It could be that I wasn't looking in the right place.
It could be that people are too tired or too busy to blog about a surgery so long after the palate repair.
It could be that once our children start to become more and more their own people, it feels like more and more of an intrusion to share their stories. I know this is the thing that's kept me from blogging these past few years.
But knowledge is power, or so they say, and so I'm blogging the experience.
The Back Story
Tate is 9 years old and in third grade. This is me with Tate on our date at Disneyland April 1:
At his last Cleft Clinic check-up, they told us to make an appointment within the year to see the orthodontist (the one who specializes in clefts and works closely with our Children's Hospital's craniofacial team).
In early December 2018, we saw the orthodontist. He determined that it was time for Tate to have the alveolar bone graft because he has some teeth that want to erupt - but have no bone to erupt into. If they break through before there's bone, they'll just erupt into open space. So he sent us off to the craniofacial surgical team for their evaluation.
When Tate smiles, you only see a typical-looking smile. But it's pretty different than my mouth on the inside. This is what Tate's mouth looks like:
The Insurance
Side note here - we switched to an HMO for our insurance when I started a new job last year. We'd always had a PPO or some kind of hybrid before. If our child needed to see an orthopedist because he grew too fast and couldn't touch his toes (or his knees!), we just did. If Tate seemed like he was having a lot of breathing issues, we could just make the appointment with the ENT doctor. As long as the doctor was in the system, we could manage our healthcare and pay our copays.
But the HMO, which is the same exact system of doctors, was so.much.cheaper. So we went for it. And it turns out that now we don't get to manage anything. To get the appointment with the orthodontist, we had to get a referral from Tate's pediatrician. Same to see the plastic surgeon. Then the insurance company had to preauthorize it. Our pediatrician is very good about paperwork. But what a pain.
The Consult
Anyway, after seeing the orthodontist, we saw the plastic surgeon and his fellow. The plastic surgeon who did Tate's cleft palate repair has handed off a lot of his surgical work to the "new guy," Dr. Samuel Lance. At first, I was nervous about this. Tate wanted to know if he could have Dr. Amanda Gossman, who he met at a summer camp she runs for kids for craniofacial issues.
So I googled Dr. Lance. Then I clicked on everything I could find. I'm not sure what - if anything - I could have done if I didn't approve. But he seems to be top-notch.
Here's his picture, in case you're interested:
We met with him and one of his fellows. They explained the surgery. They recommended taking some bone and bone marrow from Tate's hip and putting it into the space in Tate's mouth where there is a gap. (Just in time, Tate told them. Rice keeps getting stuck in fistula, and it's tiresome!)
In case you're wondering if there are other options, we were, too. So we asked. And they told us that they could use cadaver bone instead of Tate's bone and bone marrow, but the results aren't as consistently successful. (We were really just wondering if some other bone could work - didn't mean to open a can of worms!)
I asked what the mortality rate was for the surgery, which I think surprised them. They didn't know. And that's okay. I tried to find the answer online, but I didn't really find anything. So it must be pretty low. The surgery is pretty standard for kids with clefts, so it's not super risky.
The medical group billed us for this visit, even though it was pre-authorized. It was just a clerical error on their part. But holy heck, are doctor's visits with specialists seriously expensive. We were there for about 45 minutes, and the bill was over $500. Having practice law at a couple of big firms, I know that's nothing in comparison - but I sure am glad for insurance.
The Scheduling
Tate has a crazy school schedule, if you ask me. His school is not year-round, but it is "extended." This means they start August 1 and then basically have a week off almost every month of the year. They get two weeks for spring break, so we were hoping he could have surgery that first week and miss no school. Of course we aren't that lucky. But they had an opening for the week of spring break, so we took it.
More Insurance Woes
Before surgery, we needed to visit the orthodontist again to have them create a mouth guard. The surgeon will use this during surgery, and then Tate will wear it after, to protect his mouth while he heals. But before we headed back to the orthodontist, I wanted to make sure we were authorized. I was able to confirm from our pediatrician/primary care office that we had authorization on the orthodontia. But the surgery was not authorized, and only the plastic surgery medical group could do that, we were told.
So I called them. They directed me to the surgery authorization department, which confirmed the request had been made December 17. They couldn't tell me why, as of April 1, there was no authorization. They said they would make it a high priority and told me to call back in a couple days. Which I did. That person told me there was no way someone told me two business days earlier that she could help me because I was talking with the outpatient department, and Tate's surgery is in-patient. (Seriously, why would I make it up and give the person's name?) This person referred me to a supervisor and transferred me. When the number transferred, the person said to leave a message and I'd get a return call. I left the message. No return call.
So by the time of the preop appointment, I was worried. What if we weren't authorized for the preop appointment? What if we didn't have authorization for the surgery?
The Preop Appointment
It turned out we did get authorization for the preop appointment. It came through 15 minutes before the appointment was scheduled to start. Super helpful. But still not surgery authorization.
In any event, we met with the surgical resident and then with Dr. Lance. They explained, again, what to expect. They told us they'd likely take bone from the hip opposite the cleft so different surgeons could be working simultaneously. The procedure should last 2-3 hours. The hip is the most painful part of the recovery. We gave them the health and nutrition form from school because Tate will be on a full liquid-only diet for at least four weeks. And they sent us on our way.
The Cold
Of course, Tate came down with a cold. Fortunately, it's been mild - no serious coughing, no fever. He stayed home from his day camp program one day so Grandma could help make sure he was "on the mend" (Tate's words).
The Authorization
And we did finally get authorization for the surgery. On Friday. Three days before the surgery. I don't get this at all. Why wait so long?!? Anyway, at least that's all set.
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