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Archive for the ‘research’ Category

Today I saw Dr. #3. I took the copy of the Marx book with me. I wasn’t so full of questions, I wanted to shut up a bit and listen. I was also afraid of giving the perception of the “difficult patient”. I really don’t want to be a pain in the butt and after #1 am self-conscious about letting too much of myself through.

So far, I’d guess, this doctor seems to be the most straight-shooting of the 3 I’ve seen. He was fairly up front about the success rate he’s had in treating this and what can go wrong. I don’t want some rosy, “everything is going to be alright if you trust in how awesome of a surgeon I am” type experience.

One thing that was substantially different from what Dr. #2 said. He said that pre-extracting the molars before doing the surgery didn’t really have much affect unless you were going to let it heal for 6 weeks to 2 months. Dr. #2 said that he’d do the surgery 2-3 weeks after extraction. Dr. #3 said that extracting teeth all of the time, he knows it takes at least 6 weeks for it to heal up well enough to matter.

He basically said there were two options:

1) Do the procedure all at once
2) Do the removal, wait till it heals up, then do the graft.

Option #1 has about a 10% chance of infection, probably much higher with a cadaver allograft. Option #2 has a maybe less than 5% chance of infection, but is 2 surgeries. The risk with option #2 of cutting the medial nerve due to scar tissue he thought wasn’t as high.

In both cases, he’d use a rigid bone plate. What to use as a crib was an open question. He said that he’s done some without a crib and they’ve been successful. I asked him about PLA/PGA cribs, which he said he could look into. He said they didn’t always resorb. They are a very new thing, with not a lot of case history.

One of the things he pointed out was that after the graft and this always happened, the thickness of the cancellous (marrow) graft was always going to be much greater than the thickness of the bone that grows in. If it isn’t thick enough, he’d probably have to do a future graft to build up enough of a ridge to take implants.

He also said that he’d provide follow-up care if I decided to go to one of the “big names” to get my surgery done. I thought this was particular nice (and reassuring) since both oral surgeons I’ve seen so far seem to not want to share care. He discussed the risks of this though … there are always miscommunications between people and that could have issues.

Another thing that surprised me was that he said that there was a chance that I may not be completely numb. He pointed me to the section in chapter 14 of the Marx book which talks about nerve sparing techniques. I expressed my concern that ameloblast cells might reinfect the graft. He said he could remove the nerve if I wanted, but the ameloblasts weren’t like a cancer; they didn’t invade the nerve cell. According to Marx, they actually lack the enzyme needed to invade nerves. He however said that decortication was a pain in the ass and usually caused more problems than it fixed. We talked about the “nerve pullout method” and I said I’d think about it. I’d rather have a numb lip/chin than have this damned thing come back.

Another thing that was surprising was that he said that I could have my former orthodontist put temporary braces on me, then wire them shut for the surgery, then pop them off later on. I’d imagine I’d wait quite a while into my recovery before I’d let them take them off of me, just in case.

I asked him about rubber bands vs. wiring me shut and told him sometimes that I am a mouth breather. Would I be able to breath if my nose stopped up? He said that not wiring me shut, I could have micro-movements. And I’d still be able to breath in that case. He’d keep me wired up for a few weeks.

Of the 3, this doctor has the best credentials. He said that in Texas, if I wanted to go to a larger research university type environment, he’d recommend Baylor or Parkland.

He also looked at the pocket or dimpling in my back left corner. He poked around back there with what looked like a Q-tip on a wooden stick and told me that the gum was thinner back there and that might have issues.

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Here is the first book I was able to get through Interlibrary Loan. It took about a week to get here and cost $10.50 for the shipping (the usual is $2.50), but I’m happy I was able to get it.

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In San Antonio

Last night, we got out late as usual.  But for a partly good cause.  Having no sense of time is always for a good cause, right?  Anyways, Nana could not watch daughter, because Grandad had a tooth abscess.  Poor guy.  So we all loaded up and came down to San Antonio.

About 2/3rds of the way, we swapped out and she drove as I was very, very tired.  I made the mistake of stopping off at a Walmart to buy a voice recorder.  Why is it that when you want to run in and get something real quick, you 1. can’t find it, 2. get stuck behind the lady with 3 kids and a basket full of items at the only register open.  I patiently bore this, but it took about 30 minutes for something that should have taken 5 minutes.

And then we got here, at about 230 am.  The appointment was postponed till later on today, because the Dr. I’m supposed to see missed his connecting flight.

And here we are.

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Today, I went over to the oral surgeon I’m seeing to pickup my radiographs and such. I have an appointment next week at UTHSC in San Antonio for a second opinion. The oral surgeon I see (and am leaning towards) said that if I wanted to get a second opinion, he wouldn’t be offended and the place I’d want to go is UTHSCSA.

