10 months out

There hasn't been much to report the last few months, but I had a couple of interesting things this week.  First a positive progression!  I forgot my lunch knife one day this week and decided to try actually biting into an apple without cutting it up first.  It worked!  It has been YEARS since I have been able to eat an apple without "pre-planning."  I'm not going to lie, that first bite was hard! My jaw opening felt incredibly inadequate and it felt a bit like I was just nibbling on the apple for those first general bites, but I did it! My first apple in [I have no idea] how many years!
Of course I followed it with some further difficult to eat food (almonds!, chewy bread! candy!) which all resulted in some increased jaw soreness for the last couple of days, but it was totally worth it.

My first bite was MUCH smaller than this one!!

The soreness I have at the moment, does remind me that I should get back into my daily jaw stretches, which I tapered off doing a couple of months ago out of laziness... whoops!

I also saw my orthodontist this week for my 3 month retainer follow-up. I am diligently wearing my retainers 24/7 except to eat or brush.  Every so often when I start snacking on weekends I forget and go a couple hours without wearing them, but for the most part I'd say I'm actually wearing them 90-95% of the time.  I want to do everything I can to help maintain all the work that has been done in my mouth!!

I think that I forgot to mention a few months ago when I got my braces off I also had a dental cleaning that resulted in a lot of gum/tooth pain in the front of my mouth.  It turns out that with all the work I've had done in my mouth these last few years my (already inadequate) gum line over my lower 2 front teeth has receded to the point of uselessness and now I am getting some fun nerve-like pain. My dentist referred me to a periodontist who told me that I need to have a gum graft.  Of course he can't do the procedure when I'm pregnant so its on hold for the moment.  I also wanted to get Dr. R's opinion, since as far as I'm concerned he is the guru of all things involving my mouth!  Dr. R agreed and told me that the Periodontist I saw is the one that he recommends...so probably February-ish I'll be having one more (hopefully) minor last procedure on my mouth for a looooong time!


I'll update with a pic later, but I'm also eight months pregnant and its starting to show in my face! :-0

8 months post surgery

Has it really been 8 months since surgery? I feel like I was just prepping for surgery desperately trying to find advice and blogs on how to get through the upcoming weeks/ months. 

Well I love having my braces off! But really it's not even about the braces,  it's about not wearing those awful rubber bands. I can now open my mouth to talk, yawn, sing... and I don't need to worry about the rubber band snapping in my mouth;  it is so wonderful!

I am wearing my retainers as instructed... 24hrs/ day except to eat and brush. Which is a little annoying, but again so much better than braces! I can eat almost anything now (still rebuilding jaw strength for tougher/chewier foods), for example almonds are still tough, but peanuts are back on the menu!  Also brushing/flossing takes me about a quarter of the time!  I feel like my teeth are so much cleaner!

Here's what my retainers look like:

Upper Retainer

Lower Retainer

8 months out and retainers on!

7 months post surgery

It's been 7 months since my surgery and (despite Dr R. disagreeing with my decision)... I got my braces off today!!!

Getting them off was not as simple or as pain free as I had hoped it would be,  but in less than an hour. I have teeth again for the first time in years!!!

What do you think of my new smile? :-D

6 months post-surgery

I just realized that today is 6 months since my surgery!
I wish I could tell you that I feel all healed up and the surgery never crosses my mind, but I think I have a few more months ahead of me before that becomes reality.

• Pain is minimal, but I do still get some muscular soreness and stiffness along both of mandibles (lower jaws).
• Sensation is still limited along my entire lower lip, the left side of my chin, and my gum lines.
• Vertical opening is still stiff and not fully returned, although improved thanks to physical therapy!  (The stiffness might be partly related to related to the rubber bands restricting movement throughout my day.)
• Headaches- minimal!
• Eating - greatly improved, but I still struggle with harder to chew foods like apple skins, red meat, and bread crusts.

I did see my orthodontist today and we had a nice chat.  Before I get into it, I wanted to let ya'll know that I am now 17 weeks pregnant. I talked with my orthodontist last time and told him that I was [First Trimester] frequently sick and that the rubber bands were not working well for me as I was having difficulty wearing them with regularity. He had told me then that even wearing them 50% of the time was ineffective and not worthwhile.  So I have worked really hard to wear them 100% of the time this past month, but it is just not working for me. I feel the need to snack frequently throughout the day and it is difficult to find the time to snack and reapply the bands in the couple of minutes I have between seeing patients at work.  

Bluntly, I am just tired of the inconvenience and being uncomfortable constantly in the last 3 years of dental/orthognathic work, especially when I have all these new inconveniences and areas of discomfort going on inside my body. I did talk with Dr. R and he felt that a few more months of braces with rubber bands will help sit my bite a little better and allow for a decreased risk of a return of the problems I was having before surgery.  I really appreciate his recommendations as I truly do trust him to have my best dental interests in mind. However, I made the decision to have the braces taken off next month. 

