Sometimes you just have to come up with an analogy to make a person understand what is going on. And sometimes you have to come up with more than one analogy to REALLY get them to understand. In my little world of treating TMJ disorders, I make it a point to try and get our patients to understand why they have a problem long before I explain how to treat it. Recently, I revamped my MRI order with the radiologist to include measuring condylar angulation relative to the central axis. What that means in English is that I am having the radiologist measure how ‘in line’ the jaw bones are relative to the middle of the skull. It’s kind of like if you take your car to the mechanic and they explain whether or not your front end alignment is ‘in line’ or not!
The reason for the front end alignment angular measurement is that I need to know if surgery may be an option one day, and this helps me to understand how effective it might be. Let me explain. The articular disc sits on top of the condyle (jaw bone) and if the two condyles do not work in unison with each other -i.e. if they are tipped differently, then putting that disc on top of the condyle may or may not work too well. Just like the wheels on the front of your car- if one is turned right and the other is turned left, then two new tires will just wear out very quickly. If your mechanic is honest with you, he/she will not sell you two new tires- he/she will explain that a front end alignment will make your new tires last so much longer.
Well, dear readers, this is where you need a good TMJ mechanic (please excuse the analogy). If you begin treatment and those condyles are angulated at 67 degrees on the left side, and 87 degrees on the right side, then surgery is far less likely to work and the patient should know this. For this reason, you need to explain to the patient that we need to use our ALF appliances for a year or two to get the cranial bones re-aligned. With all good luck, this will level out the sockets for the jaw joints and allow the condyles to reshape and re-align to a more balanced angulation. It’s good to be balanced.
This is one of my short series on “It’s all about me today”. Look folks, I cannot work miracles. It’s as simple as that. Example: About a year and a half ago I met a new patient whose discs were terribly out of place and I felt really good that I could help him. Well, we never heard from him again. My team does reach out to see if the consult went OK, if there were any questions, or if there was anything we could do to help him figure this out. He made no effort to call back. My guess is it was all about money most likely. Well, the other day he called the office and basically demanded to come in at that time because his jaw had ‘locked open’ as he said. He was in pain, could not eat, and just plain miserable.
My schedule was totally booked up and as you know, dear readers, I do not double book for any reason – I respect your time and that’s how it is, so I will not jam someone into the schedule. Needless to say, he was not happy that we were not willing to just drop everything and see him immediately. This is what irks me I guess- he put off treatment for whatever reason and just because he wants to be seen right away, he figures we have to stop seeing the patients we are already scheduled to see. This thinking is kind of rude I believe. We gave him plenty of chances to take care of the problem while it was so much easier and yet he decided not to take advantage of the opportunity.
Maybe part of the problem is that he just did not understand how serious the damaged discs can be when they are badly displaced? Maybe it was all about money. But, if money was the issue, and now the problem is a lot worse, it’s only going to cost a lot more to fix the problem at this point in time. It’s like if your mechanic says “Hey lady, there’s an oil leak you should deal with” and you put it off. Then one day the whole engine is blown and the car is ruined. You should have dealt with it back then but just did not want to pay the price and now it’s exponentially more expensive!
As I started with earlier- please help ME now- deal with the problems before they become more difficult and more expensive and we are all upset with what we now have to deal with. If your jaw joints hurt, pop, click – LISTEN to the signals- they are telling you they need help and you need to do something about it. Inevitably I will get a call on the holiday from one of these folks who I met, talked to, made a plan with, and they simply did not care to deal with it, yet on Thanksgiving day, they will call me and expect me in the office. Will these folks ever change? Doubtful. Thanks for listening to me rant and rave today!
Don’t you just love it when a story starts out with ‘It was a dark and stormy night’. Well, not today folks. It was a bright and sunshiney morning at our office and I was looking forward to meeting the new patient on our schedule. She flew in from Canada to come see me since several people had told her she had no choice. I must admit, the visit with her was frustrating, angering, and just plain maddening at times. It truly was a conundrum! Let me explain. The moment I sat down at my bar stool, and she sat down at hers, I could tell what was wrong. Her complaint was that she had been to many practitioners and showed me her appliances. Dear readers, I tried to be nice, I really did, but on the inside I’m both laughing and disgusted with what I saw. She showed me all upper appliances, and they all were designed to let the jaw slide back into the joints. It was wrong in so many ways.
As many of you already know, you never, ever, make an upper appliance on a person who can only open to 30mm – sorry, I forgot that little tidbit earlier – she could barely open her mouth. So here she has this upper device that locks in the maxillary bone and blocks cranial motion. Not a good idea. We talked about all this and I think she understood what was going on. And then I showed her the very obvious cranial distortions- her mastoid on the left and sphenoid on the left were terribly elevated compared to her right side. And today she looked worse than her ‘before’ pictures that they did a year or so ago. In other words, wearing the appliances on her upper jaw had made things worse and more distorted.
Then to top it all off, her tongue was all scalloped, she was tongue tied, and her palate was very highly vaulted. This means she could not get good nasal breathing going so her body could not heal very well. These are the things that need to be discovered and noted in a very first initial visit folks! Needless to say, I did my best not to berate the other doctors who had seen her in the past…heck, I’m nowhere near perfect…but if you say you are going to treat these patients, at least know what you are talking about!
So in this initial 45 minute exam, I was able to give this young woman some good guidance. Maybe I over whelmed her, maybe she will never come back again because I overloaded her with information. Maybe she will return and allow me to further diagnose once the MRI has been done. A lot of maybe’s here.
