Chapter 107:
Tuesday morning Tara's phone rang. Looking at the screen she saw the call was from 'TMJ and Sleep Plus'. Instantly she realized she had forgotten to call Dr. Brad the day before to discuss her protraction module. She answered the phone to Dr. Brad's cheerful voice. After they exchanged pleasantries, Tara apologized for not calling the day before. Brad said "that is ok Tara. You certainly have a lot on your mind. You have a wedding to think about. I didn't call to berate you. I called with good news. I have talked with Dr. Olivia and she wants you to schedule an appointment week after next to have your halo removed. That is exciting isn't it?"
Tara said "yes, I am so ready to be able to be able to turn my head again."
Brad said enthusiastically "I bet you are. Now, I will want you to go back to wearing your CTO brace at night. But only when you sleep. You can wear your mask by itself during the day. That should make life easier for you. In the meantime, I did want to see what you wanted to do about your protraction module. This is a little different for me, asking the patient what they want their treatment to be. But you have earned it. We have three options. The first is what I am guessing you want. And that is to just wear your Petit mask. That is if you promise to get in your 16 hours."
Tara volunteered "I am wearing it now. And I have gotten in more than 16 hours per day, I have been wearing it pretty much fulltime."
Tara could almost hear the smile on Brad's face when he responded "I just knew you were. Tara, you are a model patient. You make my life easier. That is why I am letting you choose this. The second option we have is to have your protraction module reinstalled. I could put the protraction rods back on. I know you didn't have them long. But I am not upset about that. I understand how much they were bothering you. If we put the module back on, we could get you back into springs. In terms of effectiveness, the rods would be most effective. But you have done so well that we could get by with the mask and elastics. Most patients cheat on their wear. If I tell them to wear their protraction gear 16 hours, I will get 12 hours. If I tell them 12 hours, I will get 8 hours. But not you, you have been going over your number. Which is great, the more you wear it the more effective your treatment will be. Once you get your halo off you will be able to wear your sleep well mask again during the day and the CTO at night. In the mean time do you just want to keep wearing your Petit until you get your halo off?"
Tara couldn't even believe she was thinking about it. She surprised herself even more when she asked "so the rods would be more effective? And I would only have to wear them two weeks?"
Brad responded "yes to both." There was an awkward silence. Brad asked "are you still there?"
Tara replied "yes, I am just thinking." After a few more seconds she said "if they are going to be more effective, I would like to have the rods reinstalled. It is only two weeks. I think at this point I can survive anything for two weeks."
Brad was surprised but elated. He excitedly said "Tara, you amaze me. If there were a hall of fame for orthodontic patients, you would be a first ballot inductee. So, about the logistics of this, do you want to come into the office? Or do you want Alex to do it. Or, and don't tell other patients, I would make a house call for you."
Tara again surprised Brad when she replied "I am going stir crazy cooped up in this house. I need to get out. Would it be ok for me to come into the office?"
Brad said "absolutely. We would all love to see you. And to make it easier on you, just come by when you feel like it. Sooner is better of course. Just swing by and I will get you right on back. No appointment needed. It won't take long. And again Tara, thank you. Thank you for making my life as an orthodontist easier. You are going to have exemplary results because you have put so much into this."
As Tara hung up the phone, she couldn't believe what she had done. She called Jim to tell him.
Late that afternoon, Jim had just arrived home when Tara got a text from her boss Beverly. The text simply read "are you and Jim home? I have a surprise for you."
Tara had replied "yes, we are. What kind of surprise?"
Beverly responded "well it is a surprise. You will see in about 20 minutes."
Twenty minutes later, Jim opened his front door to find Beverly and her husband Tim standing there smiling. Beverly was not wearing her mask, just the metal wire of her retainer was visible across her top teeth. But it surprised Jim to see that her husband was sporting clear brackets. As Jim looked closer he also noticed hooks running above the archwire, ended at his canines, and the unmistakable silver of molar bands further back in his mouth. Jim said "welcome you two! Such a happy surprise. Please, come in a minute."