So I have one more month of braces and then good-bye to my metal mouth!  ... Okay I'll have to wear retainers 24/7 for 3-6 months still, but it will be so much better without the rubber bands!

5 months out!

I saw Dr. M (my surgeon) for a 5 month follow-up today and he says that everything looks great!  Nothing is shifting and he measured me at a 42mm vertical opening!!!  At my last PT session we got to 39mm, so I'm not sure where that extra 3 mm came from but I'll take it!  I was at 48mm prior to surgery so I am within 80% which he says is the goal for this far post-op!

This is what I made with popsicle sticks to help with the stretching.

Now I know that I haven't posted much in the last few months, but I and my physical therapist have been working HARD for that opening. It has been a painful few months of deep soft tissue release, stretching, and more stretching!  In case I concerned anyone, physical therapy should not typically be painful ("No pain- No gain" is NOT the way to go) EXCEPT for a few rare instances after surgery where someone develops a contracture and the only way to regain mobility is to really push it. There was real possibility that if I wasn't able to get the contracture stretched out on my own I would of had to have a procedure where they cut the tissue with a laser (called a z-plasty).  So its been a sore couple of months for me, but I made it!  No additional mouth/jaw procedures for me! :)

Look at me! I can open my mouth! ;)

As to my braces...I am so over them and the rubber bands. I see my orthodontist again in mid-July and its going to be very difficult for him to convince me to keep these on any longer.  I'm just about ready to take a pair of plyers and remove them myself. (Ok, not really, I've paid WAY too much for my jaw/teeth to risk ruining them like that...but a girl can dream, right?). The rubber bands have crossed beyond discomfort and minor nuisance to an outright loathing. It's impossible to eat a snack with 24oz of pressure keeping your teeth closed and it has made stretching my vertical opening throughout the day near impossible.

On a positive note I am eating a REAL person diet again! I can't remember the last time I made a smoothie and I really do begrudge the sight of mashed potatoes now!  I had my first bite of steak in >6 months this weekend and it was...heavenly.  I still do not have full jaw strength yet, so the chewing of the steak was a process and I fatigued before I was really done eating, but it was worth it! I still struggle with harder and chewier foods like pizza crusts and snap peas, and I'm nowhere near eating a carrot yet, but it is really getting better!  I feel like a nutritionist might (almost) approve of my diet again :)
 

 I'll update again when I see my Orthodontist next month...hopefully with the amazing news that these braces are coming off!!

Day 108: 32mm!

Sorry, there hasn't been much to post about. Progress has slowed down in most areas, which is good because that means that life has been returning to some what normal!

I am still seeing a Physical Therapist and we are still working on those tight bands of tissue I have on either side of the inside of my mouth.  She says that she's seen scar tissue like this before, but not quite this bad.  It feels like they are guitar strings that you could strum going from the back upper corner of my mouth down to the lower corner. Some days I wish I could just pop them, because I feel like those bands are the only thing keeping my mouth from fully opening.  I have been at nearly 30mm for several weeks now, but finally yesterday after a lot of manual work my opening went to 32mm! (that's about 2.5 fingers width) I am just so excited to break that 30mm mark, because now I know that progress can be made!

My diet is slowing improving.  I am now eating chicken nuggets, saltines, and some breads. I still struggle with harder foods (nuts are still far in the future for me) and thinner foods (like spaghetti and lettuce) as I can't quite seem to bite them well enough. But overall I am back to my pre-surgery soft food diet (like the days after I would get my braces tightened) so its really not bad.

The pain has really gone down dramatically.  I can almost go a whole day without thinking about my jaw at all! The braces and rubber bands are now the largest inconvenience as I am very much over needing to take them off and re-apply my rubber bands every time I want to eat a small snack.  

The lower lip and chin are still numb, but I haven't given up hope that the nerves will grow back *fingers crossed* It wouldn't matter quite as much, but when I do a lot of talking I still feel like I am drooling a lot, which frankly isn't very attractive or professional!

Look you can see my uvula again ;)

3 Months

It feels very odd to say that I had my jaw surgery 3 Months ago.  I have certainly come a long way in terms of healing,  but it doesn't seem that the operation was that long ago as it is still a very relevant part of my daily life. I mean, I still think of my jaw/mouth multiple times throughout the day.  Be it in regards to pain, stiffness,  or difficulty with functional things like talking and eating.
I'm not trying to complain!  I knew going in that this was not going to be a surgery with a rapid recovery. But I also know that everyone around me must be sick of hearing about it by now! :)

So improvements... 

