Chapter Sixteen.
The next few weeks were magical for Tara. She was amazed at how easy and comfortable her new relationship with Jim had become. In just two weeks, they had fallen even harder for each other. They were a couple. They seemed natural for each other. After that first night, they had agreed not to rush things, but instead to let things just come naturally. And what felt natural to Tara was to spend as much time with him as she could. Their orthodontic treatment was always there in the background, and especially Tara's CTO brace, but Jim was so patient, gentle and understanding with her. She had become more used to wearing it, though she was definitely not a fan of it. But she had finally figured out how to put it on herself by lying in bed so she could use both hands. She did have to admit though that she was suffering from less frequent headaches and her jaw pain had largely gone away, so she soldiered on wearing it.
At "TMJ and Sleep Plus", the staff was not as happy. On the Monday after Dr. Brad had announced that Alex and Mandy would each be getting their own 'CTO masks' as he called them, he reminded the staff that they had a continuing education day coming up that Friday. It was time for their annual CPR and first aid recertification and he had a trainer coming in that morning. He also said he had a staff member coming in from "Optimal Orthopedics" and asked that all the ladies wear a white close-fitting undershirt that day. He would not elaborate when pressed on why, he just said it was a surprise.
That Friday morning had gone smoothly. All the staff, including Dr. Brad, had completed their CPR and first aid certification successfully. Alex and Becky had some issues getting a good seal to perform mouth to mouth on the dummy due to their braces, but they managed. It did leave both of them with sore lips and inner cheeks but they did not complain. After the class was finished, Dr. Brad announced he was treating the group to lunch, his treat. Lunch was fun even if Alex, Mandy and Becky couldn't eat the chips and salsa the rest of the group enjoyed.
Back at the office after lunch, Dr. Brad welcomed Dr. Olivia Morales into the lounge and introduced her to the staff. Out of habit Alex noted that Dr. Morales, who looked to be in her mid to late 40's with a dark olive complexion and jet-black hair, had some crowding in her lower arch and her upper canines were too prominent. She also noticed that even wearing scrubs topped by a white coat that Dr Morales had an hour-glass figure, a ridiculously small waist, and incredibly erect posture. Alex was a little jealous. Dr. Morales introduced herself and said how happy she was to be there and how she looked forward to getting to know them all over the next few years. She surprised everyone but Dr. Brad when she said she was so excited that her and Dr. Brad were trading services. She said she was looking so forward to straightening out her smile. After introducing herself, she explained that she had trained as an orthopedic surgeon, but after 10 years and too many negative complications that were so common in spinal surgeries, she now entirely focused on bracing and physical therapy. She said she had a LOT of items to bring in, and asked for any volunteers to help her carry it in. Everyone pitched in by carrying a plastic tote while Dr. Brad and Dr. Morales carried a folding treatment table.
As Dr. Morales set up everything, Dr. Brad explained to the group why he had asked her to come in. He looked at his staff; Alex, Maggie, Lisa, Becky, Mandy and Janice who were all assembled on the couches; and said "So, I already told Alex and Mandy that I will be incorporating a CTO mask into their treatment. They will become very familiar with it. But I want you all to familiarize yourself with the device. I have been speaking with Dr. Morales, and she treats a lot of patients with Ehlers-Danlos. If you aren't familiar with Ehlers, it is a disorder that effects connective tissues. This leads to dislocations. One of the primary treatment options for these patients is bracing. Dr. Morales is an expert on it. She told me that she is seeing more and more cases, she isn't sure if it is due to an actual increase in patients or just better diagnosis. For years she said it was often misdiagnosed. She told me that so many of her patients also complain of jaw issues. When she asked me how many Ehlers-Danlos patients I was currently treating, I told her none. Well, that will change. Dr. Morales is going to begin referring patients that complain of jaw pain or jaw dislocations to us. Many of these patients are already in mobility aids, a less imposing way to say orthopedic braces, of one sort or another. Many of them have to wear CTO braces just to function in their day to day life. So, soon I expect we will see more of them in this office. And many of these patients will receive new CTO braces with a Sleep Well mask integrated into it. So, I want to make sure everyone is familiar with it.
