Chapter 40.

After about an hour of snuggling on the couch, Jen said to Mel "with Chrishty from Dr. Cooper'sh coming over in a few hours, I feel like I need to shtraighten up and maybe fixsh a little snack jusht to be hoshpitable.  Would you be up for helping me?"  Mel responded "Sure, I would love too!  I'm not really hungry yet, but I would love to help.  What did you have in mind?".  Jen said "I don't know, but shumthing soft.  I might want a bite myself".  Mel squeezed Jen and asked "Seriously, how is your mouth feeling?  It kills me to think you are hurting."  Jen replied "Honestly?  My mouth hurtsh.  It has for four daysh.  I haven't wanted to worry you.  But these shcrews in my palate are still really sore.  And they wreck my tongue.  I think the besht thing I can do is keep busy sho I don't think about it.  I know I didn't think about my mouth lasht night, other than what I could use it for" as she raised her eyebrows and gave Mel a sly smile.  Jen then untangled herself from Mel and stiffly stood up.  She cut her eyes down towards Mel, unable to move her head with her neck brace on, and said "I am going to go see what we might can come up with".  Mel got up and followed Jen into the kitchen.

An hour and a half later the living room and dining room had been straightened up, and Mel was removing the pizza bites and potato skins from the oven.  Jen was in the dining room, putting out three wine glasses and a bottle each of a cab and a zinfandel on the dining room table.  She also hooked her laptop up and powered it on.  Once she finished she walked back into the kitchen where Mel was carefully transferring the hors d'oeuvres to a serving platter.  Jen walked up behind Mel and wrapped her arms around her, whispering to her "I really like spending time with you.  And thosh smell delish".   Mel replied "I love spending time with you too!  But I do need to ask you something before Christy gets here.  This is the first time we have been with someone else socially since, well, since us.  How do we handle it?".  Jen responded with a "hmm... well I don't want to throw it in her face.  But I'm not embarrassed by it.  I meant it earlier when I said I love you.  I think we just go with it and cross that bridge when we get to it.  What do you think?".  Mel responded "I love you too, and I am not embarrassed at all.  In fact I want to go all Ron Burgundy and announce to the world 'Jennifer Collins and I had sex. And now we are in love'.  But I know that is not the right way to go about it.  Even if that is how I feel."  Jen squeezed Mel and said "you are just so sweet.  Let's just see what happens, and if it comes up it comes up".

Shortly before 2, the doorbell rang.  Jen, still wearing her neck brace, awkwardly looked through the peep to see Christy Thomas standing there holding a blue plastic tote.  Jen had considered removing the neck brace before Christy arrived, but she realized she had already sent her pictures of it and of her wearing it.  So, with the embarrassment already out of the way, she decided to just keep it on.  As Jen looked at Christy through the peep she realized she recognized her; Christy had cleaned her teeth before her braces installation on Wednesday.  But with her mind spinning that day, she had not connected the two when they had been texting.  Jen opened the door and welcomed her "Ms. Thomas, welcome and thank you for coming!  Please come in.  Do you need a hand with that?".  Christy replied "Please, call me Christy.  And thank you, but I've got it.  Just point me to where I can put it down."  Jen turned and said "Please, follow me, I was thinking we could sit at the table.  Mel and I whipped up a little snack, and if you like wine I have some of that too."

Mel stood up from her kitchen chair as Christy approached and said "Christy, it is good to see you.  And thank you for taking time out of your Saturday.  Just sit the tote down wherever there is room".  Christy replied "it is good to see you too Mel!  And it really is no problem.  I have never really had the opportunity to nerd out on 'teeth stuff' outside of the office or in continuing education classes.  Really, I love this stuff, so I was excited when Ms. Collins asked me to do it".  Jen jumped right in and said "Please, none of this 'Ms. Collins' mess, I am Jen.  And Christy, I have to apologize, when we were texting I didn't even realize who I was talking with.  I apologize".  Christy laughed as she sat down the tote and said "no need for an apology, you had a lot going on Wednesday, and I am sure a thousand thoughts racing through your mind.  But we can talk about all that now.  But before we do, let me compliment you both on wearing your facemasks. As a tooth nerd, I love to see patients being proactive with their treatment."

Chapter 42.