• I'm now eating cut up small bites of ground hamburger so red meat has been added back into my diet (!) 
• I'm seeing a physical therapist to help with jaw movement, after last week's session I opened to almost 30 mm (!) [Goal 40-50mm] 
• Talking feels much improved.  Although with work days longer than 8 hrs I still find myself fatiguing and avoiding long conversations. 
• The swelling is pretty much gone from my face. I feel like from straight on the right and left cheek/jaw are no more asymmetrical than they were before surgery. My nose is a little broader, but that's just vanity...maybe I'm breathing better and don't even realize it ;)

Of course I feel like when I can finally get my braces off, then it will feel like it is really all behind me. The Orthodontist says hopefully September *fingers crossed*

April ( &  January 

Day 81: Getting some Help

Has it really been 81 days since surgery??  Well this week brought several positives as far as healing.

• Have you heard of dry needling?  It is a modality administered within Physical Therapy for trigger point and muscle spasm relief.  (You have to be certified to do this!) Essentially it is the use of an acupuncture needle to go into the muscle belly to help release the trigger point and to stimulate the body's natural healing.  A friend of mine did a couple sessions of dry needling to each of my masseters, which has brought some pain relief!
• I also was able to find a Physical therapist to help me with some manual therapy to regain my jaw opening. I saw her a few days ago for the evaluation and was a bit surprised to find out how much my neck has actually tightened up through this whole processes. You know when you haven't realized that you are twisting your whole body around while driving to check your blind spot until someone asks you about it? :) Turns out that has been a contributor to all the muscle tightness around my mouth/jaw.  She did a little bit of gentle manual therapy work and gave me some new exercises to work on as it turns out I was being WAY to aggressive trying to force my jaw opening and I was actually doing more damage than good (which is why healthcare providers really should not "treat" themselves, but always find a skilled practitioner).
• No news on the food front. I'm still managing a soft food diet, but it is really so much better than squeezing liquids into my mouth with a syringe that I can't complain!

Its also hard to be upset about anything when the sun is shining and it feels like spring is finally here!  I see the Orthodontist again in a couple days, so I should have another update soon!

10 weeks

10 weeks out from surgery and some days are great and others feel like I'm rehabbing slowly.

I saw Dr. M for another follow-up this week. He said that he is pleased with how everything is healing despite only looking at the soft tissues and my bite.  I was surprised that no x-rays were taken, but he says my bite is consistent indicating that nothing is shifting. He was a bit disappointed in my opening, but I was expecting that as I have been working hard, but been unable to regain vertical opening on my own. 

Dr. M says that he sends about 25% of his patients to physical therapy to help out with this. So it's not unusual, but I'd be curious to know if that 25% fits in with the # adults that need this surgery  (versus the number of teenagers that seem to be the typical population for this surgery).  Unfortunately I have been having some difficulty finding a TMJ specialized PT that will take my insurance within driving distance...which has been frustrating, but I have a few people looking out for me so *fingers crossed* 

Anyways after 3 weeks of working really hard I can open my teeth apart 26mm, the goal for Tuesday was ~36mm. This is 80% of the ultimate goal of 48mm, which is what I had before surgery (normal opening is 40-50mm) so I still have some work ahead of me.

No real change in diet in the last couple of weeks.  I am still eating softened foods, some times I can manage really softened chicken, other times (like today) I can't seem to do anything with the chicken in my soup but spit it back out. But on the positive side, pancakes and soft fish are now on the menu!

Most of the swelling is gone, I might see a little more change over the next 2 weeks, but my face is about where it will be.  Everything I read says not to get too worried about anything until 6 months out, but Dr. M says 3 months, so... On the positive my nose is looking less crooked!

And here's a comparison of now to before surgery.... Can you spot the differences?  It could be so easy to slip into a bad pattern of obsessing over specific features. I'm really trying to just let it be, I don't think I've every looked at my face this much in my life! Oh such vanity!

Day 65: A Few Steps Back

So the last few days have been...rough.  I tell my patients all the time that healing is not always strictly linear, there will be good days and bad days. Unfortunately my last few days have been bad days. Remember how I said that the muscles spasms were growing fewer and weaker? Well they started back up on Monday with a dull cramping pain that was pretty easy to ignore, but by Wednesday the spasms were no longer dull but were so sharp they took my breathe away, again.
 I don't know why the pain has come back with such force. I have started eating more foods and I have also been more aggressively stretching to gain that vertical opening that I have fallen below the curve on so maybe with those two combined factors I've irritated the muscles into full rebellion? Wednesday I came home from work took the muscle relaxer and went straight to bed. Thursday I switched out my rubber bands from the 6oz weight down to the 3oz weights. Hopefully a couple days at the 3 oz bands won't slow my orthodontic work too much, but it was one of the few things I could think to do to diminish the pain.  Taking Alleve is helping, but does not stop pain.
Anyways I see Dr. M again in 3 days, so by the law of Doctor's Visits I should wake up pain free that morning, right?

