Initial Consult

I apologize that it has taken so long to post about my appointment. The past few days I have been extra tired. It's been exceedingly difficult to maintain my schedule with the fatigue. By the time I would sit down to post, I would fall asleep!

The hospital was much larger than I expected it to be. While I had visited before, I never actually went inside. This would had been a good idea, as it took much longer to make my way through than I anticipated. It would a good thing I arrived early because by the time I made my way from the parking garage to the oral surgeons, I only had five minutes to spare! It took about 20 minutes to walk from my car to the appointment. Amazing!

They did a panoramic x-ray which I expected. I hadn't had one done in a number of years so it was good to have a new one done. I was glad I had brought so much of my medical history with me, including a written report from my ENT, the original write-up from my accident, and a list of all the medications and treatments I have had over the last few years. It was much longer than I had realized but shows just how much treatment i've really gone through.

What we have found so far is that the condyles of my jaw are flat with bone spurs on them. The condyles are supposed to be rounded so this is not good news but is to be expected with the length of time I have had TMD and the clenching/grinding I have been doing for 22 years. They also found I have signicant myofascial problems which we already knew. We will not know much else without an MRI.

The appointment was about an hour long. There is little hope for conservative treatment due to the fact i've already done almost everything there is to do. They do not want me using the NTI splint anymore because it is doing more damage than good. The doctors (there were two) prescribed 800mg 3 times a day of motrin plus a new muscle relaxant (skelaxin) to see if it will help. In a couple weeks i'll go in to make a mold for a new mouthpiece to wear 24 hours a day. They are hoping this will help a bit.

If this doesn't work they will do athrocentesis. This is an outpatient procedure where the doctors go into the jaw laproscopically, clean out the joints and look around to get a better picture of what is going on. While they do this they inject steroids into the joint. If this doesn't work we will move forward with surgery.

The surgery we are planning on is twofold: The doctors will round out the condyles to give them a normal shape, hopefully prevents the discs from getting lost again. They will then attempt to get the discs back to where they belong. If the discs are too far damaged, they will remove the discs permanently.

90% of cases of TMD do get better with conservative treatment. The doctors said they would have expected to see mine respond better by this point. I will admit, I hold little hope for mine to get better without surgery; maybe i'm just too much of a pessimist at this time and place in my life. I think i've just been through too many treatments to have hope anymore. When the doctor wrote out the prescriptions I just kind of rolled my eyes. I've been doing NSAIDS and muscle relaxants for so long, why would a higher dose do any good? Oh well, you just go with it and make them happy. He told me it is to look good for insurance. He said most of these steps are too look good for insurance, and because most cases do get better. He also said though that no doctor ever expects to see a jaw look like mine at 29 years old. So I guess i'm just the weirdo. :)

My physical therapist encouraged me to call the doctor back after my appointment to ask for trigger point injections. He felt the motrin/muscle relaxant therapy was not enough for me. Since I would have to wait three weeks before seeing the doctor again, he didn't want me to continue hurting. My PT feels the muscles are too tight to be relieved through pills and I really need the injections. So, I called hopkins up again and have an appointment for the 13th. They wouldn't let me leave a message for the doctor to ask if he would be willing to do the injections. All I was able to do was make the appointment. I hope the doctor is willing to do it, otherwise it is a wasted 6 hours of driving. Oh well, here's hoping! The shots don't sound pleasant, but if it helps relieve the pain for a while, it is a good thing.

Overall, the appointment was amazing. He is a tremendous doctor, considered I guess the #1 in Maryland and one of the top in the nation. He treated me with a lot of respect and listened so well. I've never felt so validated in regards to my TMD and I really feel like i'm in good hands. It is the first time I know there is some direction with this and I have hope that maybe one day I won't be in pain. Just having that hope makes it all worth it.