Chapter Ninety-six:
Dr. Miller raised Tara up to a sitting position. As he did he told her "Miss Reynolds, everything looks great. Your hygiene is exemplary. Your jaw is doing what we want. I would however like to offer you the opportunity to speed up your treatment. It would help you get out of this halo faster. If you are open to try it, I would like to replace your current elastics with protraction rods. We will be able to apply more force and move things quicker. I will warn you, there will be some discomfort involved. But hey, no pain no gain right? And if it is too much, we can always move you back into elastics. What are your thoughts on this?"
Tara looked at Jim. He said "baby, it is your call."
Tara next cut her eyes towards Alex. Alex gave her a big smile, the pink petit facemask she wore shifting slightly on her face. She then said "why don't you try it? If you have to be stuck in a halo, you might as well get the most horsepower behind it. Like Dr. Miller said, we can always take them off and go back to elastics if it is too much."
Tara shifted her focus back to Dr. Miller and said "sure, ok, I will try it."
Brad gave her a big smile and said "excellent." He looked over at Alex and said "dear, a set of #4 rods please? They are in the tray beside our forsus springs." Alex stood and walked over to the cabinets where they stored appliances. As she did, Dr. Miller looked at Tara and said "you are making the right choice. I know you want to get to the finish line as fast as possible. And another good thing about the rods is that you don't have to worry about constantly changing them out or finding elastics all over the place."
Alex returned and handed a small plastic bag to Dr. Miller. Tara and Jim could see a set of stainless segmented rods about four inches long. As Dr. Miller removed the first, he explained "so, these will accomplish the same thing as your elastics. They are just more efficient. I am going to lean you back. It will only take a few minutes."
After finishing the installation, Dr. Miller raised Tara back up. He smiled at her and said "that wasn't too bad was it? Now, let me show you and Jim how to turn them. We will use the same wrench that we use to turn your expander, but I will give you a separate one to use for each. But, if you misplace one, you can use the same one for both. Obviously just clean it before putting it in your mouth." Alex held up a mirror in front of Tara. Dr. Miller continued "so, the rod is actually two pieces, threaded and connected. Place the wrench over this square section. Like this." He seated the wrench on the first rod. He made a counter clockwise turn as he said "turn it clockwise to shorten the rod. This will put pressure on your mandible, pulling it forward. Remember lefty loosy, righty tighty? Well, these rods ratchet and can go only one direction. There is no chance for them to slip backwards. The force will be constant, unlike elastics that weaken over time. I will turn each until I feel resistance." As he finished with the second rod, Tara felt slight pressure in her mouth. Brad asked "ok so far?"
Tara gave a thin smile and said "yes, so far."
Brad smiled at her and said "ok, we are now going to make two more turns on each. You will feel a little more pressure. Going forward I want you to make two turns a day on this, one in the morning and one in the evening. Just like your expander protocol. A complete turn is considered 180 degrees. I will show you."
Brad placed the wrench on the rod vertically, from the bottom, and made one turn until the wrench was pointing up. He said "on the other side, opposite. Seat it on the top and turn it so the wrench is facing down. Like this." He seated the wrench on the other rod, and made a turn. Immediately Tara felt immense pressure in her face. He asked "ok?"
Tara said "there is so much pressure in my face."
Brad smiled at her and responded "then we know it is working. Jim, I assume you will be making her turns for her?"
Jim said "I can."
Brad handed him the wrench and asked "then why don't you make the next two, one per rod."
Jim hesitantly seated the wrench on the first rod. Tara could see the apprehension in his face. She said "it is ok baby." He gave her a thin smile. He sat there not moving for several moments before Tara said "go on baby, you won't hurt me." As he made the turn Tara realized this was a lie. Her face felt like it was on fire. She tried her best not to show it, but Jim could see he was hurting her.
He said "I am so sorry baby." He looked at Brad and asked "will it be like this every time?"
Brad said "no. There will be pressure. But like so much of what we do here, she will become acclimated to it. You do need to go ahead and make the turn on the second rod though, we need to keep the protraction symmetrical."
Jim felt horrible as he made the second turn on the second rod. He could see in Tara's face that she was in discomfort. As soon as he was done he wrapped Tara in a hug. He said softly "I am sorry."
Tara hugged him back and said "it is ok." She took a few deep breaths before she said "I can certainly feel it working."
Brad said "you will be glad you are doing this."
Tara replied "everyone keeps saying that, but things just seem to keep getting worse."
Alex put her hand on Tara's shoulder and said "it is a process. It WILL be worth it. Trust me, when you first smile in the mirror after you are done you will realize that. Just hang in there."
Tara said "thank you."
Brad said "Miss Reynolds, she is completely right. I won't make any promises, but I want you to schedule your follow up in four weeks instead of the standard six weeks. You may very well be done with protraction by then. What I can promise is that we are all done with this appointment though. Tara, you are doing great. Jim, you are too. As always, if you have any questions or have issues, let us know. I look forward to seeing you in a month. I know we will see huge progress. Now, let me go check on our next patient."