Dr. Morales will refer her patients to us. In return, I will refer patients that complain of cervical or shoulder tension or exhibit poor posture or other obvious orthopedic issues to her. I suspect we already have a few patients that suffer from Ehlers-Danlos, I just didn't know what to look for to identify it. Dr. Morales mentioned that we are trading services. We are going to be providing her and her staff orthodontic care at no charge. In exchange, she is going to provide my staff, all of you, treatment at no charge.
Alex and Mandy, you will get fitted for your CTO masks today. Lisa, when you start treatment after the first of the year, I will also incorporate it into your treatment plan." Alex looked over at their hygienist who now had a look of shock on her face. Dr. Brad continued "Megan will also be getting one when she begins treatment. So in a way I will become very familiar with it as well on a day to day basis.
So, what about the rest of you and how does this impact you? Well, Dr. Morales has also told me she has seen a huge increase in what she calls 'tech neck', poor forward head posture caused by all of us staring into computer and phone screens too much. It usually eventually leads to cervical issues and pain at some point. To combat that, she developed a new posture brace for patients to wear. It fits invisibly under clothing for day time wear and has a cervical component for screen time. I want everyone here to get fitted for one, and we will today. I want you all to wear it here at work. It will just become a part of our uniforms." There were several murmurs and gasps from the group.
They had been paying attention to Dr. Brad and had not noticed that Dr. Morales had finished setting everything up. She said "ladies, if you would, please come over here and assemble around the treatment table." She was holding a CTO brace with attached Sleep Well mask. On the counter behind her was another and a row of 6 additional braces. These braces looked similar to a corset, just all white with a little more plastic and metal showing. Each had shoulder straps incorporated into them. In front of each was a white foam and cloth cervical collar. The group hesitantly approached the table as Dr. Brad smiled. Dr. Morales said "Alex, as lead assistant, I think it is only fitting that you take the lead and go first." She laughed at her little joke. None of the other women did.
Dr. Morales had Alex sit on the edge of the table and remove her scrub top. She quickly and efficiently placed the brace on Alex, tightening and adjusting straps and explaining what she was doing as she went, and then stepped back. She said "and that is it. That is all there is to fitting it on a patient for the first time."
Dr. Brad interjected "you make it look a LOT easier than it really is. Me and Alex struggled on the only one we have fit so far."
Dr. Morales smiled and said "well, practice makes perfect."
While all of the ladies had heard what they were saying, none had looked over at them. All of them had their eyes focused on Alex. She looked to be in shock, miserable and on the verge of tears. Janice stepped over and placed her hand on her thigh and asked "you ok?"
Alex said stoically "yes."
Dr. Morales had noticed this and said "it is an adjustment getting used to wearing a CTO brace. The initial sensation can be unsettling. But I promise you, while patients may never love it, they will adapt to it. Alex, you will too. Now, let me coach you on how to take it off and reapply it yourself."
She coached Alex in what order to unhook the straps, and just like that she was free again. She stretched her neck in a circular motion. Dr. Morales than instructed Alex to lay the brace open on the table, the back of it face down, and lay back onto it. She then helped coach her on how to put it back on. Once Alex was securely strapped into her brace once again, she tried to sit up like she normally would. She couldn't. Dr. Morales said "notice how you can't just sit up normally. Alex, try rolling over on your side, legs hanging off the table, and push up with your arms." She complied and once again found herself rigidly sitting on the edge of the table. Dr. Morales said "this is how patients have to get out of bed. I would recommend you instruct them, but if you forget they will figure it out. Now, Alex, I am not the orthodontic expert. But Dr. Brad told me you would also be wearing elastics hooked from your mouth to the mask portion of your brace. I will leave that to you the expert. My job is done. Would you please leave the brace on until we finish at least?" She looked over at Mandy and asked "ready?" Alex stood and walked over to get her elastics while Mandy took her place sitting on the edge of the table.