And on a positive note, I am Finally having a little success with vertical opening!  I added a popsicle stick to my stack today and reached 30mm of passive opening!! (40-50mm is "normal") Still some work to do, but I was stuck at 22mm for a  couple weeks, so its nice to have some progress!

Day 62: More Soup

With the amount of soup I consume I wonder if I should really start watching my sodium levels or even my BPA chemical levels from all the cans?
The goods news is that I am no longer blending my soups, but actually eating them as they come out of the can!  Today's lunch was Campbell's Homestyle Italian Wedding Soup... you know the one with the tiny meatballs? The meatballs are so soft you probably don't even need to chew them, but I did! Of course chewing just tangles the food all up in the braces. Also since my cheeks are still numb I tend to pack the food into my upper and lower cheeks (like a hamster) without realizing it, so I need to stop every so often and remove the food and then sometimes when I brush my teeth afterwards I think I rinse out almost as much food as I managed to eat! (you really wanted to know that didn't you? ;-)

But I am eating much more with the softened cereals, cake-like foods, and even sliced cheese (so happy I can eat cheese again...although it'll be an overnight re-gaining of 5 lbs!)

Day 58: 2 miles!

This is just a really quick update. I'm frustrated with the lack of progress I'm making on my vertical jaw opening [only 3mm in 2 weeks :( ] So I called Dr. M to get a prescription for physical therapy, but he's out of town for the week so I'm going to have to wait a few more days before I can get some outside help. But I'm ready to ask for help!

Now on a positive note... I ran for 2 miles tonight!! The pain did increase with the jolting, but I was able to make it!  My face looked a little more swollen after. ..worth it!

Day 56: 8 weeks out!

Has it really been 2 months since my surgery?!?  In some ways it feels like it was awhile ago and shouldn't I be all better by now? and in other ways it feels like it was just a few days ago! So here is the run down in Things That are Different today than 2 months and 1 day ago:

• My Bite:  Good news is that when I press my teeth together they impact on both sides of my mouth in multiple locations AT THE SAME TIME!  Prior to surgery, I had exactly 3 teeth that contacted on my right side and that was it.  It still feels a little right side dominant and my front teeth still have an overbite, but that is why I will still be in orthodontics for another 6 months to make it all perfect! :)
• Sensation: Majority of the sensation around my nose and upper lip has returned, weirdly my upper gums are still numb, but that really has no impact on my life!  The sensation in lower right lip and chin has begun to return, but the lower left side of my lip and my chin are still numb. It feels like its cold all the time and when I speak for more than a minute I get a phantom drooling feeling along that left lower side. It makes me feel very self conscious and I am constantly wiping along my left chin just in case! The inside of my cheeks are still a little numb superficially, which means I still have a tendency to bite them since I can't feel them initially (until I bite and then I feel it!)
• Pain: The crazy muscles spasms have decreased to sudden 5/10 pain along the left masseter only, but only last about 10secs. The spasms also only happen when I've been talking for awhile or at the end of my day, so they are more of a nuisance now instead of an inconvenience that stops me in my tracks.  I also would describe my normal day to have an achy pain of 3/10 all the way along my mandible. I am still taking some Aleve about every other day and I catch myself massaging it unconsciously when I have a spare moment, but it does not stop me from moving along with my day. 
• Hygiene: I am brushing my teeth like a pro again! Flossing is still challenging since I can't quite open my mouth wide enough (see below), which makes it particularly hard with the threader floss needed to go around my braces.  It probably takes me 20 mins and some pain medication to do a full flossing job!
• Movement:  This is my real current frustration. I am not making the anticipated progress as I (and Dr. M) would expect by 8 weeks.  My vertical opening is only 23mm which is not the "2 fingers width" Dr M wanted me to have at this point. I am not limited by pain, but by muscle tightness. I cannot physically seem to stretch my mouth open any further.  I have another 2 weeks until I see Dr M again to continue working on my own, but I am thinking I may really need to go see a Physical Therapist who specializes in the TMJ to help me out.
• Diet: Improved! Just this weekend I ate some Mac & Cheese my sister made for me and then my husband made me pancakes! So I am officially onto Soft diet foods! I can't express to you how frustrating a liquid diet has been, but I can tell you a good blender is truly priceless. Anyways my diet is still restricted by a couple things 
• 1. Vertical opening: I still have to take small bites from the end of spoon. Yesterday I thought I would try to bite through a banana (just to see) and I couldn't open my mouth wide enough to even pretend to take a bite. 
• 2. Tooth sensitivity: Probably from the orthodontic work, some teeth get really sensitive to pressure and cannot tolerate the amount of pressure from a not quite soggy Cheerio = pain.  
• 3. Strength: My jaw muscles are still too weak to apply enough pressure to bite through a cheese stick! (not that it keeps me from trying daily ;)
• Exercise: Improving!  I am not where I was pre-op,but strength gains take awhile so that will come back with time. Running is still a little tough to tolerate as it just feels so jarring in my cheeks, so I tried swimming this weekend. Swimming didn't bother my face at all! But I am still aerobically deconditioned regardless of the activity, which also will just take a little more time.
• Aesthetics: Pics below. I am still worried that the left-side looks so...uneven, and my smile looks funny to me, but I will give it another 4 weeks before I get really vain about it.  I do still continue to wake up in the morning feel more swollen than I did when I went to bed, so that must be a sign that there is still some lymphedema that has not resolved yet.

