Glad to see you back at this story. Things just keep getting more interesting as the story moves along. You' re an excellent writer, always leaving us with many possibilities to think about at the end of each chapter. Something like a Milwaukee brace might help keep Kim at bay???

Episode 84.

Sarah found Dr. Higgins waiting for her inside the employee entrance on Monday morning.  Dr. Higgins physically grabbed her by the arm and said "hurry up, you're going to miss it."  Sarah noticed that Dr. Higgins was not wearing her appliance.  In fact over the past week she didn't remember seeing her wearing it one time.

Sarah asked "what are we going to miss?"

Dr. Higgins asked "did you already forget my text from Friday?  Meredith Simmons and Dr. Parker are going to be on the morning show.  Discussing airway orthodontics, braces, expanders and Meredith Simmons' treatment.  We have to watch!"

As Sarah hurried along behind Dr. Higgins she apologized "I did forget.  I am sorry."  In truth, Sarah was not that interested in watching it.  She in fact was living exactly what they were going to be discussing.  But Dr. Higgins seemed excited so she humored her.

As Sarah entered Dr. Higgins den, she saw the TV was already tuned into the local morning show.  They were talking about a new greenway project the city was working on.  After an interview, the feed cut back to the host, Cindy McCollum.  She gave the camera a big smile and said "and welcome back!  Now, we have a couple of very special guests.  We have our own Meredith Simmons and her orthodontist Dr. Parker here with us to discuss and explain Meredith's ongoing orthodontic treatment.  There was such a response from viewers, so many questions, that they have been gracious enough to visit with us.  Thank you Meredith for being with us and talking about what must be a very personal journey."

The camera zoomed out and showed Meredith Simmons sitting beside Dr. Parker.  Dr. Higgins exclaimed "oh my gosh!  Dr. Parker is wearing her facemask on television.  I mean I know she said she wears it all the time.  But on TV?  I can't imagine."

Meredith turned her head towards Cindy so that the right side of her face was showing and smiled, displaying the silver hook on that side of her mouth.  She said "Cindy, it ish my pleasure to be here".  Turning back towards the camera she continued "so many of you had questions about what is going on in my mouth, I thought I could address it here.  And maybe help someone else who also suffers from TMJ and sleep apnea like me."

For the next three minutes, Meredith explained her issues, popping and pain in her jaw joints, headache, and general fatigue.  She explained she had learned to live with it.  But it was two years ago, when she was prescribed a CPAP for sleep apnea, that she started looking for alternatives.  Which led her to Dr. Parker.  She then turned it over to Dr. Parker.

Dr. Parker turned and smiled at Cindy and said "thank you for having me.  This is an issue that is very dear to my heart.  While I love all orthodontics, airway orthodontics is my passion.  In fact, sleep apnea is an epidemic in this country.  And it is something that I too suffer from.  As you can easily tell, I too am undergoing treatment myself."  She reached up and tapped her facemask.

Sarah said "hey, look, she is wearing hot pink elastics.  They match her facemask and her nails.  How cute."

The host of the show Cindy replied "yes, that mask you have on your face is hard to miss.  What does it do, and do all patients have to wear one of those?"

Dr. Parker answered "not all orthodontic cases require the use of a protraction device such as this.  And there are a few different appliances we use.  But almost all airway cases do require some type of protraction.   With expanders we widen the airway.  And with protraction devices such as this, we can also pull the maxilla forward some, opening up the airway even more.  It is a process for sure.  But the benefits, a lifetime of better health, far out way the costs."

Cindy asked "so, could you tell us about these expanders?  My son has one now.  Are the expanders used for adults the same as for children?"

Dr. Parker picked up a model and explained "they are similar in that they achieve the same goal.  But adults are literally hardheaded.  Once a patient has matured and their sutures have fused, we have to use a different approach.  Ten years ago the only option would have been surgery.  But now, with the development of the MARPE appliance; that stands for Mini-Screw Assisted Rapid Palatal Expander; we can accomplish this without surgery.  So, what your son has is an RPE.  Because he is younger the screws aren't necessary.  But in older patients, starting in the mid-teens depending on development, we have to use a mini-screw assisted expander."