Jim just realized that he had not told them how long Tara needed to wear the rods each day. He asked "oh, Dr. Miller, how many hours a day does she need to wear these?"
Brad said "how dumb of me. I didn't even mention that did I? These don't come off. They are crimped in place. You won't need to worry about replacing these like elastics. They will always be working."
Jim asked "she can't take them off?"
Brad responded "no. But again just for a month. Then we will reevaluate."
Tara could see the expression change on Jim's face. It was confrontational, much like she had seen when Dr. Miller had told him he needed to wear his facemask full time months earlier. Before he could say something, Tara reached out and put her hand on Jim's. She said "it is ok baby. My halo doesn't come off either. It is ok."
He looked at her and his expression softened. He said "baby, I just hate to see you in pain."
Tara said "if this will get me out of this halo faster, it will be totally worth it."
Brad said "I can't promise you how much faster, but it will certainly get you out of it faster. Again, you will be glad in the end. Now, let me go check on our other patients."
As he stepped away, Alex helped Tara up from the treatment chair. Once Tara was balanced on her crutches, Alex gave her a hug. Alex said "I am proud of you." She squeezed the unyielding plastic vest that Tara wore. She hoped Tara could feel it. Letting go of Tara, Alex smiled and said "you have your knee appointment now don't you? Don't let me hold you up. I just know they are going to take your cast off today. I just know it. I will get to see for myself this evening. I love you both. Now get going, I don't want to make you late."
Tara and Jim made it to Tara's orthopedic follow up on time, and then had to wait a half hour in the waiting room. The whole time, Tara's face had been throbbing. But, not wanting to upset Jim, she had not said a word about it and tried her best to hide her discomfort. He could still sense it. Finally, a nurse had appeared and called them back. Tara had crutched after her to meet with her surgeon.
Entering the room, she was instructed to have a seat on the table. After Jim had helped her get seated, her surgeon began quizzing her on how things had been going. In response to how she was feeling, Tara had responded to her orthopedic surgeon "My right knee feels great. No pain at all. I am so ready to get this cast off. I hate having to use these crutches to get around. They are making my good leg sore." The surgeon asked her to explain. Tara said "I get an ache in my upper leg and hip when I have been on my feet for too long. I can't wait to be able to put weight on my right leg again, even if it is in a brace." The surgeon asked her if she was wearing her left KAFO all the time. Tara said "yes, except when I am bathing. That is a whole other reason I can't wait to get this cast and halo brace off. I can't wait to be able to take a shower like a normal person." The surgeon had just nodded and marked things on a chart. Looking up at her, he said "why don't we see how things are looking?"
It had surprised Tara that not only did they take images of her right leg, but also her left leg and hips. She just brushed if off as normal. She really didn't have any idea of what normal was any way. After finishing with the imaging, the nurse had returned them to the same room they had been in earlier. Jim and Tara waited nervously for ten minutes before the surgeon returned.
Entering the room with the same nurse from earlier, she now was carrying an armful of x-rays, he gave Tara a big smile. He said "Miss Reynolds, your surgically repaired right knee is looking great. That is the good news." He pulled a chair over from the corner and asked "do you mind if I sit?" Before either Jim or Tara could respond he sat. He said "I do have some bad news however." He reached his arm out as he said "the bad news is that you have a stress fracture in your upper femur, near the ball joint." Taking an x-ray from the nurse he used a pen to point to an area on the image. He continued "see right here? It is minor now. But my fear is that it could worsen and spread. If so, it could completely shear the ball off of your femur. If that were to happen, you would be in extreme pain. Think 100 of 10 pain. Unbearable. But even worse, it would necessitate a full hip replacement. We do not want that. So, we need to address this immediately, today. The good news is that we caught it early enough that surgery will not be necessary. And you will have a full recovery. However I do need to completely immobilize your left leg and hip. You will be confined to a wheelchair for at least the next six months."
Jim's heart sank. How much more could Tara endure. Looking at her, he saw her face had turned white and she looked to be on the verge of tears. He sat beside her and wrapped his arm around her, pulling her close. He said softly "we will get through this." He then looked at the surgeon and asked "how will you immobilize her legs and hips? She already wears KAFOS."
The surgeon said "they are rarely used anymore on adults. Only in extreme or emergency cases. This qualifies as both. We will cast Miss Reynolds in a double hip spica. Once her femur is healed, we will transition her to a pair of HKAFOS. They will be similar to her current KAFOS. The new ones will just have hinged hip supports integrated into them connected to a TLSO orthosis. These will allow her complete mobility and independence. Without the use of crutches or a wheelchair."
As Jim closed his eyes he could feel Tara trembling. Opening his eyes back up, Jim said "so, six months in the cast. How long in the braces?"
The surgeon said "unfortunately, she will likely need them for the rest of her life if she doesn't want to be confined to a wheelchair."
Tara finally broke down and began crying.