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An interesting turn of events

21 Apr

Just fifty-four weeks after services were rendered, Blue Cross Blue Shield of Massachusetts (BCBS) has issued payment for my jaw surgery. They paid quite a good sum of money, too. They actually issued a check directly to my father, who is the subscriber for the policy, in the amount of $2976, which is what they determined their liability to be. That’s about $1000 more than I’ve paid to the oral surgeon.

Presumably what happens from here is that my other insurance plan will learn that they’ve overpaid and request that the oral surgeon return some amount of their money. I’ll then have to send the oral surgeon a check for that amount.

It wasn’t so long ago that I wondered whether my time spent on the phone with BCBS would save me any money at all. For a while, they were telling me that SHIP had already paid more than they would have paid. Between that and SHIP’s non-duplication of benefits policy, it seemed like I might have already hit a ceiling for the combined payments of those two insurers.

With this development, though, I’ll save roughly $1200, even if SHIP decides that they shouldn’t have paid anything. Needless to say, I’m pretty happy right now.

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The accident site, a year later

10 Apr

Today I got around to visiting the site of my accident, which I had intended to do last weekend. I didn’t want to commit the time needed for a 35-40 mile bike ride, so most of my journey was by BART, with about 11 miles of biking round trip between the station and the site of the accident.

To the extent that this trip had a purpose, it was to see whether the chewed-up pavement had been repaired, and it was this question that left me in some suspense as I meandered my way through the hills of Oakland to my destination, Skyline Boulevard and Grass Valley Road. This time, I approached the spot riding uphill along Grass Valley Road, opposite the previous times I’d been to the spot. A good distance away, the pavement was smooth and clearly relatively new, but when I got closer to the site I found myself on old pavement again.

As I pedaled up the last hill near the spot where I had fallen, I saw a cyclist approach in the opposite direction.  He bounced up and down a few times as he rounded the turn, thus breaking my suspense but fortunately not his jaw.* Soon enough, I could see directly that the pavement hadn’t changed significantly since I was there in July.

Bad pavement

It’s certainly not good pavement, but it’s not the worst I’ve seen. There’s actually a whole block in particular that I ride over pretty much every day, which is probably all a bit worse. It’s also downhill (at least in one direction), but it isn’t on a turn, and (on account of the whole block being bad), I’ve always taken it very slowly.

I don’t know whether the city of Oakland has decided that they won’t fix this or if they just haven’t gotten to it yet. The city certainly has had its share of financial difficulties, so they may not be able to afford to fix this kind of thing these days. As I understand, because they have been notified of the hazard, they are now liable for subsequent accidents caused by the damaged pavement. Of course, there are also signs warning people to take the turn slowly (without mentioning the road hazard), so that might reduce their liability.

I’ll write about the relevant law some time soon. That’s now two posts about law I’ve promised to write. Yawn.

*Let’s just say I’m practicing for a bad syllepsis competition, in case I should ever find one.

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Nerve damage

28 Jan

I’ve mentioned a few times that I think that my jaw fracture resulted in permanent nerve damage on the left side of my face. For the most part, I notice this as a sort of tingly numbness when I touch the left side of my face with my finger. A friend of mine who is a medical student confirmed to me that most people with nerve damage report a tingling feeling in the area.

I’ve mapped out the approximate region where the tingling occurs in the following photograph of the left side of my face. As you might guess, the tingly region is the big blue spot. In some places, it’s a more intense tingling feeling than others, but I decided that it would be too hard to color code the region by the intensity of the feeling.

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Asymmetry update

29 Dec

I mentioned in my last post on facial asymmetry a study that found that facial asymmetry increased over time in patients who had broken jaws treated by maxillomandibular fixation (MMF, colloquially known as wiring the jaw). As such, I thought it would make sense to post updates on my own asymmetry here. It’s now almost 9 months after my accident. Nine months isn’t one of the times for which the aforementioned study reported data, but it’s when I’m getting around to doing this.

Here’s my closed mouth.

It looks roughly the same as last time. Now, here’s my mouth with my lips opened but my teeth still closed.

This time, it appears that my lips are opening slightly further on the left side than on the right side.

Here’s my mouth opened slightly.

Here, it seems that the asymmetry in my teeth (largely a product of my repaired tooth on the upper right side being smaller than its neighbor to the left) is more noticeable than any asymmetry in the way my mouth is opening.

Now, here’s me moving my lower jaw as far as I can to the left.

That’s even further than I was able to move it last time. However, I still can’t really move it visibly to the right.

Finally, it looks like I can open my mouth a little bit further than last time, but the asymmetry is now perhaps even more pronounced than last time.

Opening my mouth like that, by the way, is actually fairly painful. It’s certainly nothing unbearable, but I do feel a sharp pain in the left side of my face near the site of the fracture.

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A return to normalcy

8 Nov

I think that due to the relatively gradual nature of my improvement, my prior posts might the extent to which things have returned to normal since the accident. Thus, I thought I’d write a post about which things are normal and which are not.

At this point, I would say that from a functional perspective, my jaw is normal. I can bite and chew anything I want to eat without feeling any pain. I can also talk normally (as I have since getting my jaw unwired at the end of April).

A few things are not normal, but these are of lesser practical importance. The facial asymmetries persist (and I expect that they will be permanent). I also don’t have normal feeling on much of the left side of my face, and I don’t know whether that will get any better with time. It feels weird, but I’ve been used to it for months.

