Chapter Thirty Seven:
Dr. Brad waited until all the ladies were in the lounge at lunch when he said "everyone, I want to put someone in the spotlight." All eyes turned towards him. He continued "I want to congratulate Dr. Bender on her first patient. And her first installation of a Miller appliance. She did an incredible job. I think she deserves a round of applause." After the soft applause died down he added "thank you Dr. Bender."
Dr. Andi, she was not wearing her headgear so her facial expression was evident, looked a little embarrassed as she said "oh gosh guysh, thank you show musch. But I couldn't have done it without all of you." She looked at Alex, who was still wearing her CTO, and said "or without an incredible patient. Alexsh, pleash tell your mom what an honor and privilege it is to treat her."
Alex said she would. With that said, everyone went back to what they were doing. Dr. Andi opened the refrigerator and got a yogurt and water out. As she went to leave, Dr. Brad stepped in beside her. He said "why don't you stay and eat with us?"
Dr. Andi said "Brad, eating ish susch a nightmare for me right now. I slurp and drool and it ish just agonizing. And embarrashing."
Dr. Brad replied "there is no reason to feel embarrassed. I promise you everyone here understands. We have all been there. But I have already put you on the spot enough. How about we eat in my office? I want to discuss some ideas I have on integrating a CPAP mask into our Sleep Well mask. And I know your temporary office is cramped. But have no fear, the contractors are supposed to arrive next week. What do you say?"
Andi sat listening to Dr. Brad describe his ideas as she struggled to eat a cup of yogurt. She really hoped it would get better, she didn't see how she could live like this for the next year. Dr. Brad noticed her simply staring at the cup of yogurt in her hand. He said "it will get easier. So, what do you think of my idea?"
She looked up and said "it shoundsh like it would work. So, if I understand correctly, you would have the patient use a tandem bow to attach the elasticsh from the hooksh in their mouth for protraction. Then, to counter the backwards force of the tandem bow on the lower jaw, they next would attach elasticsh through the hole in the mashk to the tandem bow, putting a forward force on it, counterbalancing the force of the upper elasticsh. How will the patient hook the elastics up though through their mashk?"
Dr. Brad nodded eagerly and said excitedly "yes, exactly. The key will be the locking mechanism on the tandem bow. Like some facebows have. It will keep the tandem bow from being pulled out of the lower molar tubes. And the patient will use a standard rubberband hook like we give all patients when they start elastics. So, here will be the steps. First, the patient would insert their tandem bow and lock it in place. I will have to have the tandem bow fabricated to fit around the twin force telescopes, like with your lower facebow. Then, the patient will attach their elastics from the hooks on their upper molars to the tandem bow, either two or four elastics depending on their treatment plan. Then, the patient will hook two elastics to hooks that are fabricated on the outside of the tandem bow, spaced roughly as far a part as the hole in their cpap mask. I will have them fabricated so they loop upwards and will hold the elastics. That is what I would consider step one. Then they would don their Sleep Well mask or CTO brace. The CPAP mask will be attached to it via the forehead support of the mask to the top of our Sleep Well mask. I think to avoid screws that would dig into the patient's forehead, we will be able to simply epoxy the CPAP mask to the forehead portion of the Sleep Well mask. Once they have that on, they will reach through the hole in the mask with their tool and hook one of the elastics that is hanging on the front of the tandem bow. They will attach it to one of the posts that I have placed in the air hole of CPAP mask. There will be one on of each side. Once they have the first elastic in place, they will simply repeat the process with the other. That is step two. Step three is the easiest one yet. The patient will get comfortable in bed, attach the air hose to their mask, and turn their machine on."
Dr. Andi said "it soundsh like it should work. I think I have a picture of it in my head. But knowing you, you will have a prototype of it for me to see in no time. But who ish going to test it out?"