Christy responded "Yes, she had springs installed the week after she had her MSE placed.  I will show you pictures and an example of it when I get into protraction devices.  It is very effective.  Traditional orthodontic theory was that you could not get protraction in adults without surgery; but new techniques used over the past few years have shown this is not true.  You can get protraction in adults with reverse pull headgear.  But the secret is it has to be worn consistently for a significant amount of time, 14 hours per day at least.  And more is better.  It doesn't do any good if it sitting on the bathroom counter or in one's purse. It has to be worn. That is why I was so happy to see both of you wearing yours when I got here.  Allison has had a couple of breaks in fulltime wear; Dr. Cooper removed the springs when they went skiing over Christmas and for their 10th anniversary vacation to the Bahamas.  He let her just wear it at night on those trips.  But other than that she has been wearing it 24 hours a day.  I will get into her case a little later, but she had a very retruded maxilla and constricted airway thanks to headgear and extractions when she was a teenager.  It is really amazing to see the changes that have happened for her over the past 10 months.  With that said, because of the severity of her case, Dr. Cooper has told her to expect to continue to have to wear it for quite a while.  She is looking at a minimum of 12 more months, and maybe more depending on how her bones continue to respond to treatment.  To make matters worse for her, she lives with her orthodontist so she can't really cheat" and laughed.

Christy continued "But before I get into individual cases, let me discuss traditional orthodontic theory.  For years and years, orthodontics has focused primarily on aesthetics.  A straight smile was the goal; the airway was not even considered.  So, and this was taught in school, orthodontists were quick to extract teeth and use retractive orthodontic techniques.  Think headgear.  I had it from the time I was 13 until right before I graduated high school at 18.  And two of those years I had to wear it to school. By the way, I know you are undergoing scoliosis treatment.  I can empathize.  In addition to having braces and headgear for much of junior high and almost all of high school, I too had scoliosis.  In addition to having the pleasure of wearing headgear, I also had the added indignity of having to wear a Milwaukee brace for the last 3 years of high school and until the end of my freshmen year in college.  You would have thought that by the mid 1990s the Milwaukee brace would have been relegated to the annals of history.  But, I am just lucky I guess.  I mean, I have never met anyone my age who wore one, not to even mention having to wear it in college.  And yes, you can imagine how much fun high school was with headgear, glasses and a Milwaukee brace.  And then, despite the relief of finishing my orthodontic treatment, having to continue to wear my Milwaukee brace off to college.  It was mortifying.  But, I lived and did eventually turn into a swan.  And the Milwaukee brace, if it didn't completely cure my curve, did keep me from having to have surgery.  I guess that is a positive.  So, I can completely empathize with what you are going through, both with your orthodontic treatment and with your orthopedic treatment.  It really is great the two of you are going through your airway treatment together.  When I read about it on your blog, it warmed my heart."

Jen jumped in "I don't think I would have been able to have handled all of thish" knocking the knuckles of her left hand on her back brace while pointing to her facemask with her right hand "if it hadn't been for Mel.  She hash truly been my lifesaver".  Mel reached over and took Jen's hand and said "Nonsense, I already told you have done as much for me as I have for you.  Maybe more.  And Christy, I don't know if you know this, but we aren't just going through orthodontic treatment together" as she lifted her Scoliclinic hoodie up showing her brace "but we are also going through bracing together.  Poor Jen's brace is just a little bit more intensive than mine".  Christy answered "awww, I knew you were a nurse over at the clinic, but I never noticed you wore a brace.  You have always hidden it while in our office.  I can't say I envy what either of you are going through, but I do understand.  Again, at least you have someone to share the journey with.  I wish I had had a "brace buddy" in high school instead of being the pariah I was.  But again, I lived."  Christy continued on, saying "my back sometimes still bothers me.  But I don't think I could handle wearing a brace again after my high school and college experience.  But enough about my high school trauma, let me get back into orthodontics."

Christy continued "so, traditional orthodontics can give a patient a wonderful straight smile.  But as we are finding out now, for many patients, the treatment they received years ago wrecked and constricted their airway.  Between orthodontics, the modern diet and sedentary lifestyles that many people live today, sleep apnea is an epidemic.  To mask the symptoms but not really fix the underlying cause, hundreds of thousands of people are on CPAPS.  And probably twice that number should be.  What current airway orthodontics is aiming to do is not just treat or mask the symptoms but fix the root problem.  We do this by opening up the airway.  We widen the jaw with maxillary tad expanders.  And we protract the maxilla forward.  This enlarges the airway and gives room for the tongue.  Then, combine this with myofunctional therapy, and we can fix the root problem in 2-3 years usually.  It is just a process to get there."

