Chapter Fifty Two:
Dr. Miller was truly amazed by his wife Megan. He had awoken well before her on Sunday morning. This was on purpose, he wanted to be sure he was awake when she woke. To comfort her, to help her. He watched her for nearly an hour, all the while she slept peacefully. Dr. Miller marveled that anyone could sleep wearing everything she had on. But she did. Finally she stirred. With the goggles on he couldn't see if she had opened her eyes. And she couldn't hear him. So instead, he grabbed her hand and squeezed it while he used his other hand to remove the ear plug in her ear closest to him. He whispered "good morning angel. I know you can't speak. I will help you remove your other ear plug and your goggles. I will then remove your CPAP and unlock your mouth and remove your appliance." She squeezed his hand back. He realized this would now be an important method of communication between them.
After Megan's mouth was free, she said "thank you sir."
Dr. Miller smiled at her and replied "no baby, thank you. Let me help you up." He helped slide her up into a sitting position against the headboard, rearranging the pillows to help provide her cushion and support. Once she was sitting up he asked her "how do you feel this morning angel? Did you sleep well?"
She replied "yes sir, I slept well. Because of you."
Dr. Miller asked "so the goggles, the ear plugs and appliance helped?"
She replied "yes sir. And that other thing did too. I have never experienced anything like it. My whole world was just that sensation." She went silent a moment.
Dr. Miller wasn't sure how to respond so he simply said "I am glad I was able to help my angel."
Her eyes were cut in his direction when she said "maybe being in a halo brace won't be that bad if you will do that for me again. Will you sir? Please?"
Dr. Miller stroked her arm and said "yes angel, I promise I will." He thought she meant that night when they went back to bed. But when she reached over and groped for the acrylic appliance he had laid on the bedside table he realized she meant right then. He reached over and grabbed her searching hand and said "ok baby." Once he had her appliance locked back in place and her hearing and sight were eliminated, he repeated what he had done the night before. From the reaction he got from Megan, it was even more intense than the evening before.
As the day progressed, Brad was in even more awe of his wife. After helping her with a light sponge bath, showering was not allowed in her halo, he helped her get dressed. She had fallen straight into her normal routine of caring for the boys. Despite his mother still being there to help, Megan had insisted on doing most everything herself.
That afternoon, Dr. Miller's cell phone rang. He looked down to see it was Dr. Morales calling. He answered "good afternoon Olivia. How are you today?"
Dr. Morales responded "I am ok. But more importantly how ish Megan? How ish she managing?"
Dr. Miller replied "she has absolutely amazed me. She is doing so well. She was able to sleep last night. And she is doing so well today. I am so proud of her."
Dr. Morales responded "wonderful. That ish great newsh. Some patientsh struggle mightily with a halo. Othersh seem to become adjusted to it quickly. I am glad Megan is adjusting quickly. Ish there anything I can do to help?"
Dr. Miller thought a moment before answering "I don't think so. But thank you."
Dr. Morales replied "well, I am one phone call away. While I have you, I have a question, or maybe a problem. When I turned my expander thish morning I couldn't get a full turn in. I certainly could not get two. I am afraid I may have broken my expander. Do I need to come in tomorrow?"
Dr. Miller said "Olivia, you were very close to maxing out your current expander at your last appointment. I suspect you may have turned it as much as it will turn. I bet that is what happened. But if you want to come in tomorrow I will be sure to squeeze you in. To at least make sure everything looks ok."
Dr. Morales replied "I am pretty jammed up tomorrow with patientsh. And I hate to reschedule. But I would like for you to at leasht take a look. Could I come in at the end of the day? Right before you close?"
Dr. Miller responded "of course. How about you come in after we close? How does 5:30 sound? I certainly don't mind staying a few minutes to help you out. It is the least I can do since you came in yesterday on a Saturday for Megan. The girls will be gone, so just call me when you arrive and I will let you in."
Dr. Brad was sitting at his desk looking down at Olivia's new treatment plan when his phone rang. He had lost track of the time in his excitement and didn't even realize that Olivia was running late. It was 5:42 when his phone rang. He answered "hello Olivia, are you here?"
She breathlessly said "yesh, I am literally running to the door now. I am shorry I am late, traffic was horrible."
Dr. Miller laughed before he said "it is ok Olivia. Stop running. We are in no hurry here. I will meet you at the front door."