As a patient, I can only imagine going to so many doctors and getting such a divergence of opinions and treatment plans. The one thing that upset me the most was that NOT ONE of them did an MRI to understand what was going on internally, and then some idiot surgeon was suggesting surgery because that is what he does! This patient (as the MRI showed later in the day) has anterior displacement of the discs in the jaw joints, so if the surgeon moved her jaw forward, this would put the jaw so forward that it would actually pinch the discs even worse and make the situation more painful. Not a great way to treat your patient, is it?
As you can tell by now, I am a bit frustrated with the various approaches toward TMJ treatment. To help out, I have just written a bill for the Virginia State legislature to have insurance companies cover this treatment more completely. TMJ disorder ruins peoples’ lives and if there was better insurance coverage, more people would be healthier and lead better lives. That’s my mission folks- stay tuned for more!
As many of you dear readers already know, I wear a sleep appliance at nighttime because I have sleep apnea. A few years back, I used to snort, gasp, stop breathing, and snore every night. It drove my wife crazy! Then I had a sleep test – after falling down and crying when I read the report, I knew I could not wear a CPAP since so many of my own patients tell me they cannot either, so I had a sleep appliance made. It’s great, I wear it every night, and feel 120% better with it than without it.
The interesting thing about CPAP is that it truly can save your life if you can handle wearing it every night. Did you know that our own government has dictated that a successful use of the CPAP is defined as the patient wearing it 4 hours per night, 5 days per week. That’s right folks- it’s considered successful by our government if you wear it 20 hours per week. So during the work week you are doing fine if you can breathe about half the night and on weekends you take a break from breathing basically. I am not sure what the logic is in that, but when it comes to the government there might be no logic involved. The reality is that you are supposed to get 8-9 hours sleep per night, which tallies up to 56-63 hours per week. So according to government standards, you are doing fine if you get around 1/3 of that amount when using the CPAP.
I have a problem with government statistics in this case. I believe that sleep is very important to people at all ages. Without good sleep, your body does not recharge the hormones needed to be healthy. Without good sleep, you are more likely to develop diabetes and heart disease. So why would anyone cut corners on good sleep? When I wear my appliance at night, and I wear it EACH AND EVERY night, I feel well rested the next day and can handle being in my office for my normal 10 hour days (that’s right folks, I don’t have a life). Would any of you like to go to a TMJ doctor who uses a CPAP and only gets about half the normal sleep they are supposed to get?
The message here is that if you think you have sleep apnea, or your bed partner, or your Mom or Dad have concerns that you might – get a sleep study done! You just might save a life. And if the CPAP keeps you alive enough, go for it, but keep in mind that compliance is not all that great whereas a properly fitted sleep appliance might provide for some better relief. Sleep well!
It all really started a few years ago when the University of Virginia hospital center confirmed that the brain really does have lymph nodes that really do drain. During the course of the day, your brain builds up waste particles called ‘Beta Amyloids’ which are irritants to the brain. These waste particles directly correlate to problems like Alzheimer’s, ADD, OCD, and even autoimmune disorders. Researchers at the University of Texas have gone so far as to explain that this build up of amyloid particles also directly correlates to slowing of brain processing, reasoning, and memory! This does not bode well for those of us who are ‘backed up’ so to speak.
So how do you ‘unclog’ and ‘open up the drain’ you wonder? Well, I have an idea dear readers! The ALF appliance is well known, well known to those of us who know about it, that is, for not only leveling the cranial bones but for increasing the flows within the skull. And this means blood, cerebrospinal fluid, and lymph. Basically, the ALF appliance gently nudges open the restrictions in the cranial bones and allows everything to move more freely. Think of it like this: if a car has been in an accident and the frame is bent a little, this means the brake lines might be twisted and restricted and so the brakes don’t work as well. As soon as the frame is ‘unbent’, then the crimped up brake hose can work properly, the fluids flow well, and the car is under better control. This is what the ALF does- it lines things up better and ‘unkinks’ the hoses in your skull- the blood vessels, nerves, and lymph drainage.
So now that you know how to unclog those drains, get out there and make it happen!
In our office at Sleep and TMJ Therapy, we are finding that there is a little problem starting. As many of you dear readers already have learned, the insurance companies have quite nicely taken control and are now denying needed surgeries and final braces or crowns, or whatevers, to finish your case and be done with me. What this means is that more and more of my patients are never going to be finished with me and will forever be wearing appliances to ‘maintain’ their position of reduced pain. I truly DO NOT want this! I want you to be able to finish up with me and go about your life, I really don’t want you stuck with me forever! As Dr. Stack used to say, it would be great to finish up so you are not “stuck to a health care provider”.
Now don’t get me wrong, I truly love working with all our patients, but since we are able to help more than 80% (my team says 90%) get better, this means that more and more are going to continue wearing one or two appliances for a long time to come because the insurance carrier will not pay for them to finish treatment properly. In other words, once the patient is better while wearing their appliance(s), there is usually no insurance coverage for either the surgery or the braces to finish up their case. What a shame. Because of this, many of my patients will forever wear their devices to stay free of the past pain they suffered and I will forever have to maintain them. It’s like a plane circling the airport forever – it just needs a bit of fuel (in my case the appliance needs periodic adjustments) to stay there.
Already, I have had a few people worry because their family might be moving to Arizona or Timbuktu, and they are not sure how to keep up with the maintenance. Some people hope their appliances will last forever- and I’ve already seen several that are 10 years old -but that is not likely. So why won’t the insurance companies just pay for the microsurgery and be done with the problem? It’s all about money- surgery costs much more than the premiums paid, so if they ‘cover’ too many people, it cuts corporate profits. There, I said it- it’s all about money and NOT about taking care of you, the patient! What this approach to corporate profits has done is to shift the burden of care and payment to both me and the patient. You see, I will not abandon my patients, dear readers, and when someone is in ‘forever maintenance’ with me, and they break their device(s), I make new ones at a huge discount- YUP, the insurance companies have now stuck it to me and they are probably laughing all the way to the bank.