Christy continued "So, how do we do that?  Well you are already pretty familiar with most of it, you already have much of it in your mouths.  But, I will show you some examples.  Airway orthodontics in theory is pretty much the same for all patients; fix and enlarge the airway.  But, individual cases do vary and there are different tools, or appliances, we use."  Christy then reached into her tote and pulled out several white plaster molds of jaws and teeth, each with expanders on them, and a model of a skull with a bunch of lines on it.  She gestured to the models and said "these are examples of some of the different type of expanders in use. One is a standard 4 screw like you have Jen.  This is a six screw model.  This is what Josie has, and what you will be getting Mel. This is for patients with thicker palates.  And finally, we have this bad boy.  This is a tandem expander with tandem mechanisms and eight screws.  We use this on especially stubborn palates.  Like mine!.  I am lucky enough to be on my second one of these" she said as she tilted her head back and opened her mouth wide. Jen and Mel both peered into her mouth at the staggering amount of metal and screws in Christy's palate.  Mel said "wow, that is intense.  So just for clarification, I am NOT getting one of those?" and nervously laughed.  Christy answered "No, lucky you, you 'only' get a standard six screw expander.  Really though, I have gotten used to mine.  I mean, I still know it is there but it doesn't cause me a ton of problems anymore."  She continued on as she held the skull up "so this is a model of the human skull.  These zigzag lines are the sutures in the skull.  This main one in the middle of the upper palate is the one we split with the MSE expander.  The secret is the screws in the palate; by anchoring the expander in the palatal bone we actually can separate it and move it without surgery.  And, once that main suture is opened, these sutures here towards the back of the palate also loosen up.  And with them loosened up, we can simultaneously get forward movement with the use of protraction forces.  I.e. the lovely facemasks all three of us have on our faces.  The key time to focus on protraction wear is when we are actively expanding.  Once the suture splits, wear the facemask as much as you can.  If you notice, I have some pretty wicked gaps in my teeth.  I am towards the tail end of expansion and am actually on my third expander.  I had a standard 4 screw that didn't open my suture, so I got the more robust tandem expander.  It worked.  But, I maxed out expansion on it and had to have it removed and this new one installed.  I hope it is my last one.  I try my best to wear my mask 14-16 hours but it is hard and I often times fall short.  In fact, maybe now is the time I go ahead and get something out of the way that I was planning to save till the end.  It is a treatment policy change that Dr. Cooper is instituting starting this Monday.  But, first let me tell you about Josie's treatment, it will make sense why when I tell you about the new policy change".