As they walked down the hall to the treatment area, Dr. Morales stated "I didn't bring my CTO. But it is in my car. Do I need to get it?"
Dr. Miller said "no, not for this. I know you are wearing it. And it looked fine yesterday. So no need to make an extra trip. I know you will put it back on when you get home. Let's just get you in the chair and take a look."
After getting her reclined back in a chair, Dr. Miller made a quick examination of her mouth and her appliance. As he raised her back up to a sitting position he said "nope, you didn't break your expander. It is just maxed out."
Sitting back upright, Dr. Olivia asked "so what does that mean? Does that mean I can get it out soon?" She had an excited look on her face.
Dr. Brad smiled at her and said "actually yes. This means we can remove this appliance in a few weeks." He watched her face light up. He smiled at her. He knew what he was about to tell her would bring her back to Earth. He continued "so, the good news is you did not break the expander in this appliance. The bad news is that you need more expansion. As we discussed initially, there was always the possibility that you would need two expanders. You do. We will remove this one when your new one arrives from the lab. Probably two weeks or so. The good news is your new appliance will not have an upper tongue crib integrated into it."
Dr. Olivia's face lit up again. She squealed "no more tongue crib? Oh thank you. Thank you, thank you, thank you."
Dr. Miller smiled back at her. He was enjoying this. He said "don't thank me yet. You still have a tongue thrust habit we need to correct. But your new upper expander will be a tandem maxillary expander. There will be two screws instead of one. You wouldn't be able to turn the front screw with an upper tongue crib in place. So, instead of an upper tongue crib, we will utilize tongue tamers, also called tongue spurs, on your upper teeth. Your lower teeth have begun to tilt in. We don't want this. So, your new appliance will also have a lower hyrax expander to upright your teeth. Along with a lower tongue rake. A tongue rake will still allow you to turn the lower expander while also providing an acute reminder to your tongue to stay where it should. And of course the upper and lower expanders will be connected by locking scopes like your current appliance. I will warn you that many patients find a tongue rake to be uncomfortable at first, so I will also have an acrylic appliance made that will cover it while you adjust to it. It will greatly inhibit your speech. Finally, I need to address why your lower teeth are tilting in. Lip tension is pushing them inward. To address this, I will utilize a fixed lower lip bumper. It won't be uncomfortable after a few days, but it will make your lower lip protrude out the whole time you have it in. Finally, I want to go ahead and get you in braces on top. We won't install an archwire yet, but it will help you to get used to them. Unfortunately, because of your previous dental work, I don't feel confident using bonded brackets like you have on your lowers currently. I will utilize bands on your upper teeth. I will keep your lower brackets on. For now at least. But I will remove their archwire too while we are expanding your lower arch. Today, I will go ahead and get you spacers installed to make room for your new appliance and bands. Any questions?"
Dr. Miller looked at Olivia. Her face had turned white. She didn't speak so he asked again "so no questions?"
She said "that sounds like so much. Is there no other way?"
Dr. Miller said "no, not without performing jaw surgery. And we don't want that do we?"
Dr. Morales shook her head and said "no." She looked devastated.
Dr. Miller said "it will be ok Olivia. If my angel Megan can adapt so quickly to her halo, I am sure you will be able to adjust to your new appliance."
The mention of the halo elicited a question from Dr. Morales. She asked "so will I need to still wear the CTO with this new appliance? And what does a tandem expander look like?"
Dr. Miller pulled out his phone and said "I will show you a picture of a tandem expander. Now keep in mind this picture is just of the upper expander. Yours will be attached to your lower expander and rake with a pair of scopes, and the lower lip bumper will be attached to that. But this will give you an idea of what the tandem expander looks like. It really is amazing though. We will be able to more precisely continue opening your suture. Right now, your suture is more open in the back than in the front. With this, we will be able to make more turns on the front expander until it catches up with the rear. It will make your gap bigger for a few months, but that is just part of process." He showed her the picture and she gasped.
https://dereferer.me/?https://i.imgur.com/iDNgBwm.jpegHe continued "and yes, of course you will need to wear your CTO full time. Once you get adjusted to the new appliance, it will seem like a lot, we will talk about halo protraction for your case."
He gave her a big smile, excitement on his face, and said "Olivia, this will all be worth it. All the girls here will be jealous of your incredible appliance." He gave a chuckle before he said "and good news, you shouldn't need to wear this new appliance more than 24-30 months. So let's get you some spacers!"
