Tax time and medical expenses

For those of you in Australia and keeping up to date with tax laws, you will know that as of today - 1st July 2013, the Australian government has done away with the net medical expenses tax offset.  The tax offset helped people who spent a large amount of money on medical expenses during the tax year, by providing a rebate of either 20% or 10% over a set threshold - depending on your income.  The offset had been declining over the years, so I guess it was inevitable it would go - however this will affect a lot of people, especially pensioners who spend a lot of money on medical services.

What a lot of people don't know (and I only just found this out myself) is that while as of this year it has been scrapped, if you claimed the offset in the 2012-2013 tax year, you can also claim it in 2013-2014. And if (and only if) you also claim it in 2013-2014, you will be able to claim for one final year in 2014-2015.  This is great news for people like myself who are due to spend another $20-$30K or so.  It won't stop the government further raising the threshold and lowering the rebate, but at least it's something for the next couple of years.

That's it - just a quick post really, but useful information for those who need it.  And remember, if you did claim it in 2012-2013, ensure you continue to keep good track of your medical expenses.

The braces are on!

Hello again bloggerland!

A major event occurred a few weeks ago - I finally got my braces fitted.  Of course I wanted to update my blog straight away, but life has been super busy since then. With a work trip to Melbourne, then my own trip to Melbourne and a busy schedule, I've hardly had enough time to think.  Forgive my tardiness, I will make up for it I promise :)  Long blog post - beware!

So on Monday 27th May I had an appointment with my orthodontist to first remove my palatal/maxillary expander (my torture device) and then have upper and lower ceramic braces fitted (my new torture devices).  Having the expansion device removed was quite an ordeal because the metal bands of the device are glued to the teeth, so there was lots of pulling and quite strenuous physical labour (on the orthodontists part) to remove it from the jaw.  I usually have quite a high threshold for pain, but I must admit I winced a couple of times during the removal.  Now as you know I'm not going to shy away from the gory details in this blog - the smell was awful!  I couldn't believe that something that smelled so bad could be in my mouth.  My orthodontist explained that food gets stuck around the expander and some of it is almost impossible to floss/clean, so the devices are usually smelly once they have been removed.  Lovely.

Now for the braces - and for all the fuss made by many people that I know who have had them, I have to say that getting them fitted was not uncomfortable or painful and I actually almost fell asleep at one point.  Hats off to the amazing orthodontic team at Sydney Smile Specialists.  While I'm here, I may as well give them a plug - if you are looking for an orthodontist in Sydney, I really don't think you could find a more professional, friendly and caring team of people.  You can view their Facebook page by clicking their name above.

The ceramic brackets that will be adhered to my teeth, made by 3M.

The first step in getting the braces on is for the teeth to be prepared.  This involves popping a plastic device into the mouth to stop the lips touching the teeth, giving the teeth a thorough clean and then gluing each bracket to the surface of each tooth.  The majority of the brackets are clear ceramic, while a couple towards the back of my mouth are metal.  Having the lips away from the teeth ensures they are completely dry otherwise the glue will not adhere.

Ready to get the braces on

Once the brackets are on the wires are threaded (kind of) through the brackets.  One wire for the upper jaw and one for the lower jaw.  O-rings are then placed around each bracket (a little uncomfortable) which close the opening of the bracket and hold the wire in place!  Phew!  The wires are very flexible, but also have a tendency to want to retain their shape.  It is these characterises that apply tension to the brackets and so the teeth, and eventually move them into the original shape of the wire.  My orthodontist advised that I have a 'super-cable' on the lower teeth which is a stronger type of wire to move misaligned teeth a little faster.  That's a nice way of saying my lower teeth need a lot of work!

The whole process including the removing of the expansion device and the fitting of the braces took around 1 hour and 30 mins, with the braces taking up about an hour.  Not bad at all really.  And once my braces were fitted I couldn't stop looking at myself in the mirror - I'm so happy to finally have them on.  I was given cleaning and care tips and was on my merry way.

Here I am with my braces on

And you know how I love these beautiful close up shots

Over the next 4-5 days a couple of my lower teeth did get very sore, but I was told this was to be expected.  I took painkillers, ate lots of yoghurt and other soft foods and after a few more days the pain was gone.  Happy days.