Not that I think they’re going to tell me something different. I know what must be done. I’m worried about the details. I’m worried about getting all of the ameloblasts out so I won’t have a recurrence. If I have to go through this once, I don’t want to repeat it. I’m horrified that I’ll have to repeat it.

I’m also worried that if I go with UTHSCSA that I won’t be able to get local follow up support. I asked about this today when I stopped by and they said that I’d have to follow up with the other OS. I guess that means I’d have to spend a week or so in San Antonio recovering before I returned to Austin.

I also have to admit that first impressions (I know I’m more judgemental and pissy here than most, so don’t take this too seriously I guess) that I’m not that impressed with UTHSCSA. First of all, they tried to schedule me with a dentist. That was my fault though, I didn’t specify that I wanted the OMS. Then they put me with a resident instead of a faculty member with lots more experience. I was hoping to see one of the faculty, especially one with 10-20 years of experience. I’d strongly prefer them to somebody with 1-2 years of experience. I really didn’t expect this and it kind of set me back. I asked them if I decided to go with them if I could get surgery with the faculty instead of a resident. They said when the resident performs, the faculty is in the room. They said it’d cost more … which I’m fine with. I’d rather pay more now than later.

There is a certain grandeur and wow factor associated with UTHSCSA. Their hospital, University Health System, is quite huge and everything is there. I mean everything. I told them that I had “ameloblastoma of the left mandible”, but it didn’t seem to make much of a difference to the people scheduling. Granted they’re just schedulers. And pretty much before they’d even talk to me, they had to verify with their financial department whether or not they’d even take my insurance. I can understand wanting to get paid … maybe there’s not a better way to handle this?

I also went over to my dentist to have them make copies of any radiographs and such they have. Tomorrow I’m going to try and get the pano radiograph from before I had braces put on 4-5 years ago. Some of what they gave me to carry down was duplicate. But they were pretty kind to me and wished me well. You get to notice things like this. And they kind of help.

I started the day out feeling pretty good, determined that things were going to get done and that I was going to be motivated to do them. My oral surgeon’s office called and asked if I’d scheduled the second opinion. I was caught up in work (and also not wanting to think about it) so I didn’t get back to them for a few days. I feel guilty about this. I sometimes wonder if they’re going to just tell me to forget it, that I’m too much trouble to mess with. I have this fear with everybody though. It’s kind of been ingrained in me from adolescence.

And I’ve started to be sick with worry again. Thinking about this makes me sick with worry, where I feel my stomach just tense up and just want to obsess about it. Then I want to put it out of my head and not worry about it. I want to procrastinate so I don’t have to think about this horrible thing. Or wrap myself up with work. Or spend hours reading Wikipedia trying to be escapist.

Some of these questions I feel are hard to answer and there’s no way to know if you have complete information. And this is frustrating. I’m trying to deal with the uncertainty. But it’s hard. And damn it, I don’t want to appear weak. But sometimes all this just makes me want to cry.

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Tonight, I updated the Wikipedia Bone Graft article to add information on risks and complications, with references.

Somehow, I didn’t get the impression that any of the major symptoms were issues from my orthopedist. Were these issues which were reported in the journals careless usage of tools during surgery? What gives?

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UT

Today, I went to libraries at UT only to find that they were all closed. I checked before I left and could have sworn that at least PCL was open (I was hoping for eJournal access). But apparently, I misread the schedule.

It was not all for naught. I did start calling library-like places in Austin and got ahold of the helpdesk of one of the central libraries tha assists public libraries in Texas. It’s handy being in the state capital like that. And she told me about TexShare.

TexShare is cool, but it doesn’t give access to all of the journals I wanted, like “Journal of Oral and Maxillofacial Surgery”. I did find a few articles I wouldn’t have been able to get.

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http://en.wikipedia.org/wiki/Iliac_Crest
http://www.emedx.com/emedx/diagnosis_information/hip_pelvis_disorders/iliac_crest_model.htm
http://health-pictures.com/conditions3/iliac-crest-picture.htm
http://radiology.usc.edu/Presentations/SaddleProsthesis/pelvic%2520girdleb.jpg
http://forums.runnersworld.com/eve/forums/a/tpc/f/678106477/m/5471046294

Apparently, the iliac crest is where leg/hip muscles attach. Shit! And they’re going to have to take part of mine. Am I going to have to hobble around on a walking cane or crutches for the rest of my life? Maybe I’ll become a crotchety old man with a cane, like House MD.

Oh great! The external oblique muscle attaches there too. How do they attach the abdominal muscles back? What do they attach them too?

And the last is from runners. I’m guessing that I probably won’t ever run again after this. Not that I really could run all that far as I had bad shin splints. But it might come in handy some day, like if I have to run from a wild animal, a crazy person or some kind of natural catastrophe that’s happening right before my eyes.

Not to mention, the pelvis can fracture from this sometimes.

I’m going to make them take a CT scan of this. Really. I don’t want them to mess this up.

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