As Dr. Parker held up an example of a MARPE with one hand and a mini-screw in the other, the camera zoomed in on it, Cindy asked "wow, so you and Meredith each have expanders literally screwed into your mouth?   Does that not hurt?"

Dr. Parker answered "there will usually be some discomfort the first few days for sure.  Installation is actually painless, we make sure and number the patient.  But there can be some discomfort in the first few days afterwards.  There is afterall a foreign object now implanted in the body.  And turning the expander certainly creates pressure.  And speaking and eating are an adjustment.  But most patients adaprt very well over the first week.  Why don't we let a patient discuss it?"

Meredith smiled and said "certainly.  The first week ish and adjustment.  A big adjustment.  I did feel pain for the first three days, but I was able to manage it with a combination of Tylenol and Advil.  And eating was a challenge.  It still is.  But that is pretty common with all orthodontic treatment I believe.  The biggest issue for me, because of my job, was speaking.  I had a severe lishp the first week.  And some words, such as lishp, I still have problems with.  That is why I took a little vacation, not so much to relax but to practice speaking.  But I think for the most part, I have gotten the hang of it."

Cindy said "you sound great Meredith.  In fact, I would never even know you had an appliance in the top of your mouth if it weren't for those hooks I see.  What are they for?"

Meredith picked up the Petit facemask and two elastics off the coffee table in front of her and responded "they are to hook my facemask to.  This is my facemask."  She held it up for the camera to see.  She continued "I am supposed to wear this 14 hours a day."  Without a mirror, she attached the elastics to the hooks in her mouth, placed the mask on her face, and then attached the elastics to her mask.  Wearing her blue Petit facemask she smiled and said "so, it isn't the most fashionable piece of evening wear I own. Or the most comfortable, and that is saying something considering the corsets I own and wear daily.  But it might be the most important for my health.  When I am wearing it, I can feel it working."

Cindy asked "does it hurt?"

Meredith said "I wouldn't say it hurts.  It is just uncomfortable after a while.  My chin was really sore in the mornings the first few days.  But I am getting more and more used to it.  Now my pride, it does hurt it a little bit.  But again, I know it is worth it."

Cindy asked "so, what does turning the expander entail?"

Dr. Parker again picked up the model expander and the wrench. She held the expander so the camera could zoom in and put the wrench on the screw.  She explained "it is fairly straightforward.  You simply place the wrench we provide on the screw, and make a turn, like this.  For most patients, I prescribe two turns a day until the suture splits and then one a day afterwards. Meredith's suture as not split yet, so she is making two turns a day."  Dr. Parker looked over at Meredith and raised her eyebrows.  Dr. Parker asked "Meredith, would you care to demonstrate for the audience?  Would you be up for turning your expander?"

Meredith laughed and said "why not.  Since we are being so personal and all."

Meredith removed her facemask and placed it on the table.  Dr. Parker moved in beside her holding the wrench and pulled it through a disinfecting wipe.  Meredith leaned her head back and opened wide, the camera zooming in on her mouth.  Dr. Parker expertly inserted the wrench into her mouth, seating it on the screw, and gave it one turn.  As she finished the turn Meredith squeezed her eyes shut, her face taking on an uncomfortable expression for a split second.   Dr. Parker repositioned the wrench and made a second turn.  Meredith face scrunched up even more.  Once done, Dr. Parker quickly removed the wrench and said "and that is all there is to it.  It's not too bad is it Meredith?"

Meredith breathed deeply and said "no, it isn't too bad.  There is a lot of pressure, but it quickly subsides.  It doesn't hurt, it is just a completely foreign feeling.  But I swear I can feel my airway is even more open after just those additional turns."  She did not pick her facemask back up and she settled back into her seat.

Cindy said "so Dr. Parker, would you recommend this for anyone who suffers from TMJ or sleep apnea?"

Dr. Parker answered "I would recommend anyone that is suffering from TMJ or sleep apnea to consult with an orthodontic professional who is versed in airway orthodontics.  Not every patient is a candidate for this.  But most are.  Orthodontics is definitely evolving.  Airway is king now.  It's not just about straightening teeth."

Cindy asked "so, you can really get people off their CPAP machines?"

Dr. Parker replied "absolutely.  This is a process.  Sometimes not the most fun I will admit.  But ask yourself what is better.  A lifetime with a CPAP?  Or two years with orthodontics?  To me, the answer is clear."