One week later I had to visit the orthodontist again because even though I had my expansion device removed, I had to get a new metal arch fitted in the roof of my mouth.  This one is called a Trans-Palatal Arch (TPA) and it is designed to keep the expansion of the jaw stable and to stop the molars moving back inwards.  Yes, it's another metal device in my mouth but much smaller than the expansion device - in fact I hardly notice it's there.

Now to the downside.  Eating.  It's not painful or sore - just very inconvenient.  My upper and lower front teeth have never met, but before the jaw expansion the majority of my side teeth did.  Due to the massive expansion I have now undergone, only a couple of my teeth meet on each side.  This along with the gap in the front teeth (yes I know it will eventually close) and food getting stuck all around my braces make eating rather tiresome.  It's not due to the braces - they are just another obstacle in the way of me doing some serious chow down.  Eventually the braces will rotate my lower teeth outwards to meet my upper teeth, and of course there will be the main surgery next year, so until then it's a waiting game.  And the result will be worth it.

And that's all for now!  Hopefully you are still reading and enjoyed this post.  Feel free to leave me a comment or ask away if you have any questions.

Before and after jaw widening

Throughout my whole SARME experience I have of course noticed my jaw getting wider.  This is mainly because of the gap that has formed between my front teeth.  However because I look at myself every day, I don't think I realised just how much wider my jaw actually is.  Last night I took a photograph of the roof of my mouth and compared this to the same photograph I took before the surgery/widening and I am truly amazed at the difference.  So here are the photographs side by side, so you can see the difference too!  When I look at these, I have no doubt that I am doing the right thing.

Enjoy the lovely nostril shots...

It's almost time for braces!

Today I am excited.  Apart from the fact that it is Friday (which calls for some dinner and red wine this evening), in just 17 days (May 27th) I will be getting my braces fitted.  There are many different types of braces to choose from, but i have opted for ceramic lingual braces.  These are braces which sit on the outside of the teeth but where the brackets are made from a clear ceramic rather than metal.

Originally I was only due to get my lower braces on and I presumed this was because my upper jaw needed to recover further from my SARME surgery. I have since found out that there was some confusion and my orthodontist thought I was having incognito braces on my upper jaw.  Incognito braces sit on the inside of the mouth behind the teeth and have to be custom made, and from what I gather it is mostly an aesthetic choice.  As I am not worried about the aesthetics of ceramic braces, I have opted for the ceramics on the upper jaw too.  So to cut a long story short (if you know me, no story is short) I will be getting both jaws fitted!  This is why I am so excited.


For all the other children of the 80's out there, the picture in this post will make sense.

Pass that paper bag

It's been a strange few days.  Last weekend I suddenly became extremely self-conscious and aware of the stares I get in public due to the gap in between my front teeth, and a Facebook post where I vented my frustration prompted an interesting conversation with a very good friend.

Why am I worried about people staring at me, when I have this blog which is showing my jaw (and journey) for all to see?

I thought that was a very good question because my blog if anything, is quite explicit in the descriptions I give and the photographs I share.  To me, it comes down to control and context.  When I post an update to my blog I am putting my face right out there for all to see.  And while I have no control in who reads the blog, the reactions of people who read it are not displayed to me right away.  If someone is reading my blog, they know I am going through surgery and so for my readers, things are put into context.  This is quite different to what happens in public.

When I am out and about in public, people stare.  They can't help it but they just do.  I have had people stare so much that I turn around and they are still looking.  On one occasion the stares have led to all out laughing which was very obviously directed at me.  The issue is this - they do not know I am having jaw surgery, they do not know this is all part of a larger plan and they do not know that I haven't been in a fight and had my teeth knocked out (because after all, I am quite butch).  Of course I don't blame people for looking because unlike my blog there is no context, however after a while the stares make me uncomfortable.  Of course the laughing to me is another matter and just plain rude, and prompted my Facebook frustration.