As Jim escorted them into the living room, Jim asked "when did you start treatment?"
Tim responded "two weeksh ago. I don't have the full Monty, a Miller appliancsh, but I do have an upper quad helix and lower lingual arch. Talking and eating hash been a challenge for sure." Jim knew what the hooks had to be for, but since Tim had not mentioned having to wear any type of facemask he didn't ask. He remembered how self-conscious he had felt about it.
Instead, Jim replied "well you will be happy you are doing it."
Beverly said "and so will I. This already seems to be helping with the snoring some. I was about ready to smother him with a pillow at night."
Entering the living room, they found Tara turned in her wheelchair looking at them. Jim said "look who I found! And look who has new braces!"
Tim smiled at Tara.
Tara said "oh, don't they look good. You look so distinguished." Tara hadn't noticed the hooks. She was just joking as she pointed towards her own and said "all that is missing is the facemask."
Tim's smile disappeared and said "oh no, I got that too."
Beverly squeezed Tim's arm. She said "and he is such a hottie with it."
Tim turned and said "it is awful."
Beverly laughed and said "you big baby." She kissed him on the cheek. Beverly turned back and said "Tara, would you and Jim please come outside? I have a surprise for you. But I couldn't figure out how to get it through the door."
As Tara rolled out through the front door following Beverly and Tim she wondered what in the world Beverly had done. As soon as she made it outside she saw. Parked in their drive was Beverly's black Mercedes. But in front of it was a white Ford Transit van."
As soon as Beverly saw that Tara had seen the van, Beverly said "surprise!"
Tara cut her eyes towards Beverly and said "no, no way. No, too much."
Beverly stepped over and squatted down beside Tara, grabbing her arm in the process. Beverly said "no it is not. I told you anything you needed, we would provide. When Jim told me how awkward and difficult it is for you to get in and out of a vehicle, I knew what I had to do. And before you try to argue, no is not an option. Come, see your new ride."
After Beverly had proudly shown Tara the van, she insisted that Tara try it out. The lift gate at the side door made a humming noise as it lifted Tara in her chair even with the interior of the van. Once it came to a stop, Beverly said "that worked perfect. Now, just turn your chair and move where the passenger seat was." Tara powered herself to where the front passenger seat had been before it was removed. Jim had the front passenger door open, standing there blocking the doorway. He was waiting to help Tara and to make sure that she couldn't possibly have some type of accident and fall out. He was there to catch her if she did.
As she came to a stop, Jim said "perfect baby." He then looked at the four straps integrated into the floor, each with a hook at the end. Jim turned his head towards Beverly, a questioning look on his face.
She said "oh, I forgot to explain those. Here, look." She nudged Jim out of the way and grabbed the furthest rear hook. As she pulled it out and slipped the hook over the wheel of Tara's chair she explained "they are seat belts. And like a seat belt, if you pull on them slowly you can pull them out and extend them to clip them in place. And they will retract back until snug." Done with the first strap, she grabbed the second rear strap. She pulled on it smoothly and then gave a sharp jerk. The strap didn't give. She said "see, like a seat belt they lock if you yank on them. If you have to brake suddenly, these will hold the chair in place." She hooked the second rear strap to the other rear wheel of Tara's chair. Satisfied that Jim understood, she moved out of his way and said "you do the next two."
Once he had finished with these two, he looked up at Tara. He asked "how you doin' up there babe?"
She said "better than if you had just stuffed me in the back of your SUV."
Beverly said "this will be much better. We are going to leave you this van before Tara tries to fight me on this. I know you will take care of it. It is the firms. But use it as long as you need it." She turned to Jim and said "you two really should go test it out. Maybe take a trip around the block. Or maybe go to the overlook." She winked at Jim and said "who's knows what you two could find to do up there?"
Jim turned to Beverly and Tim and said "thank you both, thank you so much."
Beverly smiled and said "it is my pleasure. Now take it for a spin."
