Tear-free Dentist Visit

Yep, you read that right...we had a completely tear-free and happy dentist visit last Friday.  We went in to get Liliana's front tooth fixed and I was really nervous.  My mom went with us because I wasn't sure how Liliana was going to feel afterwards.  We were prepared for the worst!

Well we got there and went right in.  Again I was so impressed with the energy of this dentist.  He is so relaxed and laid back and so is his assistant.  We went to a back room and Liliana laid down by herself on the chair.  They pulled up a chair for me to sit next to her.  They put the nitrous mask over her nose and talked to her about how it looked like a marshmallow.  She like that.  She was really relaxed the whole time.  I was impressed with how calm she was with everything.  The mask stayed on the whole time so she was breathing in strawberry flavored laughing gas.  Afterwards she kept talking about how good it smelled :)

They did the work very quickly and precisely.  It looked really great.  Liliana had her eyes open the whole time, but she wasn't uncomfortable or nervous at all.  When they were done, I could tell she still had the nitrous in her system because I was asking her some questions and she just looked at me giggling.  It was really cute.  Then they kept the mask on to allow her to breathe in some oxygen for a few minutes, which would remove any of the nitrous from her system.  

When they took the mask off, she got right up and we went out.  She got a new toothbrush, sticker and toy so we had a happy girl :)

My mom and I were prepared for everything EXCEPT her being perfectly fine.  LOL.  We couldn't go back to our house afterwards because my parents were getting new floors put in so we had even planned on getting a hotel room so we could have a place for Liliana to rest after the appointment.  Well that wasn't necessary at all!  She was completely happy and fine and ready to play.

I'm so glad I did my research and found a dentist we all seem comfortable with.  And I'm glad we didn't have to have anything major done at this point, just a simple fix!  

A Second Opinion

First I want to say thank you to all those reading that posted comments on my last post More Dental Decisions.  I took everything to heart and was able to come up with a plan of action.  I decided that although our current dentist has come highly recommended, I needed to get some other opinions.  

Eduardo and I had pretty much come to the conclusion that we would go ahead and have the tooth pulled rather than put a crown on it.  Since there is still so much risk with the crown chipping, we figured we would save the trauma of going back repeatedly and just take it out.

That was until today!  Yesterday I made it my priority to start calling around asking about how other dentist go about their procedures.  I have been deeply disturbed about not being able to be in the room with Liliana through her treatments and even my mom has been really upset about it.  I just wasn't going to take "no" for an answer!  Well I spoke with half a dozen dentist offices and didn't find the right match.  Everyone told me that I wouldn't find a dentist that would allow me in the treatment room.  Then I finally spoke with a nice man who couldn't do what we need, but recommended me to someone else.  I called and spoke with the receptionist and she said the dentist would call me back.  Well he called me back within 20 minutes and we had a great conversation.  Long story short, I scheduled a consultation for today and we went this morning.

Unfortunately the office is about 45 minutes away, which seems silly when there are about 50 offices in between, but it just felt like the right fit.  Upon meeting the dentist himself, I felt immediately at ease.  I held Liliana while he examined her teeth and we had a great conversation.  He gave me our options and his personal recommendations.

Unlike our current dentist, he gave us the option of just filling in the broken spot like our dentist in El Salvador did!!  I was so excited.  He does it a little differently because he will remove a little of the resin that's already there, but he thought it was the best choice.  Our other dentist wouldn't even consider that option!  

We both agreed a crown would be the last choice, with pulling the tooth being the 2nd best option.  I am still deciding, but will probably go with fixing the tooth.  The best part is that with either procedure, I will be allowed in the room!  The doctor said it's better to have me there to keep her calm.  Gee, what a thought!  He doesn't believe in the papoosing or wrapping them up so they can't move unless it's a bad situation of the child freaking out uncontrollably.  I would there to comfort and calm her according to this dentist :)  Ah, I feel more calm already. 

Now if we just fix the tooth, she will only get laughing gas.  He said she was so good during her exam that he felt that's all she would need.  The gas should relax her enough so she wouldn't get emotional and if she does, then I will be there.  If we pull the tooth, then she will still just get the laughing gas, but then the numbing anesthesia as well.  He said that he does not recommend sedation because the effects are so hard on them, whether it's a conscious sedation or completely asleep.  I felt more at ease as he explained his opinions and he explained everything so calmly and so thoroughly.   This was the first time I really understand why someone was suggesting something to me.  