Christy continued "so, you have heard me mention how important it is to wear your facemask during active expansion.  Josie's suture just split two weeks ago.  But, she can't wear her facemask likes she needs to.  Or at least she couldn't.  It wasn't that she didn't want to or try to.  But most nights she was taking it off in her sleep.  She tried several types of masks and the result was the same. She wasn't getting her time in.  Knowing how important it was to wear the mask, she allowed Dr. Cooper to install springs like Allison has for 24 hour wear this past Monday.  For 24 hour wear we use a different type of mask than we are wearing" and pulled out a facemask Jen and Mel had not seen before.  Christy continued on "this is a modified Grummon's protraction mask.  If you notice, it has a forehead pad.  But instead of a chincup, it has pads that rest on each cheekbone.  Because you still have to eat, drink, and turn the expander while wearing the mask, this is the best option.  The Delaire and Petit make it very difficult to access the expander for turning.  There is just not as much to get in the way with this mask, and also it doesn't 'bounce' on the face when talking like you notice from your Delaire masks or my Petit mask.  So, if it is so good, why don't we use it on all cases?  The reason is because it is the least comfortable.  It puts tremendous pressure on the cheek bones.  Eventually most patients get used to it, but the first few days are a period of adjustment.  An uncomfortable period."  She handed the mask to Jen and continued "to help, we install additional gel padding on the cheek pieces that you can see there. But even then it, simply put, hurts until the patient gets used to it.  And when Dr. Cooper installs springs, he uses 1,000 gram force springs instead of the standard 500 grams of force like you get from your elastics.  So not only is the mask just less comfortable, there is even more pressure on the face.  Poor Josie was miserable the first few days, that is why she was out on Wednesday when you had your installation.  She called me crying on Tuesday night, asking me if I could come take it off her. I talked her out of it, I explained she needed to do it, and also pointed out how Allison had adapted to it.  But, it has been hard on her.  Not only the physical discomfort, but also the emotional discomfort of wearing it in public.  She is a very pretty 25 year old blonde; she sings in her church choir and teaches a zumba class on the weekends.  She confided in me how self-conscious she felt wearing it.  To add insult to injury, she just got married three months ago and she is still in the 'newlywed bliss' stage, or was until she started having to wear the facemask all the time at home.  She was back in on Thursday, but yesterday she asked if Dr. Cooper would remove it.  Dr. Cooper asked her to just try to make it through the weekend and see how she felt on Monday, and she agreed.  He made a bit of a deal with her that impacts me, Diane, and all patients including you two.  At our Friday afternoon staff meeting, Dr. Cooper said he was instituting a new policy starting this Monday.  He is going to require all patients to wear all their appliances while in the office.  That includes protraction headgear.  He said he thought it important we set a good example for patients, and he said he hoped it would help Josie feel more comfortable not being the only one in the office wearing headgear.  And Diane had a come apart.  I mean, she is our office mom of sorts.  She was hot, asking Dr. Cooper why he was doing this to 'his girls'.  But Dr. Cooper is very persuasive and convinced her he wasn't doing this 'to his girls, but for his girls'.  He told us we all know we need to wear our facemasks, and what better setting then in an orthodontic office. Plus, he told us how much he thought it would help our current patients, including Josie, with their self confidence.  So, in summary, Diane is still not too happy with it.  But she accepted it.  So, starting Monday we will be the three amigos in facemasks.  That just leaves Sandra, the assistant that helped in your installation, as the lone holdout on treatment.  But Dr. Cooper is working on convincing her to start treatment.  It does seem to be pretty contagious in our office, and I don't think she is far from agreeing to it.'

Chapter 43.

Christy continued "so, I have given you a brief overview of the whole process.  I have pictures on my phone of my treatment, along with some of Josie's, Diane's and Allison's treatment.  Jen, would you mind if I email them to you so we can look at them on your computer?  That would probably make it easier for all of us to look at".

Jen replied "of course not, you can use my wifi too if you want.  You can just send them to the email address I emailed you from on Thursday."

Christy said "great, give me just a few seconds".  She pulled her phone out, connected to Jen's wifi, typed a quick message, attached the pictures and hit send.  A few moments later Jen's computer dinged at her, indicating a new email had popped into her inbox.  Jen slid her computer over in front of her and opened the email.  Christy stood up and scooted her chair over beside Jen so she could see the screen.  Seeing this, Mel followed her lead and scooted over too; leaving all three ladies sitting shoulder to shoulder looking at Jen's computer screen.

Christy continued "Jen, please click on that first pic and we can just go through them one by one.  I tried to attach them in the right order, but if I got one out of order I apologize in advance.  So, this first one is of my mouth before I started treatment.  You can see that I had a narrow smile; you can only see my front 6 top teeth.  And if you notice, I also had a mild crossbite, meaning my upper arch was not lined up correctly with my lower, and a bit of a class three bite, or an underbite.  You have seen my current expander in person today, but this next one is the original 4 screw MSE that did not split my suture."  Jen, clicked on it, and saw an expander that looked almost identical to her own.  Christy continued "so, as I told you earlier, my first expander did not work.  I guess I am hard headed, because it just didn't have enough force to split my main palatal suture.  The next picture is after I had it removed, you can see my traumatized palate".  The picture showed a palate with four angry looking screw holes, blood seeping from one of them. 

Mel piped in "so, I am completely expecting my installation to hurt a lot.  But how bad does the removal hurt?"