How's that for a nice long update? :)

Day 51: Pterygoids

I bought myself some Chester's Cheese Puffcorn as a treat. I found this stuff because they make a butter flavor that tastes almost (but not quite) like popcorn without the kernels, so I've been eating bags of it to subdue my popcorn cravings while I have braces on, but I have not eaten any since surgery.  So I opened the bag gleefully anticipating a soft/dissolving food I can "munch on" only to discover that I cannot yet open my mouth wide enough to eat the puffcorn...boo. (Never fear I just broke up the puffs with my hands first before shoving it into my face ;)

Because of yet another reminder that I can't eat properly, I then spent a little extra time working on my jaw before locking it back down with the rubber bands.  In particular I spent some time working on my lateral pterygoid muscles.  I know this is a muscle most people without TMJ difficulties or Jaw surgery may never have heard of so help out here is an antomical picture:

The muscles lie under the masseters, which is the more well known muscle for jaw opening, but the pterygoids are workhorses!  After surgery all the muscles of the jaw end up getting shortened and tightening up and these are particularly hard to reach! So for those of you inclined to try it out, here is how you reach the lateral pterygoid to massage it/ "release it" like you would at a masseuse for a tight back muscle. You know you are on the right spot if it feels sore and you start drooling ;)

Full jaw opening is considered 40-50mm as you measure from the edge of the bottom teeth to the edge of the top teeth.  My vertical opening today after stretching and massaging was 22mm!  It is slow progress, but it is still progress!

Its a funny angle, but I think its where I look the most different
 with my jaw line!

Day 49: Citrus?

The pain has been coming back the last few days.  I'm sure its a combination of improved talking = increased talking versus the more intense rubber band placement. I'm having about 8-10 really bad spasms a day.  The surgeon had said if the spasms come back that I could drop back down to the 3 oz. bands, but that will of course delay my healing/ delay the orthodontic work, which I really don't want to do. So I've been taking more pain medicine to get through the day, but it is a constant fight of my willpower to not trade an easier time today (instant gratification) for a longer recovery.

On the positive side of things I am talking easier; having the splint out makes a big difference in how much my tongue can move and in how I articulate my words. I do still speak through mostly closed teeth, so its not quite my normal voice yet, but it is getting there.  Also I think that the roof of my mouth is healed up from the splint wires. I forgot and drank some orange juice the other day (ok, I admit the OJ was in mimosa form ;) and the insides of my mouth did not burn with a thousand little cuts!!! I can safely add citrus fruits/juices back into my diet!

Day 47: Out to eat

I went out to brunch with a good friend today. It was really the first time I've been out for a meal in public since the surgery.  I managed to eat about half of an omelette with a fork!  Did I mention the omelette was stuffed with crab and shrimp?  The crab was really easy to eat, but the shrimp (even cut up in 10 month old size bites) was tough and exhausting. I did it though! I ate in public with a normal utensil without dropping food all over myself!  I think I'll still stick to soups in public for awhile yet, but its nice to know I'm getting there.

I am still practicing chewing with Cheerios, which are still difficult to eat unless they are softened. But soggy cereal is another welcome addition to my diet.  I am starting to get really, really desperate for variety, but I'm still limited by vertical mouth opening and pain tolerance... But I know that pizza is only a few weeks away!

Day 45: One miler

Just for y'all, a sweaty gym selfie! ;)

I have tried to run a handful of times since the Doc cleared me, however running has been painful. With every step I can feel the swelling bouncing in my cheeks and the pressure builds up my jaw and then into my cheekbones gradually building up the pain scale.  Earlier this week I pushed myself to do just 5 minutes on the treadmill. I had to really push myself to make it that long and I felt more sore afterwards.