There are a couple of things I’m not sure about, too. I don’t know whether my mouth opens as far as it did before the accident. My guess is that it does not open quite as far, but it’s hard to say because I didn’t think I had any reason to measure my opening before the accident.  I also think there might be some minor swelling in my left ear (near the site of the fracture). After the accident, the area was quite swollen, resulting in noticeable pressure in my ear. It definitely feels much better right now than it did six months ago, but it’s hard for me to tell whether the pressure has gone away completely.

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Cracking jaw

21 Oct

The last few weeks, I’ve noticed a cracking sound coming from the left side of my jaw perhaps a few times a day when opening my mouth. It’s not painful or anything, but it is definitely audible.

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A little update

27 Sep

I haven’t written any new posts lately because I’ve continued to not have much real news. There are a few things worth mentioning, though:

  • A few weeks ago, I noticed an improvement in the feeling on the left side of my face. This wasn’t all good, though, because it meant that I would get occasional pain near the site of the fracture.
  • Over the last week or so, I’ve been hearing a sort of creaking sound when I open my mouth. I don’t know whether that’s a bad thing.
  • On September 10, I received another copy of my bill from Berkeley Emergency Medical Group, dated September 3, with a letter threatening to take it to collections if I didn’t pay within 3 days. I had already tried emailing them my insurance information twice, and they didn’t reply to either email. Their threat was enough to get me to call on the phone, and so far it seems that the call was sufficient to avoid collections.

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I’m a terrible blogger

23 Aug

I haven’t updated in way too long, but that’s largely because not much has changed. Here’s what has changed since my last update:

  • The feeling on the left side of my face is a little bit more normal. The occasional sharp pains have become less frequent. I don’t know whether I should expect this to get any better than it already is.
  • The tenderness around the site of the fracture has gone away.
  • Since the accident, I have experienced (but apparently have forgotten to write about) some pain in my left ear. I’ve generally assumed it was a result of swelling around the fracture. This hasn’t gone away completely, but it is a lot better than it was for a while.

As for billing, not much is going on. I paid my $25 bill from Alta Bates. I also received another copy of the bill from Berkeley Emergency Medical Group, and responded by sending them the information for the insurance that they had neglected to bill.

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Facial asymmetry

17 Jul

As I mentioned last weekend, my jaw has healed in such a way as to compromise my facial symmetry. As promised, here are some more details. Note that all of the photos here, like most photographs, are mirror images.

The asymmetry is least obvious when my mouth and lips are closed. My chin looks a little bit slanted, but my lips look fairly normal.

Closed mouth

When I open my lips but leave my teeth together, the asymmetry becomes a little bit more visible. My lips open a little bit further on the right side than the left side.

Teeth

It becomes more obvious as soon as I open my teeth. My lips open significantly further on the right side than on the left side, and my repaired teeth are  smaller than my natural teeth.

Mouth narrowly open

One of the more striking asymmetries is seen when I move my lower jaw as far as I can to the left…
Lower jaw to left
…and then to the right.
Lower jaw to right
No, I didn’t upload the wrong photo for that last one, I just can’t move my mandible visibly to the right.

Finally, here’s my wide open mouth. The picture’s a little bit deceiving because my head isn’t quite straight, but there is some serious asymmetry. My mouth opens considerably wider on the right side, and this is visible not only in my slanted chin, but the different amounts of tooth visible on the left and right side.

Wide open mouth

Unlike some of the other little remaining signs of the accident, this isn’t something I expect to go away. I’ve read much of a study (subscription required) by Edward Ellis and Gaylord Throckmorton in the Journal of Oral and Maxillofacial Surgery found that patients who had condylar mandibular fractures treated by closed methods developed shortening of the face (measured from x-rays of the facial bones). Ellis and Throckmorton found that asymmetry in patients with closed treatment tended to increase somewhat over time rather than decrease. One caveat is that their study didn’t include any patients treated by maxillomandibular fixation (MMF) as I was, but they speculate that patients whose jaws were wired might develop even more asymmetry than the ones in their study. Thus, I don’t think this asymmetry will be going away unless I should fracture the right condyle.

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Recovery update

12 Jul

It’s now been fourteen weeks since my accident and a month since I had the arch bars removed. For the most part, I’ve considered my recovery a success ever since I got the arch bars out and ceased to be under the care of the oral surgeon, but that wasn’t really the end of this adventure. Some things have continued to get better, but other things aren’t completely normal. Here’s my list of things that have improved and things that haven’t.

  • My mouth is opening a little bit wider than it was four weeks ago.
    Open wide
    By my measurement that’s about five centimeters between my upper and lower front teeth. That’s a full centimeter better than my last estimate. I also do better on the three finger test.
    Three fingers in mouth
    That’s a lousy picture because it’s actually pretty hard to take good pictures of one’s own mouth with a camera in one hand while sticking one’s other hand in one’s mouth. In spite of the bad picture, it’s significantly improved from last time, and in fact, I’m able to pass the test without my top teeth even making contact with my fingers.
  • Four weeks ago, I wrote about as “tingly numbness” on the left side of my face. This has perhaps improved somewhat, but it’s definitely still there. I’m hopeful that it will eventually go away altogether because it’s similar to the sensation I had on the left side of my face after having my wisdom teeth removed. That lasted a few months but did eventually go away.
  • Four weeks ago, I also mentioned a creaking sound from my jaw. That has gone away.
  • I continue to get occasional feelings of soreness on the right side of my jaw, but I think that these feelings have become less frequent.
  • I haven’t mentioned this before, but for several weeks, I’ve been getting occasional sharp pains on my left cheek.
  • There’s a region in my left jaw which is somewhat tender. I’m guessing this is the area around the fracture.
  • As you might notice in the first photo above, my face isn’t very symmetrical. I’ll write about this more extensively in the near future, but this isn’t something I expect to improve.

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