As Jim watched the pair walk to their car, Jim leaned in and looked up at Tara. He said "that was an excellent idea Beverly had. What do you say we go watch the sunset." They did and Jim took full advantage of Tara's last night of freedom from her protraction module.
That Friday at their weekly afternoon team meeting, Brad had gathered everyone in the lounge as usual. Only this week there were three additional faces. After he had done his weekly review, he said "I guess you guys all already know we are growing. We will be moving into a new, larger, even more state of the art facility soon. I have signed all the paperwork. We have a new lot and plans are being drawn up now. We need a bigger office. Because I want to introduce you all to our newest orthodontist, Dr. Abby Lee." He glanced at Andi as he said "I know some of you already know her, and others have met her. Starting tomorrow, she will be full time. And since you assistants carry us orthodontists on your shoulders, I would also like to introduce you to two more new colleagues." Brad gestured to the shorter, blond haired young woman and said "this is Kristi." She waved and gave a big white smile. He gestured to the other woman, a few years her elder, and said "this is Kelly. She already has 7 years experience in general dentistry and comes to us from Dr. Usher's office." The slightly older and taller brunette waved and smiled, also displaying a smile unadorned by orthodontia.
She said "I am so excited to work with you all."
Brad turned and said "I want you all to welcome them with open arms. I know you will. And Alex and Maggie, I am going to lean on you to show them how we do things around here. In fact, I think right now would be a good time to get started with that. Would you mind giving them the grand tour and explaining how everything works? I will join you. And Becky would you come along too? Once we are done back in the treatment area, we will go over our system up front. I would like them to be cross trained. The rest of you, do your thing."
As the group split up, Andi walked over to Abby and asked "would you come with me Dr. Abby?"
Abby turned and smiled at Andi before she said "I like the way that sounds. It sure took long enough. And of course I will Dr. Andi." She giggled. Andi could see she was happy and excited. Andi wasn't sure she would be happy and excited about what she was about to hear.
Sitting down across from Andi in her office, Abby asked "what's up?"
Andi said "well first off, we are short on space here. Until we move into the new building, we just don't have room for you to have an office of your own. If mine is open you can always use mine and then we also have the lounge. I hope that is ok with you."
Abby smiled and said "not a problem. Dr. Brad already explained all that. I am perfect with it."
Andi said "good, I just wanted you to be aware. Next, your treatment. You will be getting your appliances at the show. But there has been a slight change to your initial treatment plan. We are going to use protraction rods instead of elastics right off the bat. Which will mean 24/7 wear of your Miller headgear. It takes some time to get acclimated to. I want to go ahead and have you start wearing it now, this afternoon, so you can work your way up to 24/7 wear by the show. You are going to have enough new stuff to get used to, I at least want you to be used to the headgear component. I have had a removable appliance fabricated for you." She pulled open her drawer and withdrew a pink retainer case. Handing the case to Abby, Andi asked "will you see how this fits?"
Abby briefly examined the appliance. It was just a Hawley retainer with the addition of two hooks. Abby realized it was the same design as Alex wore. As she placed it in her mouth, Andi said "I didn't know what color you wanted, and it is just temporary, so I went with clear. I hope that is ok."
Getting the appliance seated in her mouth, Abby replied "yesh, it ish ok. Oh boy, what a lishp. You want me to wear thish full-time?"
Andi replied "for this first week, wear it around the house and while you sleep. You will get more used to speaking with it. Then the second week, try to wear it full-time except when eating and brushing. I want you to wear your headgear anytime you are wearing it. Including here in the office of course. The first week, just use two elastics. The second week, use four elastics. This will help get you acclimated to the additional force the rods will provide. So, that is the first change."
Abby asked "the firsht change? What ish the second?"
Andi said "I am going to go ahead and install your spacers this afternoon. I want you to have an extra week with them, because we need to make a lot of space. Orspco has their new bracket and band system as you know. We are going to fully band your lower arch."