So today I decided to up my run to 6 mins, but a good song came on and I was able to keep going for 1 mile (11-12 mins)! Compared to how easy it was to run multiple miles before surgery one (slow) mile is nothing, but compared to how agonizing running was earlier this week... I feel accomplished! I feel like it was another milestone forward, which really cheered me up after having a particularly a sore and high pain day yesterday (the new wires, chains, & rubber band placements beat me up!)

Day 43: I'm back...

Because the surgeon was so kind as to take the splint out yesterday, today I got to go back to the Orthodontist.  I think these 6 weeks is (at least close to) my longest gap in orthodontist visits since I started with him 2.5 years ago!

I was really relieved to hear Dr R. say that everything looks good, I mean I picked my maxillofacial surgeon pretty much on his recommendation alone!  He said that he thinks I have about 6 months of work to be done and then I'll get my braces out! I'm super excited, but I know that my "6 month" splint took me 9 months, so I won't mark a date on my calendar, but it is still exciting to hear that there's a chance I'll have my braces off in the fall!

So first visit post-op, the orthodontist fixed the bracket that was broken during surgery (by the way the ceramic brackets do NOT come off easy!), he changed the wires and added a chain on both the upper and lower teeth (the silvery looking bands that go around each of the brackets in the picture), he also changed the band placement from how I've been wearing them.  The rubber bands definitely add more pressure and make it harder to open my mouth = harder to speak.  I do get to take off the rubber bands to eat, stretch, and to brush my teeth. Which reminds me I was able to floss today! Oh my goodness, until you go through this process you have no idea the joy involved in flossing your teeth and getting that true clean feeling.  For those of you out there not having this surgery, do me a favor and give your teeth a little extra TLC tonight and try to appreciate how easy it is to do things like opening your mouth wide enough to be able to brush and floss even those back molars easily. Then take a moment and appreciate just how clean it all feels... :)

Day 42: 6 Weeks Post-Op

I just so happened to have my 6 week appointment exactly 6 weeks after my surgery and *drum roll*...  He took out the splint! Oh my goodness it is such a relief. So I don't know if I ever really showed you guys, but it was like a retainer, but wired into the roof the of my mouth. How was it wired?  It was wired through my gums in about 6 places around my upper teeth (see pic of one of the wires in the front).

So Dr M cut the wires and pulled them out. It was a little painful, but really at this point what is a little more pain in my mouth?  I was going to take a picture of the splint, but after he cut the wires and pulled it down I swear it contained some kind of toxic remains (Dr. M did warn me). Apparently little bits of everything I've managed to eat in the last 6 weeks had lodged themselves inside... *gag.*  I'm assuming Dr. M threw it into a HAZMAT trash can while I was rinsing out my mouth.
Anyways the roof of my mouth is a little cut up and sore right now, but it feels so FREE!!!! My tongue can move around again and I even feel like I can breathe easier!

Dr. M was in a little bit of a rush today, but I was told that I have absolutely NO RESTRICTIONS anymore. I can lift/run/swim/ even play soccer right now if I want to! I can eat hard foods as soon as I can tolerate them.  The only thing I cannot do is actively stretch my mouth open, I need to continue passively stretching it. He seemed a little concerned at how limited my opening is and really emphasized that I need to work on it, passively.

Here is me at 6 weeks...much better than those early days right? I'm still going to hold out hope until the 3 month mark that the left side will slim down a bit more though.

Day 38: Rubber Bands

Pain: 3/10; Spasms 1



It might look like a snear, but it is
 meant to be a smile!

Yesterday was the first day I didn't have those crazy muscle spasms (pain =10/10) along my masseters.  The spasms have been gradually decreasing in number this week and I managed without the muscle relaxant at night for the last 2 nights.  The last time I saw Dr. M said he wanted to see me back in the 6oz bands (instead of the 3oz) once the spasms disappeared and of course I'm pathetically desperate to please my surgeon (and truly petrified that he will hold me back on any potential progress)! Consequently, last night I decided to risk putting back in the 6oz. rubber bands. Its about noon and so far its been manageable. I've only had 1 spasm on the left side. The larger bands go on different teeth which makes them more visible to others (they look like fangs in my pic). They also really resist my opening my mouth so I feel like I am mumbling a bit more today because of this, but such is the life of someone recovering from jaw surgery.

On a positive note I successfully made it 30mins on the Elliptical yesterday. I was certainly tired, but I did not have an increase in pain in my face from the jolting of all the movement! I also started lightly weight lifting again. I feel so weak starting back up, but that's what happens when a person does no exercise for 5 weeks!