So what do we do? I am not really sure. I have made my own patients aware of this problem, and asked them to talk to their HR directors, but it does not seem to matter. The insurance companies have decided to not pay for TMJ treatment and have transferred that responsibility back to the patient, and to me as well. Still- I won’t go down without a fight – I will always keep making my patients aware and always ask them to keep the fight going.
As a practitioner who uses the amazing ALF appliance every day of the week, I continue to see this little wire making changes in people’s lives all the time. This morning one of our patients from Ohio was here and reported in about 4 months that all headaches and most of his back pain were already gone. He came to me very skeptical to begin with – not sure if all this ‘ALF stuff’ was for real. At 2 months into treatment he was thinking that maybe this was not going to work at all. At 3 months he noticed a day ‘here and there’ as he said, and the headaches were not there. Now at 4 months, he is a believer!
Our friend from the Ukraine, who unfortunately cancels frequently on me, is still looking incredibly beautiful just about six months into treatment. She is a busy woman who travels, has a full time job, and children to manage. When I met her originally, she really looked beaten up a bit, kind of hardened. And now she just looks plain gorgeous- and I told her so! She just smiled and said “thank you so much”- but it was true- she looked really great. When I talked to Dr. Nordstrom about some of these cases, he explained that what was going on was that the central nervous system was now working better than it has in years and as the cranial bones opened up more, things simply flowed better. What this also meant was that the cerebrospinal fluid could more readily nourish the cells in the skull and the lymphatic system could now drain the crud out of the brain much more readily as well.
This afternoon I have a college kid coming in who told me last month that he was now able to cut his nails. That’s right- two months ago his nails looked long and ugly -they had not been cut in many months because he could not handle the sensory input that the cutting sensation produced. Now, the nails are looking good and not long and ugly!
Just about an hour ago a young man came in and told me this is the best he has felt in a very long time – he said ‘things are coming together’. A year ago, he was not able to cut his hair because it hurt he said. Now he is well groomed and feeling better about himself.
All of these folks have one thing in common – they all wear ALF appliances. All of them are happily, yet slowly, opening and expanding the cranial bones and increasing the flow of cranial fluids. And when the fluids pump happily, the body responds well, and the whole person runs better. That’s the way it is!
This morning I am doing my usual prepping for the day- reviewing patient records, reading MRI’s, and seeing if the schedule is looking good. As I do my review, I notice there is a note on one patient- she is very upset she could not get in sooner! As I look into her notes, turns out she cancelled her regular appointment a month ago (at the last moment) and said she would call back when she is ready. And in the meantime, she broke her appliance and now demands to come in on an emergency basis! Well folks, this is what happens when you don’t keep up with the program- the appliance wears down or grooves get beaten into it from clenching/grinding and just plain normal use. This is why it is so important to keep up with regular appointments. This way we can make sure the device is smooth, properly structured, and easy to wear so that emergencies do not often happen.
The other problem with cancelling at the last minute is that we saved that slot on our schedule just for you, and when you cancel at the last minute, it is not usually possible to replace you with someone else at the last minute. Now we have to use more time later on to accommodate you which blocks up time for someone else who could have used that time slot. You see folks, I do not do what the airlines do- I do NOT overbook and bump people off my flights! I honor their time and I would hope it is not too much to ask that they respect our time as well. Most of the time it works really well, I must admit, but when these last minute cancellations happen, it means that we have forever lost that time and now must re-create it later on which means more people becoming upset that they cannot get in when they want to. Does that make sense?
For example- yesterday I had 2 people cancel at the last minute, which seems to happen now and then. I get it, people are busy, they sometimes have work emergencies or last minute trips. But we lost that time and now have to make time for those folks in the coming weeks. Their time was NOW, not weeks from now, but they now transfer the problem to my scheduler who is being pressure to ‘make it work’ and somehow create time when there is none. One of the people who cancelled has done this three times already so in this case we cannot give her another appointment. She is welcome to call on a day when she really thinks she will come in, but by now her joints are probably in bad shape due to all the delays and cancellations, and the treatment protocol is disrupted greatly. She already complained to my manager that we are not being very accommodating and demands we see her on another day of her choosing. Well, nice idea, but we already had to reschedule other folks who did the same thing and are now taking time from other people. It’s a conundrum!
As I think about all this, I believe I understand some of what these people are thinking – that I am just like all the other doctors out there who over book, knowing people won’t show or will cancel, so who cares if I don’t show? Well folks, I can tell you that I have never done that and never will- I respect your time and all I ask is that you do the same.
In the past weeks of August in 2017 marks a shift in my education that will forever change how I see things with my patients. I spent five days with Dr. James Bronson at the ALF Educational Institute and then one day later flew to Oslo, Norway, and taught side by side with Dr. Darick Nordstrom, the inventor of the ALF appliance. This past week has now brought me to over 500 hours of actual training with the ALF appliance, and now I am into my fourth teaching trip with the ALF. Now, when I teach, I do NOT do cases like Dr. Nordstrom does- he is doing ALF on patients with severe cleft palates and the required surgery along with it. This, I admit to dear readers, ‘is not my cup of tea’ as they say. He was, however, impressed just a bit that we see many Tourette’s and Parkinsons cases. Dr. Nordstrom is an amazingly brilliant man and lives in a world where he makes his own appliances, by his own hand, and does research on a regular basis. He has even developed an amino acid supplement protocol that I would like to offer to our patients with tremors!