So there is a bit of an insight into how I am feeling and why stares in public are very different to someone reading my blog!  It has definitely highlighted my coping (or lack of) mechanisms and this is something I will be working on.  On a more positive note, this situation has prompted me to contact my orthodontist who has said they can put some temporary composite (the same material fillings are made from) across my front teeth which will disguise the gap.  It won't look like a tooth, but I won't have a huge gaping hole either so in the short term I can get back to looking fairly normal.

Now all I need to do is wait until the upper braces are fitted and the gap starts to close...

SARME Surgery post-op day 33 - mind the gap!

It's been a few weeks since I posted to my blog, because to be honest nothing much has been happening apart from the gap getting bigger and bigger!  I've become quite self conscious (although not  enough to stop me from posting this) because the wider the gap has become, the more you notice the slant in my jaw.  This has led me to covering my mouth a great deal while out in public and I have become quite sensitive, even dare I say, high maintenance.  Of course I always knew that my jaw had grown downwards at a slant - the gap just exaggrates it greatly and I'm looking more and more like Cletus from The Simpsons.  The slant in my jaw will be fixed up though through a combination of the braces and my jaw re-alignment surgery next year.

The exciting news is that I went to see my orthodontist on Monday and they instructed me to stop turning the expander as the upper jaw has now been widened enough.  So that's a total of 25 days expanding twice a day, and I'm quite glad that stage is over.  While expanding never caused me any pain as such, I did feel a lot of pressure on my jaw after each expansion.  As each expansion was only 12 hours apart - the pressure was almost constant all day, every day.

Anyhow they do not call it a rapid maxillary expansion for nothing, and the photo's below show my expansion progress since my last blog post.

Post-op day eight (six days turning the device)

Post-op day twelve (ten days turning the device)

Post-op day 20 (18 days turning the device)

Post-op day 28 (26 days and the turning has stopped!)

In five weeks time I will be getting my lower braces on - I'm quite looking forward to that.  The upper braces will not be able to go on for a further four weeks though as my upper jaw needs time to heal in the new position.  This does mean the gap will remain for at least nine more weeks until the braces can start closing the gap, and the expansion device will need to remain in my mouth for that length of time, but at least things are moving along.  I still have virtually no feeling in my upper jaw or gums, but now the jaw has started healing the feeling should start to come back.  I have been advised though that it could be a number of months for the feeling to fully return.

Eating is still a chore and while I can eat semi-solid food, I still cannot eat anything too chewy or crunchy.  I've been making up for it with the soft foods though and have been eating so much yoghurt that I've put on a couple of kilos!

As a last note, I had a really strange dream last night (which was partly red wine fuelled) where my front teeth fell out and new ones instantly grew in their place.  I think this highlights the anxiety I have been feeling, but I'm still in good spirits.

Over and out.

SARME surgery post-op day seven - Look at my gap!

It has now been seven days since my SARME surgery and I'm glad to say that everything is going pretty well.

I went to see my Maxillofacial Surgeon for the first time since the procedure and he has commented that my gums are nice and pink and that I look like I am healing fast.  I still have no feeling in my upper teeth and my gums are completely numb, but he has said it can take months for the feeling to come back!  I mentioned to him my concern over one side of my jaw sitting slightly lower than the other, but he assures me this is normal and that it will be fixed up during both orthodontics and my bi-maxillary surgery next year.

I'm really surprised with how quick my upper jaw is widening.  I know I said before that it would widen by 0.25mm with each turn and yes I know it's called a 'rapid' maxillary expansion, but I didn't realise how quickly it would become a large gap.  After four days of turning the gap is extremely noticeable and I am able to do all sorts of tricks with my gap such as whistle or direct a stream of water through it.

Anyway that's all for now - enjoy the photos below and check out my sexy (not) gap!

I'm sexy and I know it

I can almost fit a straw through the middle

SARME surgery post-op day three - I've started turning!

Three days after my SARME surgery and I am still feeling no pain, however I have been extremely exhausted and sleeping loads.

Today I went for an appointment with my orthodontist to start the adjustments/turns on my expansion device.  I freaked out a little inside when he put the mini spanner into my mouth and shook (quite visibly) as he made the very first turn.  I was so convinced that it was going to hurt, but to my surprise it didn't.  My orthodontist gave me instructions on adjusting my expander and within five minutes I was finished.