Day 37: Chopsticks

There are so many pizza commercials on TV!  I swear they must be increasing the number of them just to torture me!!! Oh the day I can bite into a slice of pizza...well that will be a truly magical day! :)

So with my goal of pizza in mind (some days its the small things). I am really trying to start moving my jaw a little more.  I am still on a no chewing diet, but "no chewing" has expanding to scrambled eggs for breakfast and oatmeal for lunch with protein shakes and yogurt in there to ensure I am getting enough nutrients. The only exceptions are the baby food Puffs and mini marshmallows that I use practice chewing at the end of my meals.  I can't mange that many pieces of either before I get tired; also I think I am chewing on the insides of my cheeks as much as I am the food (the insides are still numb and my body can't tell the difference between itself and food).  But I figure the only way I am going to get these muscles stronger is if I use them, so I'm trying.

I eat mainly with either drinking or using those espresso paddles I found on amazon.com but it is really hard to balance a semi-solid food like eggs on the little bitty surface. So I tried something a little different this morning and I ate my scrambled eggs with chopsticks!  I've never been particularly good with chopsticks, but normally I can manage to eat sushi without (completely) embarrassing myself.  They worked! Well I should say that they worked really well for the bigger pieces, which actually sped up my eating time this morning, since I didn't have to keep cutting up pieces smaller until I could place them on the paddles.  I had some difficulty when I got to just the small pieces, but maybe its just a chopstick skill I can develop?  Either way I'm treating it like a small victory and I am picking up another pair of chopsticks on my way home from work!


Feeling a little extra swollen today; Can you tell?

Day 35: 5 Weeks!

5 weeks ago I had a surgery that has dominated a large portion of my life for the last few years. Today is then one step closer to putting it all behind me as I am officially off my weight lifting precautions!  I had planned to head straight to the gym after work today and (starting back at square one) start strengthening again.  Unfortunately the weather had other plans and Virginia is in a state-of-emergency as of yesterday, which shut down the gym, (but did give me a snow day! :) So for exercise I shoveled off the porch...exhausting!

Overall I am not seeing much day-to-day changes, but...  The muscle spasms really only happen now toward the end of my day after I've done a lot of talking. I do still have a steady 4/10 ache along my mandible and under my nose, but it is now mostly relieved with Aleve. I feel more swollen and stiff in the morning particularly around my mouth and nose, but I think it goes down somewhat as I move my face muscles throughout the day. I'm still trying not to really judge my facial appearance until I reach the 3 month mark to let some more of the lymphedema go away.  Hmmm..what else?  Not much change in the numbness, but nerves regenerate at 1mm/day so I may have awhile yet, before I feel a change.
I think that's it for my update.  I'm still working on food (no chew diet still) and vertical mouth opening (I'm up to 1.5mm) and I'm still really hoping the surgeon takes the splint out next week!!

Definitely dressed for a day-off :)  You can see the the left side is still more
swollen when compared to the right side.

Many Thanks!

I know I have been talking about a lot of the frustrations that come with this surgery, but I wanted to take a moment and say thank you for many of the good things that have already happened.

A special big big thanks to my husband and sister for taking care of me those first weeks and making sure I took my medications and managed to get some nutrition.

Thank you to those of you who have helped with equipment to make sure I got said nutrition. So without naming names...

• I can not imagine going these 4.5 weeks without my Vitamix blender!
• The loan of a juicer allowed for a real nice variety in my diet!
• The loan of an immersion blender has been priceless for when I've picked up soups that did not turn out to be quite as blended as advertised (it works so quickly!)
• Those extra syringes that were provided were well used, even after I re-learned how to drink from a cup! 

Thank you to all of my supporters. Those of you who visited me in the hospital, those of you who have stopped by my house to keep me company (especially when I couldn't speak back!), and those of you who have sent cards and text messages. I can see how loneliness and depression could take a real hold on someone going through this, but thankfully I have never felt that alone through this process.

If you are about to go through this surgery I really recommend you ask your community to help support you during those first weeks. It is very easy to feel isolated, and the pain meds & inactivity are not exactly mood boosters! 

I am so grateful to my "community" both near and far! <3 <3 <3

Day 30: What is this "chewing"?

So last night I attempted to chew a lump in my mashed potatoes. I positioned the lump between my teeth and tried to close my teeth together aaand nothing happened! My teeth hit the lump and stopped. I really tried to close my teeth together and I felt the masseters (muscles) cramping, but the lump remained. I was defeated by a mashed potato lump!

Never fear, you can't keep me down for long! So today I made yet another purchase from the baby aisle... Puffs!

Designed for "crawlers" (that's right I'm not even at "walking" level yet!).

So how did it go?  Well I needed a second for the puff to soften, and it did require a surprising amount of effort and concentration, but I was able to bite through a snack puff for a 7 month old! Woo!  After about 4 puffs I was tired, but it was still one more (baby!) step forward!