Christy answered "well, I would NOT do it for fun.  But it really isn't that bad.  And any discomfort is far outweighed by the relief of getting the expander and screws out of your mouth.  It is heavenly.  But, for me, it only lasted about 2 weeks while the lab made my new tandem expander.  And getting the expander actually installed doesn't hurt much as long as we do our job with anesthesia.  It is a strange experience, with a lot of pressure.  But the actual installation doesn't hurt until the days to follow. Here, in the next picture, you can see my first tandem expander after it was installed.  You can see the two jack screws and eight screws.  That was an experience.  It had twice the screws as my original, so it was twice as fun to get installed.  And yes that is sarcasm.  You can notice that the two jack screws are fully closed."

As Jen clicked on the next picture she said "if I am going to fast or two slow with the pics, let me know." 

Christy said "no, you are doing great.  Now this next picture is when my first tandem expander was fully expanded.  I still did not have the amount of expansion that Dr Cooper wanted.  So I got scanned for another one.  I kept that one about two more weeks until the lab had my new one ready.  From this next picture, despite not being where Dr. Cooper wanted, you can see I still had a giant diastema between my two front teeth.  You two will both likely get one too.  It bothers some patients, but I actually think they are kind of cute. So, once the lab had my new expander ready, which you can see in the next picture, I had the old expander removed and the new one put in immediately " as Jen clicked on the next picture. "Here she is in all her glory before she went in my mouth.  She is still in my mouth now 2 months later, but she is a lot wider now than when she first found her new home" and Christy leaned her head back and opened wide, again showing the ladies her palate.  "I am just weeks if not days away from being done turning her.  But, I still get to keep her in while the new bone of the sutures fill in. So that will be at least six more months.  I will be honest, I am ready to get it out.  And I hope I'm not scaring you Mel, but you will understand once you get your expander installed." 

Mel replied "well, I am already terrified of it.  What's a little more fright.  But I am going to do it, if for no other reason than I can't back out now since Jen already jumped into the deep end with hers".  Out of the corner of her eye, Christy noticed Jen reach her hand over to Mel's and caress it.

Jen looked Mel in the eyes and said "it will be ok.  And I will be here to take care of you just like you have been here to take care of me."  Hearing this made Christy turn and look at the two ladies, and how they were looking at each.  She cocked her head a little as she scrutinized them.  She wondered to herself "are they 'together'?".

With that thought still somewhere there in her brain Christy continued "So, that is where I am now in my treatment.  You already see the facemask I wear, at least my daytime facemask" as she tapped the forehead pad with her index finger.  "The only thing I haven't really addressed is the Herbst appliance which each of you have.  I do not have one.  I need more maxillary than mandibular protraction.  Nontheless, at night I wear six triangle rubberbands, three on each side.  This effectively wires my jaw shut and ensures my lower jaw moves in conjunction with my upper.  It is not fun; but Dr. Cooper let me choose that route instead of the Herbst. I guess he knew I would be compliant.  Even so, he told me if I didn't wear my rubberbands he would be able to tell and I would have to get the Herbst.  So, I wear my elastics religiously at night.

Mel interjected "do you think Dr. Cooper would let us do that?  I really hate this Herbst appliance."

Christy answered "well, you can ask him.  But I can already tell you his answer will be no.  He has tried it with some other patients.  And I am not saying you girls would not be compliant, but history has shown us some patients aren't.  So, he now uses a Herbst appliance on more severe cases.  It removes patient compliance from the equation."

Jen then turned her head and looked Mel in the eyes and said "I haven't told you this, but Dr. Cooper was not going to use a Herbst on me, but instead use elastics.  I asked him for the Herbst."

A quizzical expression came over Mel's face as she asked "but why?".

Jen answered her lovers question with "I told him it was because I had a friend that I had seen it work well on, and if he thought it would work in my case let's just go that route.   But the truth is I did it for you.  I didn't want you to have to go through it, or any of this, alone." 

Tears welled in Mel's eyes as she turned in her chair and wrapped her arms around Jen in an embrace, laying her reverse pull headgear encumbered face on Jen's shoulder.  Christy thought to herself "yes, there is something going on there".

I don’t think you are, but if you think you are, then change it! My stories tend to be more straight to the point, so it is nice to see someone who pays so close attention to details. Writing is about what you think, not what other people think about it. There is no way to please everyone.

I think you're doing a great job, keep it up!

I really like the stories of the three women, and I can’t wait to see what it is like meeting Allison and Josie!

Chapter 46.

