My Doctors

This section has become interesting now as I have my old team who did my first surgery and then a whole new team that did my revision treatment. 

For the team I built for my revision surgery:  My orthodontics are being done with Robert Cuenin in Danville, CA.  My new surgeon is Nestor Karas in Walnut Creek.  They are also working together with my prosthodontist, Doug Lew, in Palo Alto.  I have nothing but amazing things to say about my new team and it's almost hard to find words to describe how much I appreciate them.  They have gone above and beyond and done right by me in every way possible from day one in my treatment. Revision treatment has been amazing. My fantastic results speak louder than words, and these are amazing results on an incredibly difficult case, so that should speak volumes too.  Not only did each of these doctors step up to take my complicated medical case, but they've also dealt with the emotional issues and natural skepticism I had after the trauma in my first round of treatment, and they've done it with such understanding, patience, and empathy.  Like a night and day experience in terms of the treatment I am receiving compared to my first round of ortho/maxfac treatment, and I can never thank my new team enough for their care.  If you are in the area and looking for doctors to consult for any ortho/maxfac or restorative needs, I absolutely can not recommend these guys enough! Below are their websites:

And in case anybody reading this blog is also a Kaiser Oakland patient and/or a patient of Dr. O'Ryan's, I'm going to put my thoughts here regarding both: My first surgery that was riddled with all kinds of surgical errors and poor planning was done with Felice O'Ryan at Kaiser Oakland.  I was torn if I should even mention her here, but I think she deserves being mentioned so patients who are pre op reading this blog know my story and where and who it happened with. 

Kaiser Oakland and Kaiser HMO:  Before joining Kaiser I had heard horror stories from a few people with regards to them.  I didn't want Kaiser, but a few orthodontists I had consulted with all brought up Dr. O'Ryan at Kaiser Oakland as being one of the best surgeons in the area for my case.  So, I got Kaiser.  Throughout my time leading up to surgery, I was not a huge fan of the Kaiser system.  I didn't absolutely despise it, but I was nowhere near in love with it either.  The one bonus you will hear about Kaiser and jaw surgery is that they cover everything easily without question.  This is true, but I guess I would say "buyer beware," or use the phrase that sometimes you get what you pay for.  My surgery was covered 100%.  With my plan through Google, I only had to pay $10 co-pay for my visits, as well as $10 co-pay for my surgery and hospital stay.  I guess I didn't know what I didn't know regarding Kaiser.  I had never been in the hospital before, never had surgery before, etc.  Looking back on it now after receiving better care with my revision team, I can say the Kaiser system is absolutely delivering sub standard care to their jaw surgery patients from the start.  My first appointment I barely saw Dr. O'Ryan.  It was mostly a work up done by one of her rotating residents.  Quick appointment, but I figured that was par for the course and there would be more appointments down the road.  I was wrong.  I only had one more appointment, and that was 2 weeks before the operation for a final look over.  You also get sent to a short 'what to expect from jaw surgery' class to help get more informed about the procedure and the recovery, but I ended up knowing more than the nurse who was teaching the class.  It was a waste of time.  The waiting room at this place is always packed.  They always have a high volume of patients at Kaiser.  My pre op appointment felt kind of rushed, which was no surprise given the number of patients that were waiting to be seen.  The place is pretty much a factory and you are just a number.  The most minimum of time is spent on your case just because of the sheer volume of patients they have.  At least that is my feeling/opinion on the whole thing.

So, only two short appointments before having my face broken in to multiple pieces and put back together again with a major surgery.  I also do not think much planning went in to my case outside of those appointments.  When I left my orthodontist and transferred to a new one 5 months post op, there were no surgical planning documents in my records.  It's very obvious in my results that little planning was done, and what was done was done very wrong.  Every time I asked for plans and  measurements during my pre op treatment, I was basically brushed off and told, "don't worry, this is just how we do this.  Relax....You'll be fine."  RED FLAG!  Please, anybody reading this in their pre op treatment, your team should be willing to sit down with you and show you their plan.  Even better, they should be involving you in the process.  They should have measurements, xrays, pictures, molds, hard data, etc.  Planning is probably the most important part of this process, and I got none through Kaiser and Dr. O'Ryan. 

Kaiser Richmond: This is where my surgery was done.  The hospital was clean, but other than that it was a bad experience.  The nurses were not gentle.  One lady shot a nasonex tube so far and hard up my freshly operated on and compromised nose that it cause me a major nose bleed that went on for hours after surgery.  I refused to let her touch me after that.  I was only checked on for vitals when they were required to do it every few hours.  If my mother wasn't there to stay up with me all night and chase nurses down, my ice packs around my head would have never been replaced.  I was told I would have a private room after surgery, but I got no room at all.  They had to keep me for 5-6 hours in the PACU recovery area (where my family couldn't see me and had already been waiting through the 3-4 hour surgery since the early hours) because there was no rooms.  I finally got to a room, but it was more like a converted broom closet and I had the most ridiculous room mate, which I know is not the fault of Kaiser necessarily, but it didn't help my situation none the less.  The nurses refused to let my husband stay with me over night, claiming that they would like to keep the room "non co-ed."  My loud room mate got to keep her husband in overnight though. 