The SARME surgery on Monday split the jaw bone which allows the upper jaw to move and now by turning the device I am making my upper jaw wider.  This is not a slow process (theres a reason they call it 'rapid' maxillary expansion) as my jaw is widening by 0.25mm with each turn.  After the first turn by the orthodontist I could already notice a gap (however this did not come out in the photo below) so it's reasonable to say that I will be looking like Cletus from The Simpsons in no time.  

That's all for now - just a quick post.  I will update more in the days to come.

SARME surgery and post-op day one

The big day has come and gone so I thought I would give you an update on the surgery and my recovery since then.

I had to report at the hospital at 1.30pm on Monday 11th March, which meant that I couldn't eat after 7am that morning.  I couldn't sleep well anyway as I was nervous so I was awake and having breakfast at 6am.  I pottered around as much as I could Monday morning (including making the last video) and then set off to the day surgery in Randwick.

I still felt nervous on arrival but the team of nurses and my anaesthetist came to chat to me at different times to go through various questionnaires and I felt confident in their hands.  They advised me that I wouldn't be having the four teeth removed at the same time as my surgeon and orthodontist had decided they would come out later.  

The day unit was a little different than a hospital ward, and I had to wait in reception until they were ready for me.  As soon as they called me through it was time to gown up and go straight through to theatre - no sitting around in a hospital bed for me.

Giving away my age again

In theatre I saw my surgeon Dr Tsakiris who came to assure me that I would be ok everything would run smoothly.  I feel so confident with him that any nerves or worry I had started to disappear instantly.  I also saw Andrew again (the anaesthetist who came to originally talk to me) and while all the team were busy with their jobs their focus was on me - asking if I was ok, keeping me chatting about what I did for work etc.  The drip went into my hand and before I knew it I was breathing oxygen through a mask.  I remember the coldness of the anaesthetic going into my hand and remember saying 'that feels good' before drifting off to sleep.

This was only my second experience of general anaesthesia and it felt like I woke up as soon as I had fallen asleep.  The surgery actually took around 1 hour and 40 minutes.  I was a little groggy when I came around and kept drifting in and out losing track of time, although I did feel quite relaxed.  I remember the nurses calling my escort to come and pick me up, and it felt like only seconds later until he arrived, even though it was 30 minutes.  My surgeon came and spoke to me and said that everything had gone well.  After a short while longer in recovery I was on my way home and soon enough was resting up in bed.

On my way home from the hospital

Resting up in bed

And so here I am one day after my SARME surgery.  I have been quite surprised with the pain levels in the fact that they have been low to non-existent!  I guess I must be very lucky as I have read from other blogs that people have been in tremendous amounts of pain after this procedure.  I am religiously taking the antibiotics and the panadeine forte (very strong painkillers) they prescribed me so the pain does not creep up on me.

While there has been no pain there is a lot of pressure and numbness on my upper jaw and the swelling is very, no extremely noticeable - think Joan Rivers meets Alvin and the Chipmunks.  

I am not allowed to spit or blow my nose for two weeks and this is because the sinus walls are damaged during this kind of surgery and need to repair.  I'm not even allowed to sniff which is frustrating as my nose is clogged, but I have been prescribed some nose drops for this.  Sometimes I have sniffed without realising which has caused some blood to come through to my mouth, but not tremendous amounts.

So what else can I say?  Well apparently a lot because I have not lost my ability to talk!  I thought it would be too painful but if you watch the video below you'll realise I'm the same old me!

The day of my SARME surgery

It's the day of my jaw widening surgery (SARME) so I thought I'd let you hear it from the horses mouth!

Maxillary expander update and three days until surgery!

My expander has been in for three days and I must say I'm getting used to it quicker than expected.  My speech is not half as bad as it was on Tuesday (I no longer sound like Joseph Merrick) and it's now only certain words and sounds that I have difficulty with.  Eating is still a challenge as food constantly gets stuck between the device and the roof of my mouth, but nothing that gargling water after every meal doesn't cure.