Cindy said "wow, this is all so fascinating.  So cutting edge.  Thank you both so much for your time here today.  It has certainly been eye opening.  And very personal.  Thank you both for sharing.  And Dr. Parker, if a viewer is interested in discussing this treatment, how would they go about contacting you?"

After Dr. Parker had told the camera her website address and phone number, Cindy turned back to the camera and said "when we get back from break, we will tell you all about the upcoming Taylor Swift concert happening next weekend."

Once they cut to commercial, Dr. Parker quickly gathered up what she had brought.  As she did, Cindy stood and took a few steps towards her.  She said "thank you again, it really was informative.  And you really can get a person off their CPAP?"

Dr. Parker looked up at her and smiled.  She replied "I haven't met a patient yet that I couldn't."

Cindy shook her head and said "interesting.  Both I and my husband sleep with CPAPs.  I sure wish I didn't have to."

Meredith overheard and exclaimed "set up an appointment with Dr. Parker.  That way I won't be the only one here rocking adult braces."

Dr. Parker said "I would absolutely love to consult with both you and your husband.  I offer free consults.  Why don't I schedule you both for an appointment?  And if you do decide to go through treatment, you will be so glad."

Cindy thought for a moment and said "sure, why not?  How bad can it be?"

I love this story!

Of course there had to be a break after this sentence! 

Episode 87.

Dr. Higgins had just managed to get her facemask attached to her face when she heard Izzy squeal.  She looked over at her.  The excitement on Izzy's face would have been evident from a mile away.  Dr. Higgins heard her say "oh my gosh, I would LOVE that!  Thank you so much!"  She looked over at Dr. Higgins and practically shouted "Gramma!  Dr. Parker said she wants me to come work for her!  Can I?  Please?"

Dr. Higgins stood up from the chair and made her way over beside Izzy's treatment chair.  Even with everything going on in her mouth, and even with her facemask strapped to her face and everyone else in the treatment room looking her direction due to Izzy, she smiled.  She looked at Izzy and said "baby, that ish your decision.  You are a grown up.  But if you want to do thish, eh guessh that meansh we better get you that driversh' licensh we have been talking about.  That you been practicshing for.  And if you do that, I guessh that meansh you will need a vehicle too."

Izzy's face lit up even more.  Dr. Higgins didn't know how it was physically possible, but it did.   Izzy said "really?  Oh wow.  This is so cool!  Thank you Gramma!  And thank you Dr. Parker!   And thank you Cassie!.  I promise, you won't regret it!"

Dr. Parker smiled at Izzy and said "I know I won't Izzy.  You have been so incredibly attentive and compliant with your treatment so far, I know you will do the same here.  But there is no huge rush.  So, take the time you need to get everything done you need to.  And of course, there is some paperwork we will need to do to get you all set up on payroll.  What do you say we set an anticipated start date for the Monday two weeks from now.  We will need to get you some scrubs too before then."  She looked at Cassie and asked "maybe you could help her with that?"

Cassie said "of course!  I love to shop.  Especially when it is someone else's money!"

Dr. Parker said "excellent!  I will let you girls figure all that out.  Izzy, you are doing so good with your treatment.  Maybe you could offer your Grandmomma some encouragement?  Help her to do better with her treatment?  She needs to wear her FR all the time and her facemask for 14 hours a day now."

Dr. Higgins hung her head a bit as Izzy responded "Oh, I will!  You hear that Gramma?  We are doing this together.   And I know you can do it!  I will help you!"

Dr. Parker said enthusiastically "I know you will Izzy."  Turning to face Dr. Higgins she added "and I know you will too.  Because the REDD frame is not something I like to install on patients.  And they certainly do not like wearing it.  But anyway, Izzy everything looks great with your treatment!  Cassie has you all fixed up.  Just keep doing what you are doing.  And Susan, I think our appointment was very valuable too.  I know you will do better."