So back to the title of this blog. I have had it further ingrained into my rather thick cranium that a patient often needs a bit more than just what the ALF can do, although, based on this morning’s patients, we are doing pretty darn good just with the appliance therapy alone! So now I must put on my humble hat and admit that we could, and should, be doing even better. What that means is that many of the patients I see could do even better if we use a myofunctional therapist during the course of treatment- referred to as ‘MFN’ therapy. What this entails is exercises to keep your tongue working correctly (and believe me, MOST of us have poor tongue posture and movement). In addition, many people have a forward head posture, twisted neck, etc. so they would also need an osteopath – a ‘D.O.’ to help with distorted cranial bones, uneven leg length, out of place hips, and cervical spine (neck) problems.
In my world, I see people every day who have an amazing variety of ‘whole body’ problems that need to be dealt with. It is simply not enough for them to wear a couple devices in their mouth. Sometimes it will take a lot more effort and time to help them get better. And sometimes, about 10% of them simply do not get better without surgery or similar interventions. Some patients are simply in such bad shape that I cannot help them- they end up getting frustrated and angry because they spent ‘all this money’ and expect results. Unfortunately, sometimes there are just too many ‘imperfections’ in the person to help them get better. I see this when a person has been in an accident or two, was in a bar fight, or was T-boned while on a bicycle and a drunk driver outright nailed them. Yes- these are all my cases folks- and they are all quite difficult to fix due to the extent of damage.
I find it interesting that when people come to me, they expect me to fix all their problems with just an appliance or two. When I explain that they also need body work- i.e. an osteopath or physical therapist – many of them just will not do what needs to be done. This is due to cost or time in most cases. But I can tell you that when I see their xrays and their neck is all twisted up or their cranial bones are completely uneven, then I know they need that bit of ‘extra’ help- it’s as simple as that! And when the patient finally listens and does the required ‘extra’ therapy, that is when they get the results they are looking for – almost every time! So when I ask, request, demand, or simply advise that you also do myofunctional therapy or osteopath or physical therapy work, please take heed and just do it!
This week I had two young women in the office to deliver their ALF appliances. One of them asked me why snoring was so bad since her boyfriend ‘snored like a banchee’. As I explained the problems that are associated with snoring- there might be sleep apnea issues that lead to heart disease and diabetes, I noticed the woman’s father was turning red in the face. His daughter then told me that her Dad snored really bad too. Busted! He then said “I guess I should come see you too” and about all I could do was agree with him.
As many of my dear readers will recall from a previous blog, sleep is absolutely critical to your health! It allows your hormones to recharge at night and allows your body to heal from the stress of the day. And to top it off, if you snore, then you are more likely to have sleep apnea, not to mention there could be damage to the carotid artery from all that vibration. Whew…that’s a lot of stuff going on! The situation with children can be even worse- when a child snores, they are depriving their little body of the oxygen needed for body growth AND neurological development. And if they don’t get that oxygen at the proper time when their brain is developing, there will be a high price to pay as they get older. In other words, deal with the snoring NOW, not later!
When I use the ALF appliance, I find that in almost all cases the child or the adult sleeps better after just a few months. The ALF was invented by Dr. Darick Nordstrom nearly 35 years ago and yet very few doctors have any idea what it can do. Too many people come to see me after they have had nasal surgery- balloon plasty, turbinate reduction, septum straightening – and we could have avoided a lot of these if only we started with the ALF first. I was actually in Norway last week and had the honor of teaching side by side with Dr. Nordstrom and we met about a dozen or so local patients who needed some help. As it turned out, most of them had had some form of surgery and it simply did not help all that much. In all cases, our plan was to get them into ALF’s to ‘unwind’ that which had been done to them. I guess the term ‘unwind’ is something I say frequently, but it is very accurate in explaining what we do – I take people who are all tightened up and get them looser over time – and this gives them better health.
As I start this new day, it looks like I will be meeting around six new patients. This makes me realize that we are indeed getting the word out there- the ALF is working well and we have started to spread the word so to speak. As I lecture more and more each year, I see other doctors are beginning to learn that the ALF is a great concept and now that it has been in use for 35 years or so, it might one day become mainstream. I look forward to being part of this!
Hello dear readers- I knew this title would catch your attention! The blog for today is actually about one of our patients that my osteopath/physical therapist buddy, Dr. Logan Cooper, just saw a short while ago. This is a case of a fellow who came to my practice a few months ago and he had an MRI in hand from a local radiology office. He had gone to some local dentist who said he understood TMJ disorders and could help him with all the neck/back/jaw/shoulder/migraine pain that he had been experiencing for decades. I took a look at the guy’s TMJ MRI and the report said there was nothing of note – i.e. nothing wrong at all. Well, this made no sense to me so I asked the fellow to re-do the MRI up at Novant – the place I had used for many years. As it turns out, the new MRI confirmed blatant medial displacement of the discs on both sides of the jaw joints – i.e. this guy was a mess (sorry for the technical terminology here).
I discussed the MRI findings (the good MRI that is) with our patient, then took a few xrays to see what else we might find. The films showed the cranial bones were all distorted- really bent out of shape. This was when the patient became a little perturbed, so I asked him “What’s wrong?… what is upsetting you?” He explained that the other dentist wanted him to go right into braces, and then later do around $50,000 worth of crowns. He said it was very upsetting to hear such a difference in ideas and on how to treat because my plan only involved a couple appliances and nothing further until and unless the discs are back in place – and by now, dear readers, you have heard this many times- NO CASE FINISHING until and unless the discs are much improved! This patient was basically told to go right into a finished position right away. It would have been a disaster and he knew it now.
Anyway, back to the story. I explained all the distortions and slipped discs problems and he understood very well. Today he began working with Dr. Cooper and at the end of the appointment came over to me and said he was amazed what he learned. Dr. Cooper was able to show him that his leg/foot problems were actually causing his severe neck and back pain! And if I may once again say what I’ve said a million times: “It’s ALL Connected!” Who would’ve thunk it! 😊 Music comes to mind: Da foot bone is connected to da leg bone…da leg bone is connected to the hip bone…and onwards. In other words, what goes on in one part of the body really does affect the rest of the body, which affects your sleep, your healing, your entire well being. Get it? Got it? Good. ‘Nuff said.