Dr. Brad smiled before replying "I have a very willing and eager patient at home. I have already called one of the sleep centers here in town and explained to the doctor there what I am looking to do. He was very intrigued by the way. I have scheduled Megan for a sleep study. In fact, he is so intrigued he squeezed us in for this Thursday. Regardless of the test results, Dr. Bovenizer understands what we are doing here. He will fit Megan with a mask even before her study. Then, while she is snoozing, we will burn the midnight oil to fit make the necessary modifications to the CPAP mask and attach it to a CTO brace. Obviously I won't be able to fit it to the one Megan has been wearing as she will be wearing it. But if this works, she will need two anyway. One with an integrated CPAP mask for nighttime wear and one without for daytime wear. Friday night, we are going to have her perform a second sleep test wearing the CPAP. Just to see how her results compare with it and without it."
Dr. Andi asked "and she is onboard with thish?"
Dr. Brad smiled and said "oh yes, she is onboard with it."
That Thursday afternoon after work, Dr. Brad looked at Megan and said "this is so exciting kitten. Aren't you excited?"
Megan demurely said "yesh sir."
Dr. Brad smiled. He said "let's go ahead and get your expander turned. And I am going to take your belt off. You get to sleep without it the next two nights. That is a nice little surprise isn't it?"
Megan replied "yesh sir."
After turning her expander twice, Dr. Brad locked Megans twin force telescopes. He then applied her CTO brace and hooked her elastics in place. He admired her for a moment before exclaiming "I will grab your overnight bag!"
Sitting on the edge of the bed in one of the sleep center bedrooms, Megan stared straight ahead in her brace as the sleep tech began hooking up the wires and straps needed for her sleep study. Dr. Brad and Dr. Bovenizer stared at one of the screens in the monitoring room watching.
Megan had already changed into her pajamas. The sleep tech, Darlene, stepped back and said "hmm, how am I going to do this." She leaned in and examined the Sleep Well mask that covered much of Megan's face. The tech said "well, we will do the best we can" as she began attaching the last few sensors to Megan's head and face. Once done, the tech said "I am going to pull your top up ok?" When she did she said "oh, wow. You wear a corset to sleep?"
Megan replied "yesh. I jusht had a baby. I am trying to get my figure back."
The tech replied "well it is certainly working. Wow, look at your waist. And you just had a baby? Dang, I am going to have to get me one of those things."
After wrapping the last of the straps around Megan torso, the tech helped her lay down in the bed, carefully lowering Megan's stiff torso down onto the pillow and lifting her KAFO wrapped legs into the bed. She attached a monitor to Megan's index finger and then pulled the covers over her. She asked "does everything feel ok?"
Megan said "yesh. Thank you. And thank you for not making a big deal about my brasches. I hope I can fall asleep, I am nervoush. I really hope I don't have shleep apnea. That would jusht be one more thing to deal with."
The tech said "of course. I understand about the brace. I was in a pretty bad car accident in high school. I graduated with a halo brace bolted onto my head. I get it. I understand you will be with us tomorrow night as well. Maybe then you can tell me about your accident? And do not worry about sleep apnea. That is why we are here. That is why we already fit you with a mask. They aren't bad to wear. I wear one myself. I am not sure how it would work with the mask you are wearing. But Dr. Bovenizer said there was a way. But don't think about any of that. Now it is bedtime. Sleep tight and don't let the bed bugs bite!" Darlene gave her a toothy, crooked smile as she flipped off the bedside lamp.
As Darlene entered the monitoring room, Dr. Bovenizer said "excellent job as always Darlene. Thank you."
Darlene looked at the two and said "my pleasure. I just feel so bad for her. That has to be hard enough to sleep in without all the extra wires. What kind of accident was your wife in sir?"
Dr. Brad replied "she was not in an accident. Unfortunately, Megan suffers from joint instability. The KAFOS, those are the leg braces, are to keep her ankles from dislocating. And the CTO brace she is wearing is for cervical instability in conjunction with her orthodontic treatment. Her facemask is solely for her orthodontic treatment."
Darlene stepped over and looked at the monitor as she responded "oh poor dear. But as long as it helps her, good for her. I have never seen anything like that mask she is wearing though. Who is her orthodontist? I have been thinking about getting braces myself. I know I need them. I want to know who to avoid."
