF will want to work with me on that and not be too put off that I would want to go see another doc for the procedure and then come back here to continue follow ups and therapy/recovery with him.

Definitely a lot to chew over here. I am going to try really hard to not turn this jaw blog in to a knee blog, but obviously it's going to come up. Hopefully I can get the knee issue taken care of in the coming months and be mostly healed by the end of the year so I can then shift focus back to going in to the revision surgery for my jaw.

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Detour Down South

2/11/2015

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So... brief detour from my jaw to some place down south. Not that kind of south. Get your minds out of the gutter. ::ehem:: So, for once in the last 2 years, the problem is not my jaw. Now it's my knees. Funny, because when I first started my braces/jaw surgery journey in Feb 2013, I busted my right knee up! Completely tore the lateral collateral ligament off the outer knee where it connects to the shin bone. Well, I didn't do anything to it. Some asshat who thought he could fly better than he really could on our skydive did it to me. But anywho... back to my jacked knees. I've had some knee issues all my life pretty much. It was never enough to stop me in my tracks though. Just always had achy and creaky knees, even as a child. The last year or 1.5 years, the knees have become quite achy. I figured the right one was all bajiggity from the full ligament tear and I was just going to have a sore knee forever. Then the left one started acting up and I figured it was because I was subconsciously favoring it over the right one when it was healing. Then I started to get clicking in the left knee really bad, and aches so bad that I couldn't sit for long periods. Sitting was the worst. I finally drug myself to my orthopedic surgeon who worked on my knee tear two years before. Was thinking worst case a little bit of cartilage popped off in the left knee and was causing the clicking. I really wasn't worried going in to see the doc. Results were definitely NOT what I was expecting.

What a normal knee xray looks like:

What my knees look like:

Normal knee on an MRI:

My knee:

Both knee caps are subluxed (partially dislocated) towards the outside of the knee. Maltracking (patella does not float in the middle of the groove it's supposed to and is out of alignment) is a pretty common issue, especially for active females who are wider in the hips like myself, but the distance mine is out is not only not normal, but it puts me in a 'severe' category where I am automatically a surgical patient. Not just that, but the knee cap is also tilted badly too (can see it in my MRI clearly), which is an automatic kiss of death in terms of getting a card that says "do not pass go, do not collect $200. You get to go straight to surgery." A simple maltracking issue can be corrected with some physical therapy to strengthen certain muscle groups to crack a whip and line it all back up, but I don't think it will work for me. Given the shit storm that was my jaw surgery, you best believe that I am booking not just a second opinion on something now, but a third, fourth, and even fifth opinion. So, I book 2 other orthopedic surgeons after my first one threw all of this at me. One was a referral from a friend who's son had some knee work, and the other I found through websites, knee forums, and looking up patella femoral orthopedic specialists (there aren't a lot of them....of course!). The referral from the friend said he wouldn't even mention PT to me and will talk surgery only. He was pretty pessimistic and overall super adamant that surgery was my only choice. The knee specialist I went to go see in San Francisco wasn't as pessimistic, but he didn't try to sell me a unicorn floating over a rainbow bs story either. I could see in his face that it wasn't really the look of optimism, BUT.... he's willing to try 6 weeks of hart core PT first. SCORE! He already had bonus points because out of all of these surgeons, his method to fix this is 100% arthroscpic vs. the other guys who want to butterfly me open and go to town. I don't care about scars, but it's a shit ton more of recovery time and all. I'm still looking at getting both jaws broken and all that jazz at the end of this year-- mamma needs to save her sick leave! Being out for a few months times two for each knee? Ain't nobody got time for that!