The strange thing is that since having my expander in my sense of smell seems to have heightened.  I did not expect this to happen and haven't read it in other peoples experiences so it came as a surprise, but I must say it's a rather pleasant surprise.  I seem to be picking up smells that transport me back in time to a place with fond memories - spices in an Indian market, the smell of damp English soil when camping as a child, the smell of the sea breeze on San Francisco Bay.  Call me crazy, but they do say that if certain senses are limited, the others compensate for them.

Aside from this it is only three days until my surgery and I am starting to get a little nervous.  However, I am in the care of an absolutely fantastic team who make me feel comfortable and I have every confidence in them.  Dr. Peter Tsakiris is my Oral and Maxillofacial Surgeon and will be performing the SARME surgery on Monday, Dr. Steve Stromotas is my Orthodontist (who also has an amazing, friendly and professional team of staff) and will be assisting me with the expansion device and later my braces, and my dentist Dr Kenneth Wong is keeping my dental health at top notch condition.  That's enough love for one thread!

So what am I doing this weekend?  Well apart from stocking up on mashed potato, soup, protein drinks and other soft meals I am going to make the most of my oral freedom <insert naughty pun here>.  I have some friends coming for dinner on Saturday evening (I love to entertain) and will be chilling out on Sunday and catching up with as many people as I can on the phone while I can still talk.

I'll be updating this blog pre and post surgery so watch this space!

The expander is in!

I finally got my expansion device in today in preparation for my SARME next week on Monday and for the first time I have started feeling nervous!  The expander only took 15-20 minutes to be installed and glued into place, and after a quick check by the orthodontist I'm ready to go.

Learning to speak with the expander in is a lot of fun as I suddenly have a very prominent lisp.  Add to that the constant swallowing from the excess saliva and it all adds up to a rather attractive package!  I haven't tried to eat anything yet but have been warned to stay away from any sticky foods - so goodbye chewing gum, sweets and caramel :(

While I'm feeling nervous I am also excited as it means things are now moving along.  I can't wait for my SARME surgery next Monday and will keep this blog updated of my progress.

For now here are some photos showing the expander in my mouth as well as some side pictures which show the metal rings of the expander attached to my teeth.  Not very attractive camera angles but what can you do?

When my palette is split in half this device will widen my jaw

The metal rings surround two teeth on each side of the upper jaw and are glued into place

Another attractive shot

With this ring, I thee bled!

Ok, so grammatically the title of this post is pretty rubbish, but hey - I'm trying to be funny!

I went back to the orthodontist on Tuesday - just 24 hours after having my spacers put in.  The spacers were removed and the rings (which will eventually be connected to the SARME / expander device) were sized for my upper molars and front upper teeth.  I think I had become complacent about pain as the spacers did not hurt or cause any discomfort - but I can tell you, having the rings fitted soon kicked me back to reality!

The process of sizing the rings involves sliding various different metal rings up over the teeth in question (quite roughly I might add) in order to find ones which are the perfect fit around the tooth - not too tight and not too loose.  The rings hit my gums a number of times and I could feel the edges of them against the inside of my cheeks as well as against my tongue.  This caused some discomfort but luckily the whole process only took 20 minutes or so.

Once the metal rings were fitted I had some impressions made and the rings were removed - phew!  The impressions will be sent to the lab to have the device built and this will be 'installed' on 4th March. Oh happy day!

How much will it all cost?

When I started enquiring about 'fixing' my jaw I first did a lot of research on pricing.  While the costs have worked out to a little more than I originally expected (well OK around 40% more), I still had a fair idea of what I was letting myself in for.

So for those of you out there who are looking into SARME/SARPE, orthodontics and bi-max surgery - here is the cost for each stage along with a breakdown of what fees make up the total.  All prices are in Australian dollars before any rebates from my private health fund or Medicare.

Stage 1 SARME = $6,250

Surgical fee = $3,000

Teeth removed x 5 = $550 (total)

Day surgery fees = $1,800

Anaesthetist fees = $900

Stage 2 Orthodontics = $10,800

Braces, adjustments and all appointment fees = $10,800 ($3750 initial deposit then $470 per month for 15 months).

While the orthodontics sound expensive this also includes consultations for two years after orthodontic work is completed.

Stage 3 Bi-maxillary (double jaw) surgery = $23,000 (approx.)