So the reason he recommends fixing the tooth is because there is no serious present decay on the tooth.  He also said there is enough of the original tooth that can be saved that it doesn't need to be pulled out.  I think the only real benefit to pulling it at this point would be that we would know for sure that she wouldn't have to go back for anything like this again until her permanent teeth come in.  Even though it gets fixed, it could still chip and we would have to fix again.  So that's where I'm at.  

Eduardo seemed excited we could fix it and so did my mom so it seems like we will probably go that route.  I think I got myself talked into pulling it that now I don't know.  Aesthetically I'm not sure which would look better.  She gets a lot of annoying strangers asking where her "other" teeth are so I don't know if it would be better to not even have one or keep that one there.  Every time I ask her she says she wants to keep it :)  I don't know which way will be better for her self-esteem when she's older??

The last thing I will say is this dentist was telling me that when the baby teeth are pulled this young that the permanent teeth will actually come in later, not earlier.  That was really good to know.  We have an appointment scheduled for December 16th and I have until then to decide what we want to do.  Thanks again for all the support with this.  I'm so glad I stood my ground and found someone that will work with what makes us comfortable!  

More Dental Decisions

We have come again to a place where we need to make some major decisions about Liliana's teeth.  I usually get quite nauseous just thinking about it and I'm finding this decision particularly hard.  

If you've been reading for a while, then you will know that my little Liliana has had a lot of work done on her teeth.  She has a history of rapid decay and she currently only has one of her four front top teeth left.  The other three have had to be removed at different points.  All of the work was done while we were in El Salvador and though it was traumatic for her and us, we always felt comfortable with our dentist there and her procedures.

We originally saw a dentist in the States about Liliana's teeth and after hearing the bad news decided to get the work done elsewhere.  We didn't have insurance and there was no way I could afford it.  Also Eduardo was already in El Salvador at that point and Liliana and I really needed his emotional support through the process.  

We've never regretted getting the work done down there and actually prefer the way our dentist did things.  But now that we are back in the States, our American dentists are too impressed with the fact that we had work done in a 3rd world country, heaven forbid!  It's kinda looked down upon with complete ignorance on their parts.

Anyway, the point of this is that Liliana's lone front tooth got chipped.  I think it was from trying to bite into an apple instead of letting me cut it up for her.  She was so proud of herself when she did it that I had a hard time saying no and it wasn't until later that I saw the chip :(  

So we went to the dentist that we have been seeing since coming back here.  This dentist's office was recommended to us and accepts Medicaid (which Liliana is on) and we've been mostly pleased so far.  

That was until this visit.  We went into a private room and saw the 3rd different dentist we have seen in our 3 visits and I wasn't impressed with that as I had to explain our whole story each and every time to each dentist.  Then she told me what my options are for the tooth.  

I'll back up a bit by saying that this tooth has chipped once before in El Salvador.  The dentist there suspected it would happen because of her age and the size of the tooth.  We went into her office and she quickly filled the tooth in (it's not all her real tooth).  It wasn't too traumatic.

Well this dentist is now recommending we either put a crown on the tooth or simply pull it out.  She suggests just pulling it.  Even if they do a crown at this point, it can still break, especially her being so young.  I don't know which one I want to do.  I'm completely devasted and on the fence about either situation.  

I might not feel so horrible if we were in El Salvador where I know how the procedures are done.  Here they are a lot different.  These dentists will NOT let me be in the room during the procedure and I'm freaking out about this.  I have always been with Liliana through everything in El Salvador.  They also will not put her to sleep like we've always had done.  They just give her laughing gas and she will be awake and conscious (but relaxed supposedly) the whole time.  Then to top it all off, they basically put her in a straight jacket to keep her from moving.  It all just sounds horrible to me. 

I have put in a call to the dentist's office to ask some more questions, but haven't received a return call just yet.  Once I hear back, I will make my decision about which route we will take.  Hopefully this can be the end of our dental nightmares, particularly for Liliana's sake!  

To catch up on all of our previous dental experiences, check out Liliana's Teeth, Liliana's Dental Surgery and Another Tooth Pulled.

What's New

So it's been a while.  The last month proved to be a tough one and it seemed hard to find inspiration in anything, even just a little to write a blog post.  But I am back and with many life updates.