And now the dilemma that runs through my mind every day. Why is it that so few doctors out there simply do not understand that the body really is connected? This fellow in the above paragraphs had been told by many doctors that all he could was to take botox and pills for the pain. That is simply not true. What actually works better is being seen by a doctor who understands the human body and strives toward better alignment of the body. When you are lined up properly, the CSF (cerebrospinal fluid) flows better and the lymphatics (crud) drains out better and you are simply healthier!
Since this is my blog, I have every right to get up on the podium and let you folks know how upset the insurance companies make me! Every month I meet many new patients who really need my help, but it is sometimes cost prohibitive. It’s a good and a bad thing really. Let me explain. When insurance does not pay, in some cases this might be good because if the person simply is not motivated to fix their problems, then they will not return because cost is the main driver for them. Yesterday I met a fellow who could only open his mouth to about 29mm, and as you all know, this is not healthy. His comment to me was “What does my insurance pay?” and my response was “I don’t know, but my manager will help you with that” He openly admitted that if the treatment was basically ‘free’ to him, he would try it for a while. I told him it will take at least 18-24 months of appliance therapy to unwind the problems. When I him smirk at that, I told him it would be best not to work with him and he agreed. We parted on good terms.
Last week I met a family, or I should say I met three children and their mother. All three children, and the mother, really could use ALF treatment and right away- they ALL had big circles under their eyes and were breathing through their mouths. When they found out that the cost for each of them would be starting at around $8000, the mother almost cried – she said her insurance does not cover ALF or TMJ treatment. These are folks who I would really like to help, but insurance won’t pay anything at all – that stinks! These are the cases that I can do so much good for, yet without some kind of insurance coverage, they simply cannot do it, or they will make a decision on who gets help and who does not.
Now, some of you on Facebook are wondering why I don’t treat them for free. The answer is that I cannot save them all- it’s as simple as that. Already I do about $10,000 per month in services for free – i.e. I help the people who need appliances that cannot afford our services, or give a big discount to an elderly person, or replace an appliance at no charge when the child leaves it sitting in a napkin in the cafeteria. This all adds up- a lot! Maybe it’s time we all look at the insurance companies and the idiots who are denying services. If you look at the insurance carriers profits, it is interesting how they all turn a nice profit year after year, even when the economy is down. Not a bad deal. They interestingly coerce people into signing up for these plans, and then later turn around and deny services – i.e. the TM joint! It is a joint like any other joint in most cases, and yet for some reason insurance companies exclude it in their plans. What a rip off to the customer!
Maybe it’s time for a little insurrection people! Maybe it’s time to call your legislature reps and tell them what a rip off these insurance companies are! Maybe it’s time to fight back and let your congressman know about the stupidity going on. So I’m sorry for ranting today, but after being on Facebook yesterday I realized how upset all of us really are and it’s because we are all paying piles of money and not getting a good return on our investment with our insurance carriers. Time to do something!
Here is one way to care for your teeth while wearing ALF or Gelb style appliances:
The only problem is that you need to do this outside and it can get a bit messy. Why not make things easier for yourself and try the Waterpik approach instead:
As you can see, it is just a small spray of water that will nicely clean the teeth and also keep your appliances clean as well. All you have to do is plug the pump unit into the electric outlet in your bathroom, fill the water tub, and blast away- it really is quite simple and you can do this right over the sink so it’s neat and clean!
A product that we more recently came upon is even easier to use- you just fill it with water and use it in the shower- there is a pump at the bottom, you just pump up the pressure and clean your teeth in the shower with ease -no batteries, no electricity at all- just hand pumping makes it go. The device is called: FAMI Portable Dental Care Air Pressure Oral Irrigator Water Jet Flosser and you can find it on Amazon for about $13. Not bad.
The reason for all this concern, dear readers, is that I am seeing a few too many people these days who are not brushing and flossing like they should while they wear the appliances. It is really important to keep your teeth clean at all times while you work with the appliances. If you do not, then you could end up with gum disease and even lose teeth! This would not be good for anyone!
So please take the time to clean up your act by cleaning up your teeth and gums!
It was a strange day last week when I met this new patient from about 20 miles away. She came in with a bad attitude -it was obvious what was going on – there was pain in her face and you could see if from 20 feet away! I palpated the muscles of the head/neck region and almost everything was incredibly painful -she just hurt everywhere! I knew for sure that I could help her and told her she came to the right place. The problem came up when I ordered the MRI of the jaw joints. She became very angry that she would have to drive to Tysons Corner to Novant imaging and there was no MRI center down the street from her house. I tried to explain that for us she was considered ‘local’- i.e. one of the neighbors.
The funny thing is that while she was in our office we had a family from Kuwait and New York here at the same time. As it turned out, these families were talking to each other about the difficulties of finding someone who understood TMD and craniofacial issues and neither family seemed to mind traveling as the patients were starting to feel better. It made me wonder if this local person was just in so much pain at all times that she was angry about everything that got in her way- like a little drive to see the TMJ guy!
So here I sit in my little office on a rainy and cold Monday morning. I have already seen seven TMD patients as of 10:30 this morning. They are all feeling a bit better overall, which is pretty darned good considering how they started in so much pain. A couple of them just got their appliances last week and have remarked how things are ‘already changing’ for the better- that makes my day when I hear those words. You never know what to expect in our office. And then there is the one from Colorado who feels better and wants me to finish even though the discs are still not in place. In addition -if I start to lower the appliance there will be postural changes that need to be addressed, yet there is no one near her to help make that happen, so we are not ready to lower the device. If she lived here, I would have Dr. Logan Cooper adjust her accordingly. Again, without the local resources, it is hard to finish treating someone who really does live far away!