Dr. Higgins felt so self-conscious as she stepped into the waiting room wearing her facemask.  She felt every eye had to be looking at her.  She scanned the room.  To her surprise she noticed only a couple of people looking in her direction.  In the corner though something caught her eye.  There was a man, he appeared to be in his late thirties to early forties, wearing some kind of purple anodized metal frame on his face.  Dr. Higgins was trying to see how it was attached to his face when she realized with horror that it was screwed into his head above his ears near his temples.  From his mouth protruded two thick silver wires that bent up and attached to the frame with heavy duty looking threaded rods that were hex shaped at the end.  She tried not to stare but could not help it.  She was interrupted by Missy asking "Dr. Higgins?  Can I make you and Izzy's next appointments?"

Startled she turned.  She said "yes, of course."  Dr. Higgins quickly agreed to the time and date suggested by Missy.  She then quietly asked "Missy, what is that man in the corner wearing?"

Missy said "That is a REDD frame.  That stands for rigid external distraction device.  It is used in severe class III craniofacial cases.  And in cases where patients won't wear their facemask as needed.  I always hate to see a patient emerge from the treatment area wearing one.  I know it has to be so hard.  And several of our patients have told me how much they hurt, especially the first few weeks.  But they work.  The results are always fantastic.  And they work faster than facemask therapy.  Because the forces are heavier and it is worn 24/7, most patients only have to wear them for a few months.  So, I guess there is at least that.  We actually have a pair of patients, twin brothers, who volunteered for it from the start.  They said they just wanted to get it over with as fast as possible.  But I don't want to have to wear one.  I am told that tightening the screws to pull the maxilla forward daily is no fun.  Just the whole experience is not fun.  So, I am very compliant with my protraction.  We have one patient now that is on the verge of getting one.  Just a lovely young lady, she is in college.  Just so sweet.  But she just won't wear her facemask."

Dr. Higgins turned subtlety and took another glance at the man.  It did look tough.  Then she had a thought flash through her head.  A lovely young lady, in college, so sweet.  She spun around towards Missy and asked "Laikyn?  Don't tell me that patient is named Laikyn."

Missy pursed her lips around the elastics protruding from her mouth.  She looked at Dr. Higgins and replied "I can't say.  Patient confidentiality.  Do you know Laikyn?"

Dr. Higgins said "yes, Laikyn works for me."

Missy said "again, I can't answer your question.  But since you do know Laikyn, please implore her to do a better job wearing her facemask.  Please?  Again, I hate seeing patients walk out of here with a REDD frame bolted onto their face."

 

Episode 88.

Having arrived back to Vista View, Dr. Higgins felt so self-conscious walking across the employee parking lot wearing her facemask.  On the drive back, she had felt particularly mortified stopped at one traffic light as the driver of the car beside her practically broke his neck to turn and stare at the pair in the car beside him, Izzy and Dr. Higgins both wearing their facemasks.  Dr. Higgins had to make a concerted effort to concentrate on driving, the last thing she wanted was to get into an accident, more for Izzy's sake than her own.  Now, even back in a much more comfortable and familiar environment, she was still terrified.  What would everyone think?  The boss having to wear an orthodontic appliance that most people thought of as relegated to children and teens.  Add to that her speech impediment and she was dreading the rest of the day.  Actually, she was dreading all of the days to come while she was in treatment.  Nonetheless, part of her brain was thinking about Laikyn and what Missy had told her.

After hugging Izzy and telling her how proud she was of her, Dr. Higgins retreated into her office.  She tossed her purse on a chair and checked her emails.  There did not appear to be any emergencies.  She planned to check in with several people, her head nurse and Sarah being at the top of the list.  But she procrastinated.  She wondered what it would be like to walk the halls of Vista View wearing her facemask?  She knew Sarah had done it.  Everyone had just seemed to get used to seeing her in it.  And poor Julia still had her headgear wired in.  But she thought, that was different.  And lately, she had even caught a few glimpses of a couple of her guests wearing their extraoral appliances in public.  Dr. Higgins attributed this to Sarah.  She thought it was great these guests were apparently so unashamed and compliant with their treatment.  But that was them, not her.  First she thought "I need to speak with someone.  I can't stay locked in here forever."

She knew it was irrational.  She was a trained psychiatrist after all.  But she also knew that knowing something and feeling something are often completely foreign from each other.  Perception IS reality she thought as she walked down the hall.  Because while she logically knew this was no big deal, she felt like she was walking towards the gallows.  Still, she put one foot in front of the other and made her way to the reception area.  She was so grateful she didn't bump into anyone in the hallway.

