Sunday, 18 November 2012

Second, Third and Fourth Opinions


During my journey through orthodontic treatment and now pre surgery, my very good friend from primary school was training to be an orthodontic nurse and hygienist. She was working in Eastman’s one of the top dental schools in the country. She had discussed my case with a few of the staff there, who were as baffled as my surgical team. No one has ever seen something like my case and they too thought that it should be categorised as TMJ disorder. Being such a close friend since we were 3 years old, she decided to take it upon herself to get me a second opinion at Eastman’s. She knew how unhappy I was with King’s for postponing my treatment. My friend arranged for me to have a second opinion in May 2011 and Eastman’s asked for my notes and images to be sent over. Mr Lloyd was the surgeon and Professor Hunt was the orthodontist at Eastman’s. They are both incredibly rated in world of the oral and maxillofacial surgery. You will often see their names in the newspapers and medical journals.

I went to Eastman’s on the day to see what they had to say. Unlike King’s, Eastman’s have their own dedicated psychologist, who is part of the surgical team and will assist the patients throughout their surgery. I was assessed by the Prof Hunt (the orthodontist) and he said there is 2mm of movement that needs to happen on one of the lower back teeth and then I should be in the optimal position for surgery. He also pointed out that a few of my teeth had become detached from the arch wire. Mr Lloyd (the surgeon) then assessed me and proposed the same procedure as my surgeon but added he would rotate the top jaw by 2mm and pull it forward by 2mm. The psychologist also advised that I should see someone about my mental state and I should take up the offer of psychological help. Both the orthodontist and surgeon said that they would be unwilling to take my case on and that “they would not touch me with a barge pole”.  I could never imagine that my case would be so complex and that there was nothing more anyone (including my surgical team) could do to stop the pain.  I cried when I left the building and told mum I would have to contact my friend when I had calmed down. Along with this they also told me…. (like all the other professionals) that the operation might actually make the pain worse. I do not even know how that would be possible.

I felt crushed and like a freak after leaving the hospital. I did not understand why this was happening to me. My teeth and brace work had moved my face around so much I was unrecognizable  I looked in the mirror and my jaw was more noticeably curved and my teeth appeared so odd and out of place when I smiled. I just wanted this operation so I could feel normal again. I could not see how the pain could get any worse. It was so debilitating and horrid already… how could it possibly get any worse?

When I went to the Guy’s to get my braces fixed I was unable to see my orthodontist as he was in lectures. Instead, I saw a lovely professor who started talking to me about my case. He knew I would not be seen by Mr McDonald the head of department and sparked up a conversation asking why. I had been seen once by Mr McDonald when my orthodontist was off sick…. Never again! The man was brutal. He could not get my wire from the brackets so continued to yank and pull on them until my teeth almost felt they would fall out of my mouth. So I told the professor the horror I had experienced and he seemed to find it slightly amusing. We spoke about the condition and he advised I might be able to try a muscle rub, to massage the muscles on my face. I knew my body and I knew the pain I experienced even if someone just brushed past my face, so I knew I could not massage it. The professor said many of the TMJ patients he had seen benefited from massages. This further intensified my worry that this pain was nothing to do with my TMJ.

After this day I was emotional and cried a lot. One Friday my dad popped in and told me he had been researching into his free company healthcare plan. He was wondering if I would be covered by the plan as I am his daughter. The plan covers spouses and children. With luck, as I was still in university until July 2011, I had one month in which I could use the healthcare plan. I decided I would like to see if I could get the orthognathic operation performed privately. I researched a few private hospitals and consultants and decided to book an appointment to see Mr Massoud Hosseini Ardehali. Mr Ardehali is a top surgeon who has worked for all the large teaching hospitals and also specialises in facial pain. A really lovely and genuine man. I met with my mum and dad and we went to see him at the Bromley clinic in June 2011. Again he assessed me and took a few measurements. He proposed the same operation as my surgeon. I felt really drawn to him and felt I could trust in him. But unfortunately he does not perform these types of big operations anymore. He also explained that a lot of the hospitals do not have the type of specialist equipment that is needed for this type of surgery. During the conversation Mr Ardehali informed me, he knows my surgeon Mr Matthews well and he was his mentor and teacher before he retired from the NHS. He reassured me I would be in safe hands. He was sorry he could not help us, wished me the best of luck and did not charge us for his time or the consultation (which would have cost my dad £50).

Another reason I looked at going privately was because I did not like King’s Hospital.  I was anxious about having the procedure at King’s because this was where my baby brother died. Although the hospital has been modernised since, I still have not got over my brother’s death and the blatant mistakes made by the nurses who should have been looking after him. I did not trust them to look after me when I was at my most vulnerable. The hospital as a whole has a bad vibe for me. So, as I had accepted Mr Matthews as my surgeon, I thought I may be able to pay privately to get the date pushed forward and to have the surgery completed in a different hospital (away from King’s). My mum spoke with Mr Matthews one morning whilst he was in California. He explained that he would not do anything differently from private to NHS, he said he would not perform it privately as it does not make a difference to the waiting times (he controls his own diary) and the procedure would still need to be performed at King’s as that is where all the special equipment and facilities are. Fate seems to be steering me towards having the operation at King’s after all.

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