For all these reasons, I am trying very hard to increase our network of PT and osteopath doctors all over the country, and indeed the world. More recently, I put the ever so famous Dr. Tony O’Connor from Cork, Ireland, on my list of great people to work with. He has a myofunctional therapist in his office who is doing great work for a couple of my patients who are from Dublin. It saves the patients time and money on the travel. Yet, I am still lacking in such resources in other areas of the world. I guess it’s a matter of time- we will get there one day!
It was a dark and stormy night….don’t you just love it when the story starts that way? Well, with most of the calls that I overhear to an insurance company, this seems to be appropriate. It was a couple weeks ago and I was overhearing one of my team talk to the representative from an insurance company. I will not mention the name of the insurance company since it does not really matter- most of them have the same level of ethics and caring as most hardened criminals. The difference is that this time they did it in writing. The policy states something like ‘We cover TMJ treatment’. The next line, however, states ‘We do not cover non-surgical treatment’ and the next line states ‘We do not cover surgical treatment’. So, in my little mind, the hamster is spinning on his little wheel as I get my head around all this. The little guy is running furiously trying to keep up with what my brain is trying to process. And after a moment I realize that this is more insurance doublespeak! I know I have written a little about this before and I just cannot let this one go for some reason! Was it some MBA who wrote the first line and then decided, “Hmm…these patients are a bunch of idiots…they never read the policy…let’s say we cover the treatment so we can truly say that to our idiot patients…then let’s just negate what we said in the next two lines”. My dear readers- all I can say is that this is brilliant, absolutely and totally brilliant! This MBA guy must think everyone out there in medical and dental world are a bunch of flippin’ idiots! Maybe he is right!
Just imagine if your automobile policy states that they cover you in an accident. Then the next lines state that they do not cover if YOU caused the accident, and the next line says they do not cover you if YOU DID NOT cause the accident. So now, in their advertisements, they can state that they cover you in the event of an accident because it says that in their policy manual. It’s like most deceptive advertising practices – just pick out what you want that suits your purpose and who cares about the rest of the sentences that tell the rest of the picture. I think it’s like those lawyer shows on TV when the lawyer asks a question and the person on the stand starts to tell the story, and the slick lawyer cuts them off and does not allow them to finish the whole story – the lawyer will just use the words they want and the heck with the rest of the truth. It’s deceptive and just downright dishonest and unethical.
So sorry for the deviation to the story, here we go, back to it. Anyway – the lady in my office was in disbelief when she read the policy back to the rep on the phone. She said this is a bunch of doublespeak and you could get in a lot of trouble for this. Eventually, after a short eternity of being bounced from one rep to another, to another, to another, did I say to another? She eventually reached a supervisor after many different transfers. She explained to the supervisor that she had the language in hand and would really enjoy filing with the state insurance commission and explain to them her concerns. Well, lo and behold and maybe even a hallelujah being sung in the background (I’m thinking about Shrek right now), the supervisor gave us approval and agreed to pay for the treatment that was needed! It sounded more like the supervisor was trying to pay off the upset patient more than anything else. As for myself, I just fell apart laughing when I heard that the case was approved, but it took multiple hours and countless transfers to get there. So I am thinking that if this is the level of difficulty it takes to get a case approved, why do we have insurance companies anyway? If you have to fight like a badger to help a patient get their claim approved, where does it all end? Perhaps we could go back to Roman times, have our disputes settled with my team members being gladiators and going against the reps at the insurance companies- let’s see them duke it out, maybe a fight to the death and winner keeps the money?
This is why folks, when you deal with those sons of…excuse me, super nice people, at the insurance company, that you write down their name (even if they won’t give you their real name), and write down the case number so that you can track the conversation. This way, later on when they say they never heard from you, you can refer them to the case number. Then when they say the case number does not exist, then you know for sure the game they are playing. This, my dear readers, is another example of the insurance company two step- a dirty little game they all enjoy playing and it costs you and it costs me dearly!
As many of you know, dear readers, I cannot fix everyone who walks through my doors. So today I am going to make a confession about one of my personal failures. This should provide some really good fodder for my naysayers out there, especially when you read about the outcome. This patient’s story goes as follows: Motor Vehicle accident in 1999- he was rear ended at fairly high speed while stopped as a jaywalker was crossing the street. The next morning, he was unable to move his neck or back due to the injuries sustained. TMJ MRI showed displaced discs. The two neurosurgeons told him the same thing: he needed surgery- rods down the neck and back to get stability. This surgery had nothing to do with the TMJ problem so there would be more work to do is how I figured. Anyway – this patient then told me that one of his surgeons told him he looked like “one of those marines who have jumped out of a helicopter a thousand times over” when it came to how damaged his cervical and lumbar spines were. And just to make it better, one of the surgeons told this guy that even if he did the surgery, he would probably be in a wheelchair within five years.
I knew right then and there I was over my head, but I had to try and help this guy. I made the usual decompression appliance which helped a lot. Then the patient went back and forth to MANY different pain specialists –from acupuncture, to chiropractors, to nerve specialists, and more. This poor guy saw everybody you can imagine and yet never really got a lot better. Fast forward almost twenty years and this patient is still wearing a similar appliance as he had right after the accident. He ‘manages’ the pain. There are lots of heating pads, back massagers, advil, hot soaking tubs, and whatever else he can manage with.