I barely saw Dr. O'Ryan for my surgery.  As soon as I checked in it was pretty much her residents spearheading the whole thing.  They did my pre op work up, wheeled me in to the OR, told my family how I was, wheeled me to PACU, and did my check up and discharge the day after surgery.  Obviously I was asleep for surgery, so I would like to assume that Dr. O'Ryan had a hand in the surgery, but at this point who knows.  My long operative report is authored by the one resident who appeared to be running the show.  Couple this with the fact that my work is SO sloppy and incorrect; to a point where no specialist I've seen since is able to believe this is the work of a great surgeon like Dr. O'Ryan.....so I think 2+2=4 here but I will never know for sure what went down while I was out, and I'll probably never find out.

Post Op:  Again, this was a 'you don't know what you don't know' situation.  Dr. O'Ryan wires her patients shut for 10 days.  Mine ended up 12 days since my 10 days fell over a weekend.  So, first time Dr. O'Ryan was able to take a look at me post op wasn't until 12 days since she was not the one to look me over and discharge me from the hospital.  Again, a short appointment and was sent home.  The next post op appointment was at 4 weeks post.  This was the appointment that I brought up that things looked off.  I was rushed out of her office and told she would be in touch, but then she was never in touch.  I requested multiple times to be seen so she could examine me and diagnose what else was off/wrong, but I got pawned off to my orthodontist and I never heard from her again.  I think had all gone well, the next check up would not have been until 6 months post op.  Again, I didn't know what I didn't know, but I know now that all of that is NOT normal for post op care.  Surgeons usually want to see you frequently, especially in those days and weeks immediately post op, to check to make sure everything is going as it should during the most crucial early stages of healing and bony fusion.  I have yet to find another patient outside of Kaiser who saw their surgeon as infrequently as I did post op.

Dr. O'Ryan: From what little time I spent with her, I felt like I liked her personality.  Her bedside manner was good.  She was a nice lady.  In all of my research before choosing her and Kaiser for my surgery, nothing poked out in any negative way against her.  In all of my visits with many specialists in all dental and maxilliofacial areas for my revision surgery consults, none of them can believe that I am the product of her work.  She comes very highly regarded as a trusted and skilled surgeon-- one of the best in the San Francisco area and probably all of Northern California.  Regardless of her reputation, I am the product of her work (or the work of one of her residents who was hopefully under her close supervision-- again, I'll never know for sure what happened there).  I am a scientist in an imperfect science (meteorology), so I know about things not always going right.  Mistakes happen.  The surgical errors I understand.  It sucks, but I do understand, and I firmly believe I was a LOT more understanding than probably 99% patients would be in my situation.  What is unacceptable is the treatment I got as a whole post operatively, but especially after I brought up that both myself and my orthodontist thought things were off at that 4 week follow up.  It is her fiduciary responsibility as my treating surgeon to both assess, diagnose, and treat this undesirable surgical outcome.  It was very obvious that my results were not right, and she either chose to ignore it and go on like nothing was wrong and hope I didn't notice, or she legitimately failed to diagnose until I was the one who had to self diagnose and tell her it was off, which at that point with a quick look, only agreed to a 2-3mm cant in the upper jaw.  I knew there was more off, and despite multiple requests, she would not see me to examine the work and diagnose what else was off.  My surgeon left me out to dry when I needed her the most, despite how understanding I was of everything.  From 4-8 weeks post op I tried to get her to further assess and see me, and after that I had to start pursuing other surgeons outside of Kaiser to get a diagnosis on exactly how bad my results were.  No wonder she distanced herself, because the results were so much worse than I even feared they were.  Unfortunately, those first 4-6 weeks were critical as this is when she could have taken me back in and done a clean revision before bony fusion without having to rebreak my jaw entirely.  That window came and went as she refused to see me for an exam during that time.  So, although my results may not be a good indicator for what her results usually look like, I think her actions post op negate any kind of talent she may have as a surgeon.  A surgeon absolutely can NOT handle a case like she handled mine.  That is far below the standard of care and it's unacceptable.  Making honest surgical mistakes is one thing, but to consciously choose to leave your patient hanging out to dry after making said mistakes is completely unacceptable.  Both Kaiser HMO and Dr. O'Ryan should be ashamed of themselves over how my case was handled after my surgery.

My original orthodontist was Gregory Wadden in Milpitas.  Unfortunately my orthodontic treatment also did not go without issue.  My teeth were set up wrong for surgery, and everything done to me post op was also wrong.  The only solace I have here is that Dr. Wadden was at least able to stand up and admit to that he did some things wrong.  He was also kind enough to refund me back 100% of my $8300 treatment cost with him because of this.  Otherwise, I have since learned that the orthodontics all together were incorrect and sloppy.  My teeth were never monitored for root resorption (I never had an xray taken in the care of my orthodontist during the year leading up to surgery), and because my teeth were probably moved too hard and too fast (coupled with the fact that I may just be more prone to resorption), I now have severe to extreme root resorption on my 4 front incisors and my lower front incisors and will lose these teeth after my revision treatment.  I will need a lot of restorative work (thousands and thousands of dollars worth) to correct the damage that has occurred to my teeth during the 19 months of treatment with my first orthodontist (and surgeon).