As Dr. Higgins walked up to the reception desk, Laikyn looked up from her conversation with Izzy, who was still wearing her facemask proudly.  Dr. Higgins noticed a startled look on her face.  She wasn't sure if it was because she hadn't realized anyone was there.  Or if it was shock from seeing her wearing her facemask.  The startled expression was almost instantly replaced by a smile and then Laikyn saying "Dr. Higgins, you are wearing your facemask.  Good for you.  And Izzy says you need to speak with me?  She's going to man reception I understand.  I hope I'm not in trouble."

Dr. Higgins said "No, you aren't in trouble.  But I want your help.  To ahsk a favor.  And yesh, I am wearing my faschmashk and appliancesh.  I have to.  I got in trouble today.  But I admit I feel so self-conscioush.  That ish why I want to shpeak with you."

Before Laikyn could respond, Izzy exclaimed "you look wonderful in your facemask.  Just so pretty.  You have no reason feel self-conscious."

Dr. Higgins smiled and said "it sheems the roles are reversed doeshn't it.  But thank you sweetheart."  Turning her attention back to Laikyn she asked "care to walk with me to my offish?"

Once seated Dr. Higgins noticed Laikyn seemed a little nervous.  She said "Laikyn, you aren't in trouble with me.  I promish.  But I do want to chat.  About thish."  She pointed up to her facemask.  She continued "I am going to have to wear thish some around here during the day.  Not all the time, but several hoursh a day.  And I am going to have to wear my appliansh all the time.  So pleash bear with me ash I learn to shpeak."

Laikyn said "it will get better Dr. Higgins.  I had so much trouble speaking at first.  But it got better.  Now this gap I have between my teeth now makesh me just a touch lishpy.  And it is embarrassing, the gap.  But nothing like the facemask.  It is so awesome you can wear yours though."

Dr. Higgins replied "well, I don't have much choice unlessh I just quit treatment.  And I won't do that.  It would break Izshy's heart.  And I don't want the alternative.  It ish brutal looking.  Have you heard of a REDD frame?  It stands for rigid external distraction device.  I saw a patient, an adult man, wearing one in the waiting room when we left.  It was literally screwed into his head, attached to his expander with these wires and bolts that have to be turned.  THAT is what the alternative to not wearing my facemask would be.  And I don't want that.  Has Dr. Parker mentioned anything to you about it?"

Dr. Higgins noticed Laikyn's face had turned white as she described the REDD frame.  Laikyn said "she said I need to do better about wearing my facemask.  And she did mention something red.  But she didn't explain what it was.  I took it was just some other kind of mask.  That I wouldn't wear.  Surely, she wouldn't do that would she?  Screw one onto a patient?"

Dr. Higgins said "well, from what I saw, it is clear she will.  Laikyn, I am so self-conscious about wearing this.  I mean, I am the bossh here.  And old.  But I am going to do it.  Sharah did it for so long.  Izshy doesh it.  But it would make me feel better if you would too.  Will you?  For me?  To make me feel less self-conscioush.  Would you wear yours while manning the reception desk?  I won't make you, but it would mean a lot to me."

Laikyn swallowed before replying "yes... I will.  But you might want to make sure we have lots of tissues up front in case I break down and cry."

Dr. Higgins said "Laikyn, you will do fine.  We will both do fine.  I know we will.  And hey, if we can just recruit a few more employees to join us in treatment, we will be in the majority.  Those without facemasks will then be jealous of all of us cool kids that have them.  Right?"

Laikyn shook her head back and forth but laughed.  She said "I seriously doubt that.  But ya' know, I have had two people here ask me about my treatment in the past couple of weeks.  Both Paige and Mitzi seemed pretty intrigued by it.  In fact, Mitzi went so far as to say she has really been wanting to fix her smile.  I think she has really been considering getting braces."  She thought and then added "and you know Melanie has a facemask too.  Maybe I could talk her into wearing her's here too.  Make it one big facemask party."

Dr. Higgins smiled.  She responded "see, all the cool kids want a facemask.  Why don't you work on Paige and Mitzi then?  And I will have a little chat with Melanie."

This is such a great story with so much going on and each chapter leaves me wondering what will happen next. Excellent work!