It was quite recently that I coined the term ‘train wreck’ with patients like this. It was also at that time that I openly learned to admit that I most certainly DID NOT have all the answers! And that was when life got just a little bit easier perhaps. I knew I could not fix everybody that walked in our doors because you see, dear readers, that patient is ME! Because of an irresponsible driver nearly 20 years ago, I now suffer daily back and neck pain and have learned how to manage my case very carefully. As I sit here typing, there is a massage device wrapped around my neck and I am wearing my dental appliance to support the TM joints. I simply could not take that risk with the rods going through my back- I did not want to end up in a wheelchair. So I too am seeking answers as I go along the journey. Maybe that is what makes me so passionate about what I do. My own failure with my own case has shown me that sometimes a person has so much damage that all you can do is to manage the pain and learn to keep looking for better answers.
I must admit that one of the ‘better answers’ has been working with the osteopath doctors that I work with. They seem to have a handle on getting things lined up better, longer. It is quite interesting having this type of doctor put their hands on your head, feel the cranial pulses, and tell you that you experienced an accident years ago when you never told them anything about it. So as a patient myself, I will keep you all informed of my own personal progress. My goal is to learn as much as I possibly can about this disorder that affects millions of people and is so poorly understood. I am hoping to educate millions of people in the coming years and to give them hope!
Today is a bit different from my previous blogs. Today I am going to speak about the experiences of my oral surgeon who does the TMJ surgery for my patients when they need the disc repaired or removed in the jaw joint. His name is Dr. Eugene Gregory and he has allowed me to use his name and explain what he does in this blog. Dr. Gregory has been doing TMJ surgery for about 30 years now and he has done thousands of joints- that’s right folks, THOUSANDS. In the past month I have had 4 or 5 of my own patients who needed the surgery try to find a surgeon ‘in their plan’- well that was a disaster of epic proportions. One of them actually called 19 – NINETEEN- surgeons hoping to get a discount on the procedure. As it turns out, not one of the nineteen surgeons really did TMJ surgery, although the insurance carrier said they did. (The patient was terribly misdirected by the insurance reps…but that’s a whole other blog) Anyway, all of these people ended up working with Dr. Gregory because no one else seemed to have the experience that he has.
The problem these people had with the surgeon was that he does not participate with their insurance plan – his fee of $6500 simply is not covered. The patient has to pay him the $6500 for his services and the hospital fees are usually covered by the insurance company. I actually asked Dr. Gregory the other day how he set his fees and why insurance did not cover that fee. He explained to me that 30 years ago, Blue Cross paid him $6000 to do the surgery and they also covered the hospital fees as well. It turns out he set his fee according to what the insurance company would pay and figured that would be fine as the years go by. Well, dear readers, what actually happened was that as the years went by the insurance carriers paid less and less for the TMJ surgery and today they only pay around $1500 or so to the surgeon who participates with their so called ‘plan’. This whole thing smelled kind of fishy to me. Instead of keeping up with inflation, ever increasing fixed costs, and higher malpractice rates the insurance company has undercut the surgeon to the point where there is no logic in participating!
I can see how sensible Dr. Gregory has been about all this, but I am also a bit perplexed. He has barely raised his fee in the past 30 years! To me this is incomprehensible for such a sensible surgeon! And when I asked him why he has barely raised his fees, he responded that he was just trying to keep it as simple as possible and help the patients out. So here I am, a guy who has an MBA and lots of business background, absolutely floored that his fee is that low and yet the insurance company has cut their payment by more than 75% over these past years – and this is based on THEIR original reimbursement plan, not Dr. Gregory’s, he was just following their lead years ago and being cooperative.
The way I look at it, these insurance companies are very readily taking over how we look at health care in this country and quite honestly it makes me sad. Just the other day on Facebook I was lambasted by two people – one said their fees would be set based on insurance company current rate plans (good luck with that) and the other said we had a free market system (that comment made me laugh for a good while). What we really have is insurance companies indoctrinating our people into thinking that the insurance company is doing right by them and the doctor is the real enemy who is ripping them off. Every week I explain to the patient who needs surgery that Dr. Gregory charged $6000 thirty years ago and today insurance would only pay him around $1500 if he participated. They are first a bit shocked, then angry, then really not sure what to do. Just imagine that your salary was cut, year after year, instead of going up. If you are smart, you would go find another job. Well folks, that’s what the good surgeons have done it seems- they do not participate because there is really nothing to participate with. But then, you have to wonder, who is really making the money when insurance rates go up, up, and up every year and benefits go down?
Dear reader – did you know carriers like Delta Dental in the past paid about $1000 per year to each of their dental subscribers for their benefit plan? And today, they pay about $1500 per year on many plans. There’s something quite wrong and really rotten with this. If subscriber fees were let’s say ten dollars a month forty years ago, and today it’s more like fifty dollars per month, then the benefit should be something like five times what it was forty years ago, not just 50% more. Do the math- you are being ripped off people!
So to finish up, my conversation with Dr. Gregory was a real eye opener the other day. He has only raised his fee by less than 10% over the past thirty years. I think if I was a patient, I would be quite grateful for a surgeon like that. If the insurance companies were run by people who could actually appreciate this, they would realize that he is doing remarkable work at a fee that is fair and reasonable, but alas, that is not how they think. I guess the motto of the story is that it might be more sensible to trust your doctor more than you should trust the insurance company!
Last Thursday I spoke to three of the osteopath doctors that I share patients with. The patients had all either been through a year of treatment, had the surgery, or were pretty much done and feeling good overall – that is until I sent them to the osteopath for their final checkups. You see, dear readers, I work with cranial osteopaths every day of the week and we very carefully check to see if my patients are able to go into braces and handle the stress of the braces. Let me explain a bit more. When a patient has an archwire- i.e. the wire attached to the bracket- and it goes across the midline, across the upper front teeth, this will effectively slow down the motion of the skull and may even slow down CSF and lymphatic drainage. And this is not a good thing.