The past two weeks I focused on nothing except finding myself a vehicle and finding my family a place to live.  My mother has been kind enough to let us use her car these past five months, but she was ready to have it back and I was ready to give it back.  There are a lot of details involved with the car purchase, but I won't go into it and just leave it at the fact that I actually bought one!  It's not total winner, but it was only $1500 and it will get us through until we get back on our feet again.  And the best part is that it's mine, all mine :)  It's a 1998 Dodge Grand Caravan.  I wanted a van so I can use it for all my markets and work things as well as day to day.  Some of you may recall we drove our beautiful Honda Odyssey down to El Salvador a year and a half ago with the intention of leaving it there.  Some have been open with their disapproval of that decision, but we've never regretted it at all!  But it did leave me here without a vehicle so I am happy to say that problem has been solved!  

The house/apartment hunt is still on.  I was hoping to move this month, but apparently you have to have money to rent an apartment and I'm a little short in that department.  So unfortunately my big plans fell through, but it's only for now.  I really wanted to have our own place by the time Eduardo came back, but we will just have to suck it up and wait until the circumstances are right.  But I am getting a head of the game and finding the places I like so it will be easier when the time comes.

Eduardo had his appointment with the psychiatrist on October 25th.  It went as well as it could and the doctor even admitted to all of this being "a big misunderstanding".  Gee thanks!  There are again more details with that, but the main point is that he is actually signing the papers we needed him to and forwarding them on to the next people that need to sign them.  Hallelujah!  

His next appointment is with the embassy in less than a week, on November 9th.  It's coming so close!  This will be his final appointment where he submits all the insane amounts of papers they have requested again and then the case will close and they will send him his passport with the visa stamped in it through the mail :)  Once he receives the passport, I will book his flight here as soon as possible.  My plan is for him to be here by Thanksgiving and then Liliana's 3rd birthday the week after.  Please God, let this happen!!!  I have been constantly praying this last appointment goes smoothly for us with no complications.  We certainly deserve it!

On a less dramatic note, Liliana had a dentist appointment last week.  It was routine, but I was nervous because she had been complaining of pain in her teeth.  Luckily everything was great!  But turns out the pain and grumpiness and sleeplessness had been side affects of her top molars coming in.  It was actually a relief to hear because we had seriously had a rough couple of weeks and I was feeling like a terrible mother because of our crazy interactions.  But the past week she seems to be feeling better because she is eating more, much happier and sleeping better, which makes me happier and sleeping better :)

We didn't do Halloween.  I didn't want to trick or treat.  Liliana is intensely afraid of anything in a costume so I didn't think it would go over well.  And then the thought of a basket full of candy in the house sent shivers up my spine thinking of all the tantrums and arguments it would cause.  So we hung out with a friend who was also not doing Halloween and I was happy with our choice :)  

Yesterday at the license branch Liliana was decked out in a pretty snazzy outfit she had picked out herself and the lady commented "oh, I see someone is still in Halloween mode."  I said "no, this is just everyday mode!"  It was pretty cute.  

Our New Doctor

Most of you will be pleased to hear after the post Damn Doctors!, that we have a new doctor here in Indy that I absolutely adore.  She has actually been a patient of my mom in the past and is very open to my birthing and vaccination choices.  She even went as far as to go home and look up the hispanic girl growth charts so she could see if there was a difference with Liliana on those scales.  And there was!  It's not a significant difference.  She is still very little, but at least she is on the chart, where as the American charts she does not get on to the chart at all.

Because of our incident with CPS, which I don't think I openly talked about on the blog, but did on Facebook, our new doctor is taking special precausions with us.  She was shocked when she read our past doctor called CPS on me for child neglect.  She knows our family personally and also knows our old doctor personally and felt as though it was completely uncalled for.  Unfortunately for me though, because it's in the system, I have to do everything by the book.  Our new doctor, Dr. Fox, wasn't originally too concerned with Liliana's weight until she say the past notes and is now having us get a bunch of testing done.  I feel annoyed about it, but it's mostly because I have an issue with authority figures and people telling me I have to do something makes me feel rebellious ;)  I can't help it!

Anyway, so she is having us get more blood work done for childhood allergies and lead poisoning.  I also get the lucky job of collecting poop and pee samples for parasite testing and some other things.  Despite my annoyance by it, I'm actually very glad to be getting these specific things tested.  They are the type of things I would want to have done as opposed to a bunch of unnecessary testing.

We also have to go see a dentist here in the States and she gave me a name of one to see if they take Medicaid.  She said even if we have the work done in El Salvador, we at least need to show we have been seeing someone here.  So that's on the agenda as well.