Dr. Morales went through the same process with Mandy. Afterwards, she also asked Mandy to keep her brace on. Mandy went over and stood beside Alex, who handed her a bag of elastics. Both of them stood there, elastics stretched taught out of their mouths, trying to come to terms with the restrictive braces they now wore. Dr. Morales said "and now for my Posture Plus support. How about we do this as a group? I will coach you through it as we go. If you have ever worn a corset, this will be somewhat familiar to you. The braces are adjustable for most body shapes, there is a S/M, a L/XL and a 2X+. Dr. Brad told me your approximate sizes, and each posture support is tagged with your name. Will you each strip down to your undershirts and then grab your support?"
It took a few moments, but finally each woman was aligned in a row in front of Dr. Morales holding their support. She looked over at Alex and Mandy and said "just watch what they do. It is easy, and you will find putting on this device a piece of cake compared to the CTO braces you are wearing." She turned back towards the other four women and instructed. I am going to call it a corset just for simplicity, but it is so much more than that really. Take your corset and wrap it around your waist, laces in the back, and attach each of the clasps in the front." Each woman did as instructed. "She continued "now, notice that each corset has three straps on each side. Each strap has a series of metal grommet enforced holes. I want you to suck in, grab the lower straps, and pull evenly. Pull as tightly as you can, and then hook the grommets over the same clasp that you attached the front of the corset together with." The ladies did as instructed. Dr. Morales said "one down, two to go. Now, repeat that with the top strap and finally the middle strap." Each of the ladies did, and all immediately felt like they were standing up straighter. And all but Lisa noticed that breathing was going to be more difficult as well.
Dr. Morales said "now, let me check the fit. She checked Maggie's and said "good." Then Janice's, who she also approved. When she got to Lisa, she said "just a little tighter." She unhooked the three straps, then reattached them. This time though it was two notches tighter than before.
Lisa grunted as the straps were tightened. Once they were attached she looked at Dr. Morales and said "this feels too tight. I can't breathe."
Dr. Morales gave her a compassionate smile and said "it needs to be this tight to work. You will get used to it."
She then moved to Becky and said "good."
She said "now for the shoulder straps. I will attach them. They are very similar in design to the other straps. You probably didn't notice the little flap of material under each arm, but there is another small post under each of those. You will hook each shoulder strap to those. I will do it for you the first time to size it. She went down the line. As she tightened the straps, each woman immediately felt themselves standing straighter. Slouching was no longer an option. Once she had everyone's shoulder straps attached she then turned back to the group and said “there are just two more things." She walked over to the counter and picked up a pair of scissors. She explained "I will now trim each of your straps, the waist cinching straps and shoulder straps. This will do two things. One, it will make it much smoother and streamlined under your clothing. Two, there will be no confusion on where you need to hook your straps." She went down the line trimming the straps as she went. Once she was finished she turned and said "wear these at all times during the day. It will just become a routine part of your wardrobe. When at the computer, also wear this." She reached over and picked up one of the soft neck braces. She started with Becky, who was closest to the counter, and secured it around her neck. She then attached a brace to each of the three other women. She said "I will not prescribe night time wear at this time. It is a challenge to get used to sleeping in. But it can be done. I wear mine 23 hours a day." She pulled back her white coat and scrub top and showed the ladies a peak of hers. She continued "however, if you want to try it won't do anything but help."
She looked at the group and said "that is it for the Posture Plus support. I would like all of you to continue wearing everything until we wrap up. That will give you time to get a little acclimated and come up with any questions you have. Speaking of questions, does anyone have any?" She looked around the room at all the faces. She noticed a lot of shocked looks. She said "none? Well in that case" she looked at Dr. Brad with a big smile on her face "why don't you all get me my spacers! And Dr. Brad, maybe you can show me this new appliance you developed that you say can fix all my issues. With just one appliance too!" She looked around the room. Dr. Brad was the only one smiling. She exclaimed "Come on girls, smile! This is all so exciting!"