Too many of my new patients come in complaining that their pain started during the braces or shortly after braces were done. I learned a long time ago to pay attention to the patients who tell me these things. The way the skull works is that it really needs to ‘move’ at all times to keep the CSF moving, otherwise things ‘lock up’ and ‘back up’ at the same time. Think of it like this- if the drains in your house are not open and able to drain out all the crud that happens to them, they back up and you end with damage to the house. That’s what happens in your skull too- if the crud produced by the brain is not allowed to drain out, then it backs up and you end up with things like ADD/OCD/autoimmune disorders, and other not so fun things happen. Don’t take my word for it- look up the research done at University of Virginia hospital center regarding the brain and lymphatics. This is going to be huge!
And so I have digressed…apologies. Back to the story at hand. The three osteopath doctors told me that the five (that’s right, five) patients that were supposed to be ready for their braces were not quite there yet- in other words crossing the midline with an archwire would have been too stressful on their bodies. But fear not, dear reader, they would all be in good shape with another month or two of osteo treatment. At that point in time, their cranial bones will be moving quite well and they can handle the small bit of stress caused by doing the braces and we can finish up their cases.
Now is where the ominous music should be placed in the program- the dum dum dum dum with lots of drums and scary sounds because by now, some of you have just realized that maybe, just maybe, they should take a different path other than slapping on braces or those clear aligners you see on TV. Just maybe you should have someone who understands TMJ disorders take a good look at you and figure out if your body can handle doing those braces. Just maybe your body is not ready to have the cranial motion locked up for a while. Just maybe such a screening would help you avoid headaches, neck strains, cranial distortions, etc – all of which are caused by having braces put on too early. Just maybe!
When a patient goes to their TMJ doctor, it is vitally important to make sure that certain technologies are used in order to get a good diagnosis and even greater treatment! In this article we will be looking at the merits of the dedicated Tesla coil, the xrays to look at the jaw joints, the digital impression scanner, and the low level laser therapy.
When it comes to getting a really great MRI of your TM joints, it is really important to be sure that the imaging center has a Tesla coil dedicated for this kind of work because it is so sensitive and can allow us to see the articular discs much better than the old technology. In too many cases, the MRI is done with an inferior machine and the reading is simply not that precise. This will often lead to a misdiagnosis and a path of treatment that costs lots of money, time, and frustration.
Another piece of technology in getting proper TMJ treatment involves the right xray equipment. It is important first of all to go with ‘green’ technology- i.e. low dose radiation and three dimensional imaging. The 3-D imaging comes in really handy when the doctor wants to see what’s going on behind and around the corners of various bones, especially the condyle or jaw bone. This information helps when trying to correlate to the findings of the MRI: Do the slipped discs make sense and is that why the jaw bone has shifted in that direction?
A very fun and very special advancement when it comes to doing braces to finish up a TMJ patient is the digital impression system. What this system does is that it basically uses a camera to videotape the teeth and the computer effectively ‘stitches’ all the videos together to show the lab what the teeth look like, instead of the old fashioned putty and tray method. In addition, the digital impressions are so much more accurate than the putty even could be. Then, the braces manufacturer uses a device to ‘cut’ each bracket to the best fit possible for every individual tooth- this means that each bracket is custom made, by hand (the hand of a computer guided laser that is) to the proper tip and torque needed to achieve the best result in the shortest time possible. Think of it like GPS for your trip up to Canada- the computer will design the least difficult, quickest, and most efficient path to get you there.
Let’s not forget to give mention to our old friend, the computer, which has advanced so much in recent years that we have become used to it running on terabytes, not kilobytes, of storage and how fast the processors have become. Without the computer, we could not show the patient the wonderful world of digital xrays and show them how their progress has changed. The computer and all these other technologies have surely changed our world!
In recent months I have met way too many new patients who were scheduled to have jaw joint or other more extreme types of surgery to handle their pain. This is about as smart as jumping into the path of a moving bus- in other words, it’s NOT smart! I am not sure why the increase in recommended surgeries is happening, but I think it’s important to put a stop to it now. The reason for this is that doing any kind of surgery will leave scar tissue and adhesions that will restrict the motion of the body. In my own practice, doing TMJ surgery is always done as a last resort after a course of careful and thorough appliance therapy. In addition, it is very critical that if the cranial bones are uneven, then there must be a concerted effort to level them out in order that if the surgery is done, it will be so much more successful.
The idea behind waiting on TMJ surgery is actually twofold: 1) The first phase oftentimes involves taking the pressure off the jaw joint discs so that inflammation will reduce, and many times those discs will actually go back into proper place so we can actually avoid the surgery and 2) Leveling the cranial bones, lining up the cervical, lumbar, and thoracic spine are all critical to good health and longevity when it comes to doing the actual surgery.
In other cases that I am currently working on, patients were told they would need one side of their jaw ‘cut and shortened’ to make it even with the other side. Well, that’s another ridiculous approach to a fairly simple problem. You see folks, in most of these cases the jaws are just twisted to the side because the discs are pushing the jaw bones out of the sockets and all we need to do is work on relieving the pressure on those discs and the jaw will actually realign correctly.
The only time that I have ever seen the need to ‘go in’ right away and do surgery is if the patient simply waited way too long to be treated and their jaws are locked shut. This is always a difficult situation. The patient tells me that it all started ‘a long time ago’ when the jaw just started to tighten up, things started to close down, they could no longer eat a hotdog or sandwich and eventually the jaw just locked. Sometimes I can use our low level laser to loosen up the muscles to take an impression and make our appliance but sometimes it’s too little, too late, and surgery is the only way to fix it.
So folks, if you are having head/neck pain, jaw popping/clicking, or even a movement disorder, get it checked out carefully before you become a surgical case!