Pre-op surgical appointment = $1,500 (approx)
Surgical fees = $17,000

Hospital and anaesthetist fees including 1 night high dependency unit and five night stay total = $4,000 (approx.)

Other fees for x-rays, consults, veneers, cleaning and general dental = $3,000 (approx.)

Grand total for entire treatment = $40,000 (before any rebates)

Expensive?  Well yes it is - but remember these fees are before any health fund or Medicare rebates.  I can expect to receive about $8,000 in total from these rebates.  Then there are the tax refunds on top of that - the Australian government will give 20% back on all medical expenses over $2,200 in any tax year (after rebates from health funds and Medicare).  The cost of these procedures will be spread over two years, but I can still expect to receive another $5,000 or so back, which brings the grand total out of pocket to around $27,000 which is much more manageable.

If you are still reading but unsure of the prices I think its a matter of putting things into perspective.  Some people would not think twice about spending this much money on a brand new car.  Some people will easily spend $10K on an overseas holiday.  This is something that will last me for the rest of my life, so I definitely think it is a wise investment.

Well that's all for now - it's late here in Sydney and time for bed.  If you have any questions feel free to drop me a line or leave a comment.

The spacers are in!

It's all finally happening!  I had an orthodontist appointment today and got the spacers put in ready for the expansion device which should go in about a week from now.  The spacers are simply little plastic discs that are placed in between teeth to create a larger space in between them.

I had four spacers placed in total (two on each side of my upper jaw) and I have to say they are not as uncomfortable as I was led to believe.  My orthodontist had warned me to take some painkillers as he said there would be soreness and I did take a couple of painkillers over twelve hours ago, but I have felt no pain whatsoever.

While its not the most attractive pose, here you can see one of the blue spacers in my upper jaw - they're kinda cute :)

I'll be back in to see the orthodontist tomorrow to have the final impressions made for the expansion device. Three weeks and counting!

Countdown to SARME surgery

It's a brand new year and I'm excited about the challenges that lay ahead - 2013 is certainly going to be a big year of change for me.

Even though I started out on this journey over a year ago (information gathering, getting restorative dental work), my first medical procedure is now a lot closer than I realised.  Of course I have known the date of this surgery for a few months now, but it was always easy to say "the surgery is next year".  Well it's now next year and less than two months away!

I'm booked into Randwick Day Surgery on Monday 11th March at 9am for my SARME surgery and extraction of four teeth.  The surgery will be performed by my Maxillofacial Surgeon, Dr Peter Tsakiris and as the name suggests this will simply be a day surgery.

I mentioned the SARME in my first post and also posted a YouTube video, but here is some further information as to what the surgery involves:

• A week prior to the procedure my orthodontist will fit a widening device in my mouth just like in the video, allowing me time to become accustomed to it and learn how to speak with it in.   The device pushes against the inside of the upper jaw (a little like a vice) allowing it to move once the procedure has been completed.  
• The day surgery will involve incisions through my palette basically splitting it in half - of course they will remove the separation device while performing the incisions.  I am also going to have four teeth removed which will assist with the orthodontics later.
• The device will then be placed back into my mouth (while still under anaesthetic) and they will insert the key and perform some of the widening as part of the surgical procedure.
• They cannot widen the jaw by the desired amount all at once, so for 3-4 months after surgery I will regularly insert the key into the device myself widening my jaw further.
• The device will then be removed by my orthodontist and they will allow my mouth a month or so to settle and heal.
• I will then move onto the second stage which will be braces.

So now I'm getting a little nervous!  Not so much for the anaesthetic or even what they are doing, but just in regards to the rehabilitation, post surgery pain and how I will look afterwards.  My surgeon assures me that the healing time is very quick (only about a week) and the pain is minimal - but I still find that hard to comprehend considering what the surgery involves.  In terms of how I will look, I will be waking up with a lovely gap in between my front teeth.  Of course this gap will grow so I'm bound to look as attractive as a camel.  I feel like getting a neon sign made up now stating 'yes I am having dental work' to save the myriad of questions, stares and comments that are bound to result from this!

Oh well, I just need to keep thinking of the final result after braces and jaw realignment, even though it is still 18 months or so away.