Dr. Brad replied to the cutting remark with "actually, I am her husband AND her orthodontist. And that mask is my invention."
Darlene looked up with a deer in the headlights look. She turned and nervously said "I didn't mean, I just, it is just, I have never seen anything like it before. I didn't mean anything. Oh goodness... I am sorry."
Dr. Brad laughed. He responded "it's ok. It is different. But it works amazingly well. Most patients don't like it at first. But many actually come to, if not love it, at least be grateful for it. Airway and tmj orthodontics is such a game changer for so many. Yes, the treatment can be inconvenient at times. I get it. But long-term investments sometimes require short term sacrifices."
Darlene said "that is right. Again, I am sorry. I am not sure what I can do to make up for that comment though." She could feel her boss looking on judgmentally. She added "really, I am sorry. It was unprofessional. And if there is anything I can do other than take the best care of your wife to make up for it, please let me know."
Dr. Brad replied "there is something you can do to make up for it. You say you are considering braces? Well, come see us. We have an incredible new orthodontist in our practice. She is great. Dr. Andi Bender is young, enthusiastic, and most importantly a great orthodontist. And she is accepting new patients. Why don't you call and at least schedule a consultation with her? Consults are free and there is no commitment. What do you say? And let me remind you that you did ask what you could do to make up for the comment."
Darlene felt trapped. She said "umm, I guess I could do that."
Dr. Brad said "wonderful! I will let Maggie, she is our scheduling coordinator, know to be expecting a call from you. And we do offer a discount to those in health care as a professional courtesy."
Dr. Bovenizer said "there you go Darlene, no excuses now. You have been talking about it for a while. Sounds like it is time to bite the bullet and do it." He looked up at Dr. Brad and said "Darlene doesn't need us here, why don't we go and work on mating a CPAP mask to a Sleep Well mask?"
As they walked down the hallway, Dr. Bovenizer asked "so you guys are accepting new patients?"
Dr. Brad replied "absolutely. Heck, we aren't just accepting new patients, I am actively recruiting them for Dr. Bender."
Dr. Bovenizer said "when our girls were in braces, my wife mentioned she would like to fix a few things with her own smile. She wears a mouthguard at night for her bruxism and our girls' ortho told her he could fix her bite so she didn't have to rely on it anymore. But she never went through with it and the girls are done now." They took a few more steps and he asked "You mentioned a discount? What kind of discount?"
Dr. Brad answered "our standard health care discount is 15%. But I have been known to work out trades before. I am sure we could work out the details. You should call and schedule an appointment for her. We even have cute little gift cards. You wouldn't be the first person to give orthodontic treatment as a present. Surprise her! I am sure she would love it if she was considering it before."
Dr. Bovenizer took a few more steps thinking before he replied "sure. That would be fun. Definitely a different type of gift. Plus I bet she would look super cute with braces."
Dr. Brad said "I am sure she would. Just look at how stunning my Megan is with hers."
Dr. Bovenizer said "I think Tricia, that's my wife, would be up for braces. But do many patients have to wear something like the brace your wife wears? I am not sure she would be willing to do that."
Dr. Brad said "a lot of patients do require some type of extraoral device. But they adapt quickly. No different that wearing a CPAP mask at night right?"
Dr. Bovenizer said "Hmm, I guess not. And I already have Tricia in one of those. I tell you what, I will call and make the appointment. What's the worst that happens? She says no?"
Dr. Brad replied "that's right. Do you want your wife to receive treatment?"
Dr. Bovenizer said "well, if it would help her grinding. And she would end up with a gorgeous smile too. So that would be a win/win. So yes, I guess I do want her to get treatment."
Dr. Brad smiled and said "well then, call and make the appointment. And tell her you want her to do this, for herself. If she knows you want her to do it, I am sure she will. Spouses will do a lot for their partners. I am sure she will be onboard. Even if she does need to wear an extraoral appliance for a few years, or longer, like my Megan."