I just love that I feel comfortable now with our health care provider.  Everyone got rather upset with me after the previous post on doctors because I didn't feel finding a good one was possible.  Well now I know it's possible and am very pleased.  If only we had gone to Dr. Fox in the first place!

Another Tooth Pulled

After a month of trying to get into our dentist here in ES, we finally got Liliana in for her dental work on Saturday morning.  We knew from the brief check-up that the two molars that were filled before had cavities again.  The fillings had come out.  Also, one of the two front teeth was going to get a crown since the tooth the dentist had built kept chipping because the tooth underneath it was clinging to was too tiny.  To read more about Liliana's teeth from the beginning, check out Liliana's Teeth and Liliana's Dental Surgery.  

We got there around 8am.  Luckily the dentist is only 2 blocks from our house:)  The dentist had hired a different guy to put Liliana to sleep and we were all a little nervous about it.  He does things differently than the first guy we used a while back.  The first time they put her to sleep completely.  It was really traumatic for me because they had to stick a tube down her throat and pump oxygen into her lungs the whole time.  This time the guy gave her a shot and it knocked her out right away.  It was different because it puts you to sleep, but not as deep as the other method and is supposed to have less side effects and she could breath on her own.  They still monitor he heart and everything, which was a relief.  I have to say this way was better because it wasn't traumatic for Liliana and when she woke up it was just like she was waking up from having a nap instead of really freaked out.

We snapped a couple pics for before and after, but it was hard to do.

The bad news is that when she went in to look at the front tooth, it had a huge whole in the back and was unable to be saved.  Also, one of the side teeth she has is super tiny.  The infection was taken out, but it looked really bad, like it's not being taken care of.  We asked if we should just take it out and the dentist agreed because she said it will be really hard to take out later since it's so small.  So the poor baby had 2 teeth pulled and 2 cavities filled.

The tooth on the right got removed.

Eduardo and I were devastated about pulling the front tooth because she is now left with 1 front tooth out of the 4 on top.  It's been bugging her a bit because it's rubbing on her lower lip, but I think it just needs time to adjust in her mouth.  We beat ourselves up for a few minutes in the waiting room and I had a little cry doubting our parenting abilities, wondering what we could have done differently to avoid all this.  After a few minutes, Eduardo reminded me that there's no point in thinking what we could have done.  We have to move and and see what we can do from here.

The dentist told us that Liliana's teeth decay 3 times quicker than anyone else's, adult or child.  She is just blow away at the rate of decay in her mouth.  So that means we need to be even more diligent about taking care of them.  They need to be brushed every time she eats, even snacks.  Especially if it's crackers or cookies she said since that stuff stays in your teeth longer.

So we have been good about it so far I think.  It's not easy because Liliana fights us every step of the way, but we are doing what we have to and as a good friend told me "someday when she is older she will appreciate the lengths you went through to save her teeth."

Daniela and Liliana with her 1 front tooth!  Still beautiful as ever!!

I think she is still detoxing all the anesthesia, medication and infection that was in her little body.  It took a while to stop the bleeding and the holes are still healing.  She threw up a couple times the following hours after the procedure.  I think it was a reaction to everything.  She wakes up at night and tells me not to take her to the dentist...poor baby!  I think she's having nightmares.  And she's also teething her molars!  But she's healing well and getting better.  And I know without a doubt, she will be feeling so much better getting all that infection out of her body.  I think we will see major improvements in her weight gain as well.  We already have.  Hopefully we can avoid any more complications.

We did quickly discuss the option of putting in "baby dentures" in the next year or so.  Eduardo and I discussed it right away and are pretty sure we will be getting that done on those 3 missing teeth.  It won't affect the big teeth coming in and it will look a lot better.  Since she will be like this for another 6 years or so, I think it would be best.  Maynor had the same thing happen to him when he was around 6 years old and he told me how devastating it was to only have 1 front tooth.  Hearing the anguish in his voice alone made me want to get the dentures.  It's not so bad in El Salvador, but honestly in the States people are way more vain and judgmental about appearances and for Liliana's sake I don't want her going through that.  I'll let you know what we decide when that day comes!

Medical Tourism

In searching online for information on quality dental care in El Salvador I came across an interesting concept called "Medical Tourism".  Medical Tourism is the practice of traveling abroad to receive medical and dental procedures.  The concept is decades old in Europe and has been practiced for hundreds of years in Asia, but it's a fairly new idea for Americans.  There are actually a number of companies out there that provide what I see as a "package" service that includes the care, hotel stay and expenses for a sort of "medical retreat."  I find this quite interesting and can see the appeal for many Americans in a lot of different situations.  I also think that besides the "retreats", word of mouth care is just as functional.  

