I read with interest Robin Marantz Henig's article on the controversy and profitability of treating TMJ problems {Dentistry, Feb. 9}. My story is a classic case study.

About six years ago I experienced severe TMJ muscle spasm, an inability to open my mouth, a dysfunctional bite and a clicking in the joint. The dentist blamed it on stress and bruxism and suggested a soft night splint to treat the problem. Over the next two years I had treatments including a series of soft and hard splints, homeopathic medication, ultrasound therapy, hypnosis and stress relaxation from a psychologist and massage and heat treatments from a physiatrist. This culminated in TMJ arthrograms and five hours of TMJ arthroplastic surgery by an oral surgeon who dismissed the prior treatments as quackery. The surgery eliminated the click and relieved the pain and locked-jaw problems to some extent.

Hoping to correct the bite problem and prevent further occurrence of the joint pain, I embarked on an orthodontic approach. Over the last two years I have had yet another series of splints and full upper and lower braces, whereupon I was told by another oral surgeon that the problem was inherent in my jaw structure. The "solution" was another five hours of orthognathic surgery on both upper and lower jaws. The complications included anemia severe enough to require two blood transfusions, prolonged facial swelling, numbness and pain and changes in my appearance that caused me to be unrecognizable to some people.

The orthodontist and oral surgeon are thrilled with the results of the surgery. I am less enthusiastic since I still have a dysfunctional bite, difficulties with opening my mouth, visible scars and other dramatic changes in appearance, not to mention a recurrence of moderate to severe muscle spasm. When I mentioned the muscle spasm problems to the doctors, they suggested that it might be stress-related . . . and that maybe I needed to wear a splint at night! De'ja` vu.

Did I mention that all this wonderful treatment has cost countless hours of office visits and over $30,000? TMJ does indeed spell money.

Andrea J. Sloan, RN

McLean

Courage and Resourcefulness

Thank you for publishing Carolyn Hughes Crowley's excellent article, "The Bed Rest Prescription" {Women's Health, Feb. 16}, which describes our program for women in risk pregnancies who need to remain in bed.

One woman commented that she was still recovering 1 1/2 years after a healthy birth. As a perinatal psychotherapist, I often see individuals and couples who need extra support following risk pregnancies. Postpartum depression and marital problems are common reactions. These parents are often engaged in a grieving process during the pregnancy in preparation for the possible loss of the baby. Even when a healthy baby is born, there are remnants of grieving that need time to heal.

Unfortunately, it is very confusing to finally deliver such a dearly wanted child and find that feelings of stress, anxiety and loss from the pregnancy don't vanish overnight.

In doing this work, I have seen remarkably strong, creative families working against all odds to give birth to beloved children. Their courage and resourcefulness never cease to amaze me.

Susan H. Johnston

Social Worker

Founder, The Confinement Line

McLean

The article on therapeutic bed rest for high-risk pregnancies was all too familiar to me. Bed rest was prescribed twice for me, first in 1983 and again in 1986-87.

My purpose in writing is to state the fact that support services for women like myself in a middle-income bracket do not exist. We were not aware of this until we sought out these services with my second therapeutic bed rest. We had planned ahead and enrolled our 3-year-old in an excellent preschool but soon found out that we needed more support. However, we didn't qualify for the county or state services and yet couldn't afford to hire the services on only one income.

We now have two healthy and beautiful daughters and feel extremely fortunate, but without the help of my husband who did it all and a psychologist who waived her fee so that I could vent those feelings of depression and helplessness, it would have been impossible.

Margaret Sauter

Brookeville, Md.

Vigor or Politics?

In your article on presidential health {Cover Story, Feb. 9}, you talk of "some of the healthiest presidents never {having} seemed to achieve the vigor image" and follow with: "John Adams, for example, rarely missed a day of work and lived to be 90. But he lost to Thomas Jefferson in his bid for a second term." You say that the presidents who failed to achieve the vigor image "suffered politically as a consequence."

John Adams did not fail to defeat Jefferson because he lacked "the vigor image." I would call your attention to the fact that the election won by Jefferson was a three-way race between Adams, Jefferson and Aaron Burr, and that politics decided the election in the Electoral College, not anyone's "vigor image."

Robert J. Evans

Harrisburg, Pa.

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