It was slightly before noon on Monday when Jen pulled up in front of the Scoliclinic.  She pulled into a spot where she could see the front entrance and sent Mel a text letting her know she was out front.  A few minutes later she saw Mel come out the front door, so Jen pulled her car over by curb.  She noticed that unlike last week when she had met Mel here for their picnic, Mel had not removed her facemask before heading out the door today.  Instead she was still wearing it as she opened the door, put her purse on the floorboard, and hopped into the passenger seat. 

She looked over at Jen and said "hey babe, thanks for the ride" and gave Jen a big metallic smile. 

Jen replied "aww, look at who is being all cute today.  Come here.." as she leaned over and gave Mel a hug across the console.  As she pulled out into the parking lot she continued "I would have loved to have kissed you too, but I guess that will have to wait till later.  Are you going to wear your facemask to lunch?  And how has that new Grummons mask felt today?  I know your cheeks were hurting yesterday."

Mel looked over and said "it is ok, I am getting used to it.  It is definitely a lot easier talking with patients with this on versus that other one. And yeah, I figure what the heck, I might as well.  We are going to lunch for Josie afterall, and maybe if I wear my facemask it will make her feel better about her whole situation."

Jen responded "shoot, I didn't even think about that.  I don't know if I am brave enough to wear mine out in public, but I should have at least brought it with me so I could think about it.  Instead, it is still sitting on the counter in the bathroom."

Mel replied "if you are serious about it, I can help you out.  I brought my Delaire with me to work today in case this one got too painful.  I have it in my purse.  And I know it fits you well enough.  I still remember that first night we spent together.  I remember putting it on you, even though you didn't have braces to hook the elastics to, and it fit you ok.  And I also remember you putting it on me, and the jolt I felt when you brushed your finger against my cheek.  And I also remember falling asleep in your arms wearing it, not even realizing at that moment that I was right in the midst of falling for you" and ran her hand up and down Jen's shoulder.  Jen looked over at Mel with love in her eyes and Mel snapped "eyes on the road young lady! I don't want anything to happen to my momma's only baby girl.". 

This drew a laugh from Jen as she turned her eyes back to the road and spoke "aww, you are just soo sweet.  I would like to wear it into lunch.  For Josie.  And you.  I just don't know if I am brave enough to do it."

Mel answered "sure you are.  And I will be right beside you.  And know that if anyone does look at you, it is only because you are the most gorgeous woman in the world."

Parked in front of "Deli Delish", Mel pulled her Delaire facemask out of her purse and handed it and a pack of rubberbands over to Jen.  Jen hooked an elastic on the hooks in each corner of her mouth and then connected them to the corresponding posts on the facemask's horizontal bar.  Mel looked at Jen and said "you look absolutely gorgeous.  And I will adjust the strap for you" as she reached over and behind Jen's head.  After a few moments of tinkering with it to get the length right, she snapped it shut around Jen's head.  She looked over and said "Ready?"

For a long moment Jen just sat there frozen, not moving or speaking and staring out the front windshield with a thousand yard stare.  About the time Mel was going to say something else, Jen exhaled deeply and said "Yeah, I guess" and opened the driver door.

After both had exited the car and Jen had locked it with the key fob, Mel took Jen's hand as they made the short walk across the parking lot towards the deli. In Jen's mind, all she could think about is what a strange site they must make; two pretty 40ish year old women walking hand in hand, and both wearing orthodontic facemasks.  Her thoughts were broken when Mel squeezed her hand and said "you really are the sexiest woman in the whole world, I hope you know that". 

Jen answered "thanks babe, you aren't too bad yourself.  And here, let me get the door for you". She knew Christy and the gang were already there and had a table somewhere near the back corner per the text message Christy had sent on their ride over.  As she entered the deli, she looked to find them.  And if she had thought that the sight of her and Mel walking across the parking lot wearing reverse pull headgear might have been strange, it was no match for what she saw in front of her.  There, in the back corner at a large table, was Christy waving at her and saying loudly "hey! back here".  Seated around her were Allison, Josie, Diane and Sandra.  No, it was not an unusual sight to see 5 ladies sitting around a table for a quick work lunch.  What was very unusual however is that 4 of the 5 of them were wearing reverse pull headgear themselves.

Nothing like a little peer pressure to get the last holdout to join. Love it.