So, now here I am in PT. Week 1 went well. I have been pretty sore, but some of it is not just the knees but is the muscles, which is a good thing. The therapist looked at my MRI though and without hesitating said, "You know PT can't fix this right?" ::sigh:: So, the consensus seems pretty unanimous that I am in the surgery category. I've got nothing to loose except for 6 weeks of more time and a few hundred bucks out of my wallet by trying PT. At least at that point I'll know that I tried and I'll never have to sit and think "wow, I wonder if I could have done OK with just doing PT and no surgery?" Regardless, my tinfoil hat doctor paranoid ass went ahead and booked a 4th opinion in San Fran on March 17th, which is the same day I follow up with the original San Fran doc after my 6 weeks of PT. So, we'll see how this goes. Even though the outlook doesn't look good, I am sure going to try my hardest at PT. If anything, it's an excuse to tone up and get stronger legs before surgery. I'll have some hot looking drum sticks by shorts season hopefully ;)

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Braces And Jaw Surgery.... Take 2!

2/1/2015

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Whelp... here we go again. This past Tues was a busy day. I got banded on my lowers once again, had my lower right incisor extracted, and starting this whole process all over again. Outside of one of my molars proving to be troublesome in terms of getting a band to fit right, the banding was pretty quick and painless. The brackets my new ortho uses is totally different from my last orthodontist. The last ones were self litigating American Standard. I don't know what these ones are yet, but they feel sharper/rougher and they don't self litigate, so I have the classic little rubber bands that go around each bracket. I got them in silver, so it's really not any different looking than when I had the self litigating ones. These brackets overall look MUCH better than my last set, mostly because this ortho used the least amount of cement as possible. I can now see the difference how extremely sloppy the last banding was. What a ridiculous amount of cement was on my teeth. I just didn't know what I didn't know then. About an hour later, I was out the door to go get my grub on before getting the incisor yanked.

That bracketless lower incisor is about to go meet it's maker

I normally don't eat before going to any mouth doc, but I treated myself to a super yummy Indian buffet in the hour I had between leaving the orthodontists office and going to my surgeons office. I was a bit nervous about the tooth extraction, as I've always been put out for my other ones (lower back molar and my 4 wisdoms). I got in the chair and immediately got some gas. I felt bad, but I kept asking the chick to turn it up. Finally she's like, "it won't go up any further than this." I felt nothing.....zip, zero, zilch. Granted, my only experience with laughing gas is doing it recreationally in high school at a few concerts, and all I know is that I wasn't even feeling the hint of floating/goofy that this stuff gives you. It was a waste of 60 bucks honestly. BUT, I didn't need it anyway. Doc numbed me up REALLY good. I usually need 2-3 needles as I tend to have a high tolerance for the novicane. I told him that before hand, so whatever he gave me, he got me good right on the first shot. And it took effect really fast. I am not sure if all extractions go like this, but this was so gentle that I didn't even know the tooth was out. I didn't feel him tug, no pressure applied to me anywhere, and no audible sounds. Not sure if my surgeon has some magic hands or that is just how this particular extraction goes. All in all, I think I was in and out of the office in 20 minutes, with the tooth out in just a few seconds. I really feel silly now for being put out for the last molar extraction!!

I head right back over to my orthodontists office. They fit the arch wire in and send me on my way. As for the arch wire, it's also different than what my last ortho used. I think they put the lightest wire they have in for the first one. I asked how soon before they start closing the huge hole that is now in the front of my grill, and they said not until I get 2 wires up. My next wire change is in 5 weeks. Bbbboooo.... this is going to be a long ride with the grand canyon right smack in the front lower teeth. I am not liking this wire. They have it pulled through the back brackets and looped in a little "J" on the ends so it doesn't bend through the brackets. I've had that before with the lighter wires, but the way they have these looped are much more uncomfortable than anything I've had before, so I would say the back brackets is where most of my discomfort is right now where it and the looped wire is tearing up my cheeks and needing wax. Otherwise, the extraction site remained pretty painless (only took 2 advil and barely needed that), and I just had the slightest hint of tooth soreness in my bicuspids from the braces. Overall, nothing too bad. My husband said I am still tough as nails ;)

Just after lower extraction and braces back on

So, here we go again. The gap will be slow to close, and I'll just keep chugging along until everything is sorted out and I'm surgery ready again by the end of this year.

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Disturbing...

It's Never Ending This Week

Detour Down South

Braces And Jaw Surgery.... Take 2!

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