Abby look confused. She said "nobody ushesh full bandsh anymore do they?"
Andi said "it is very rare, bands are primarily used on molars and premolars. Some patients do require them on individual teeth that have had prior work done to which brackets won't adhere well. But remember that your installation also is a marketing event. They want to use full bands on your lower arch. Honestly Abby, you are going to have so many other things going on in your mouth you won't even notice the difference between bands and brackets. The worst part will be the spacers. Now for the third change."
Abby said "wait, there is more?"
Andi said "yes, there is. Orspco is also bringing out a new appliance. There is nothing exactly like it on the market. There will be a fixed and removable version. It serves the same purpose as a Frankel appliance, but it is an improvement. It is not a one-piece design. It is a two-piece design, somewhat similar to a twin block but with the addition of the acrylic cheek and lip pads of the Frankel. Also, it is more versatile. It can be fabricated to be compatible with an expander or other palatal and lingual devices. In your case an upper MARPE, lower lingual expander, and upper tongue crib." She pulled her drawer open again and pulled out an additional plastic case. She sat it on her desk and opened it, removing two bulky flesh toned acrylic and stainless appliances." She said "this is Dr. Tim's new appliance. He is having it installed in the morning." She held it up and explained "see the pads here on the sides and in front, between the teeth and lips? This is to keep the cheeks and gums from pushing against the teeth." She placed the two appliances together. She continued "and see how they mate together? See how these metal struts mesh together? They can be used to adjust the occlusion over time with the adjustment screws.
The two-piece design allows patients to open their mouths much easier than the one-piece Frankel. This means it is possible for a patient to eat with it, which is why it is possible to use it as a fixed appliance. However, as you can see, the appliances do cover the rear molars top and bottom. See, the front teeth cannot meet. So while eating is possible, it will be difficult. The wearer will not be able to bite with their front teeth and instead will have to cut everything. Your treatment will include one of these, a fixed version. We will install it all at the show. I didn't want to surprise you with it. Abby, it is going to be a lot to deal with. It will be hard. But you will be ok. I know how excited you are about your treatment. This is just more to be excited about."
Andi saw Abby just staring at the appliance in her hand. It seemed she was speechless. Andi again encouraged her "seriously, you will do great. You will get to see one in action tomorrow when we install Dr. Tim's. I do have one more thing I wanted to discuss with you Abby. I was hesitant to bring it up now. But I think I need to. Would you stand and slip your coat off for me please?"
Abby looked at her. She asked "what? Why?"
Andi said "your back Abby. Your hips and your shoulders aren't level."
Abby asked incredulously "what are you talking about?"
Andi said "your hips and your shoulders aren't level. Stand up, take your coat off, turn around and I will show you."
Abby was still in a daze from hearing about the new additions to her treatment. The last thing she wanted to think about was her back. Yet she complied.
As she stood with her back to Andi, Andi took several pictures with her phone. Once she was satisfied, Andi said "please come around here Abby." Abby moved in beside Andi and looked over her shoulder. Andi pointed at the screen of her phone and said "see, your hips and your shoulders aren't quite even."
Abby said "they have always been like that. It hasn't caused me any issues. I am fine."
Andi said "If there is one thing I have quickly learned, what we do will cause any back to hurt. Abby, at least have someone look at it. We work closely with the Morales, you met them at the party. Go see Olivia and at least find out what is going on. I have already made you an appointment for tomorrow. Olivia was gracious enough to agree to see you on a Saturday. When we finish up here tomorrow, we will go see her. I will come with you for moral support."
Abby protested "no really, I am fine."
Andi said "Abby, it is important that we practice what we preach here. I will go with you. At least meet with her."
Abby looked like she was pouting. She said "fine" and crossed her arms.
That night Abby struggled to fall asleep with the intrusive and uncomfortable headgear strapped to her head. When she finally did manage to fall asleep, she had a nightmare she was wearing a Milwaukee brace like Becky and Megan wore. She woke up and thought "thank God, it was just a dream."