Consultation Appointment

The appointment went great. Dr. Piper is so much different than other doctors...he's caring, thorough, and willing to answer any and all questions that his patients have. We left his office close to 10pm last night and didn't feel rushed at all. 

To give you an idea of Dr. Piper's schedule yesterday...there were 3 brand new patient consultations, meaning 3 new patients arrived by 7am. Each new patient started with a CT scan in the office, molds, wax bites used for an MRI later in the day, tons of pictures of the mouth, and an initial visit with Dr. Piper. Dr. Piper also starts seeing his postop patients at 8am. I would guess he saw 10-15 postop patients before noon. In between seeing his postop patients, Dr. Piper also comes back to see the 3 new patients for a further exam that gives him a better health history and allows him to see the current jaw situation. At 1pm, Dr. Piper has follow up phone conversations for patients that have been through prior consultations. After those phone conversations, he starts the longer health history visit with the 3 new patients, followed by the full consultation and treatment plans. Yesterday sounded like a routine day. In other words, Dr. Piper routinely finishes his day on Mondays and Tuesdays (days that he sees new patients) around 10pm. But, remember as I mentioned earlier, he did not rush or make us feel bad for asking additional questions. 

Rebecca's day went as follows: we arrived at 6:50am and were the 2nd patient; around 7:15, she was taken back for a CT scan, molds, wax bites, and an initial, short visit with Dr. Piper; around 9am she was finished with these preliminary steps; around 11am, she had a full health history done by Dr. Piper's physician assistant followed by a 15-20 minute visit with Dr. Piper; around 12:15, she had to redo her molds because they didn't take very well (mainly due to the fact she couldn't open wide enough); at 12:45, we headed to the MRI office for her 1pm appointment; at 1:15, she was called back to get ready for he MRI; the MRI started around 1:45 and was complete around 2:30; once we were back at the office around 3, we watched a 35 minute video explaining the evening consultation with Dr Piper; around 3:45, we were given a break until 6; we arrived back at the office around 6 to wait for the evening consultation; we met with Dr. Piper starting at 7:05 and left his office around 9:25; we met with the patient coordinator after that meeting to discuss surgery scheduling and costs in addition to what they will do with insurance companies; and we finally arrived back to our hotel room at 10pm, a whole 7 and 1/2 hours before we needed to be packed and ready to head to the airport. 

So...what did we find out? We were given tons of information last night. We have 5 pages of handwritten notes from last night's consultation, and we will receive a full report within a week containing all tests, the MRI, and Dr. Piper's dictated notes. We went into the consultation hoping that Rebecca's joints were salvageable. We found out the previous night that the condyle on each side needed to be at least 50 square millimeters in order for Dr. Piper to do the surgery. Luckily, boths of Rebecca's condyles are larger than the minimum requirements. I was much more relaxed after finding out about those measurements. Here are the highlights of what we found:

- As Dr. Holmes told Rebecca, Dr. Piper agreed that there was a trauma early in her development years causing these problems. Dr. Piper thinks the trauma happened closer to 5 years of age. 

- Rebecca's left jaw is the size of a 5 year old's jaw. This is the case because of the trauma at a young age. The trauma caused damage to the growth plates, meaning her left jaw stopped growing at that point.

- Dr. Piper is cautiously optimistic that Rebecca has enough bone that has not degenerated - meaning that he hopes no rib graft procedure would be necessary. 

- Dr. Piper has a 98% success rate with his surgery. If Rebecca's bone still degenerates after the surgery, she would be in the 2% and the only option would be a total joint replacement. The total joint replacement is only done in Dallas, Texas and isn't a lifetime solution to someone in their 30s. 

- Most jaw doctors just want to complete a bite surgery without trying to correct the initial joint problem. Because of this common practice, the pain does not go away and the problem is not solved. A bite surgery involves cutting the jaw in several places and realigning the jaw with screws. This is a major operation with more complications than Dr. Pipers surgery. 

- Dr. Piper feels that he can solve the pain problem with his fat graft surgery. Other surgeries might be involved at a later date (most likely 2+ years later), but that just depends on how well the fat graft works in the jaw. 

- The fat graft surgery will allow Rebecca close to normal function in her jaw. It will not mean that she looks different or that her jaw bone will be a normal size. 

- After surgery and after the extensive 9-12 month healing process, Rebecca will need braces to adjust her bite. 

There is a ton more information and a ton more that we learned, but those are the highlights. 

So where do we go from here? Rebecca thinks Dr. Piper is amazing and thinks this procedure is best for her. After 20+ years of trying to manage her pain, finding a solution that has such promising outcomes is great. Many people have stopped us and asked why we are rushing into this without finding another opinion. This isn't a first opinion. Or a second opinion. Rebecca started seeing doctors in St. Louis 20 years ago, followed by a specialist in Decatur that made 3 splints for her over the years in order to manage pain, in addition to 2 doctors in Bloomington that both agreed Dr. Piper was her only option. There are other places we could check. However, all of these other options will lead to the options we've been given. If we would explore every option presented to us, we would be spending a lot of extra money (without being reimbursed by insurance), time, and energy that just isn't there. We appreciate options that have been presented by others, and we have honestly looked into those options. There is tons of research available on the Internet. However, Rebecca is physically and emotionally drained from this process and can't imagine trying to find other doctors, especially knowing we will eventually come to this conclusion. 

We don't have surgery scheduled right now. The summer months are booked solid for Dr. Piper. There is still a possibility Rebecca will be able to have the surgery during the summer due to cancellations. We will know more in the next few weeks and can hopefully secure a date in order to start planning. 

We are excited, relieved, anxious, and grateful that we have this opportunity. This is the beginning of what we still hope is a better future...