As I said there are many reasons why someone would want to travel to a foreign country to receive medical or dental services.  The #1 reason is Cost Savings.  Here is an excerpt from Medretreat that discusses why and how the savings can be so high in acquiring services abroad:

 

1.      “Many workers in the health care industry are basically getting paid to shuffle paper around. The health insurance companies are paid to deny health claims and the government workers at Medicare and Medicaid offices are paid to find new ways to deny payments to doctors and hospitals for services rendered. Thus, doctors' offices and hospitals have to employ entire armies of people to sit around and reclassify procedures in ways that can get paid by insurance companies, Medicare and Medicaid. It's a massive waste of time, money and effort.”

”As a medical tourist in another country, you eliminate these paperwork shufflers. And right there, you can save as much as 80% right off the bat. Because now, your dollars are actually going to the surgeons, anesthesiologists and other hospital workers who are attending to you during your surgical procedure. Whereas in the United States, your money is going to the insurance company and then the insurance company money is being used to pay paper shufflers.”

 

2.      “Another reason these surgical procedures are so much more affordable in Asia or other regions of the world is because of the liability issue. In the United States, doctors and hospitals must carry extremely expensive medical malpractice insurance policies. And patients seem to love to sue in the United States. In contrast, when you undergo a surgical procedure as a medical tourist in an offshore hospital, you sign paperwork that says you agree not to sue under certain conditions. Thus, you save a fortune by essentially not funding the legal fees, settlements and malpractice insurance costs normally found in a U.S.-based healthcare practice.”

Another reason for one to consider for travel abroad is the experience of a new country or a vacation and medical/dental work in one!  Even after the cost of plane tickets and expenses, the cost of traveling to another country is still less than what you are typically going to pay in the States for the same services.  Why not go somewhere else and get it cheaper and have a vacation.  

I think the number one hesitation of getting any kind of medical care outside of the United States is the belief that the care is quite up to par.  I can tell you that this is not always the case.  I'm sure it is different country by country, but I can personally say that in El Salvador the care is equal if not more that in the United States.  There are sites you can check online for doctors and dentists that are reputable and as I stated before, word of mouth is the best.  

We took a chance when we first arrived in El Salvador in search of dental care for Liliana.  We had been to a very high priced dentist in Indianapolis before we came down here only to be hit with a very pricey quote we knew we would never be able to pay, especially without insurance at the time.  We got the opinion and quote of the dentist in Carmel, Indiana and then talked with a dentist here and got a quote and opinion from her.  I can say without a doubt that we have always been happy with the quality of care in the dentist we chose.  She is only 2 blocks from our house, has great prices and best of all has all the up-to-date equipment as in the States.  And usually I would find that since I am American I would get charged more than a local, but our dentist actually gives us even deeper discounts and free services!  She also is always going to Guatemala for continuing education every month.  She has given us some different perspectives on Liliana's teeth than we received in the States and we've always trusted in what she has to say.  She does want to put metal in Liliana's mouth for reasons that make a lot of sense, but she is understanding of why I do not want to do that due to the fact that Liliana already tests high for heavy metals in her body.  The dentist always respects our decisions and is very educated in her craft.  She is also very good with kids and has a 3 year old herself so she understands our struggles with getting Liliana to brush her teeth and other issues.  Never once have I ever felt that she is judging us, which is something I always find in the States.  No matter how nice the doctor/dentist is, I always feel they are judging my choices or decisions.  With this dentist I have never once felt that.  She just gives us the facts straight on and if we haven't followed through, she tells us what the consequences will be plain and simple.  

My mom has recommended my brother and my grandma to come to El Salvador for dental work.  My grandma was quoted about $9000 for the bridge she needs and we have told her how much she could save by doing it here.  We will see if either one of them actually come here, but it's a good option.  And after all my researching, it's interesting to see that there is really a market for this kind of thing and that hundreds of thousands of people are actually doing it.  It's definitely appealing for the majority of people without insurance and even with insurance the doctor may just be tacking on more services for the sake of making more money.  

Below are some links to websites with more information about international medical care:

Tim's El Salvador Blog

MedRetreat

Tropicool Tours

MedicalTourismCo