Day 28: Good Hygiene

One of the things Dr. M commented on yesterday was that I had good hygiene.  *pats myself on the back*  But seriously! I asked him, how can I possibly have good hygiene?   The insides of my teeth haven't seen a toothbrush in 4 weeks!  Never mind "daily flossing!"  He laughed and said it was normal and I was doing fine. 

I do brush the outsides of my teeth several times a day with the smallest baby toothbrush I could find (it has Snoopy on it! :) and I use mouthwash like it is going out of style!  But I am constantly worried that I have bad breath and that the fuzziness on the insides of my teeth is going to take over...

Why am I telling you about all this loveliness? So that you can maybe appreciate just a slight bit of the joy I felt today when I brushed my teeth with the elastics off.  I could open my mouth (just 1 cm) and some of the bristles reached the inside of my upper teeth...oooh cleanliness! The bottom teeth were jealous, but when I tried to angle the bristles over the lower teeth my jaw cramped up and said that was enough of that! So only a few teeth got just slightly cleaner, but it made me feel so good for a moment.  I bet you've never thought that brushing and flossing were a privilege!

Day 27: 4 week appointment!

It feels incrementally slow that I am only 4 weeks post-op, but everything (the pain) is still so acute at moments that I am surprised that it has already been 4 weeks.

• Dr. M is still happy with the alignment and the bite. (yay! nothing has shifted!)
• He is concerned about the muscle spasms I am still having along both my masseters. He wants me to give it a few more days and if I am still having those sharp 9/10 pains he wants to prescribe a topical compound analgesic vs. the muscle relaxers (that I can't take because I am working).  He also left the 3oz rubber bands on for now, although he said he would really like to get me back on the 6ozs once the muscle spasms stop!
• All the pain around my upper lip and nose is normal.  I didn't realize it before, but he actually cut my nasal spine during the surgery. (see the purple area in the picture)
• Good News: I can start taking off the bands and passively stretching my mouth open vertically a few times through the day. The goal is to be able to fit 2 fingers-width between my teeth by 8 weeks.
• Better News: I can take off the bands to eat!!!  (Now this is not an immediate food gratification moment as I still can't really open my mouth wide and I have no jaw strength to chew, but it does mean that I am on the path toward semi-solid food!) 
• Even Better News: If everything keeps progressing, he will take the splint out in 2 weeks!!!

Below you can see my 4-week post-op selfies.  I feel like my jawline is stronger than it was pre-op and my cheekbones have definitely re-emerged.  I do still have some swelling under my eyes, around my nose and upper lip.  As you can tell my smile is still awkward, that's partially from the swelling, partially from the current nerve paralysis (similar to Botox), and partly because I am just awkward ;)

Day 25: Spoons

By now you all have an idea how I am struggling with food and feeding myself.  Monday will make 4 weeks of a liquid diet and I have so far manged to keep my weight loss to 14 lbs.  I have started to use a calorie counter to count up my calories and make sure I am eating enough....a complete reversal of what I was doing 3 years ago! With working this week I have only managed to eat about 800 calories a day. This is not a healthy a number for any adult, never mind one who is trying to heal nice strong bones!  I know this, but it is a struggle to eat when I can only consume thinner liquids through a cup or straw and moderately thick liquids with the use of a syringe. (Not to mention how nothing liquified looks appetizing!)

But today I received an order from amazon.com that marks a win in my eating column!  I have tried to find spoons that would enable me to fit something between the small opening I can make in my mouth  without much success (see previous entry on Eggs).  A normal teaspoon is too wide and too deep to fit into my mouth.  The first baby spoons I bought were coated in rubber making them too deep to fit into the opening.  The toddler spoons I bought were shallow, but too wide to fit between the bands on my teeth.  So I spent some time scouring amazon.com for something that might work.  I couldn't find any simplified baby spoons (crazy!), so I thought of gellato spoons (these you can order in packs of 500 and will ship in 4-5 weeks...too late for me, but might work for someone who thought ahead!) and from there I found Espresso Paddles! The product reviewers actually commented that they were even smaller in person...perfect!  You can see in the picture below that they really are small and shallow, not much too them at all.  BUT with those "paddles" I just ate some hummus and then a little mashed avocado! Both hummus and avocado were sticky enough that I could turn the paddle upside-down in my mouth so that I could drop the food into/use my tongue to eat (remember I have a splint covering the roof of my mouth immediately behind my teeth).  Its still slow going, but oh to eat something semi-solid!

Paddle, Baby Spoon, Toddler Spoon, & Normal Teaspoon

Monday is my 4-week follow-up with Dr. M. and I have a couple of hopes:
#1 Is that I am healing up appropriately (obviously)
#2  I am really hoping he lets me take these bands off for at least a few hours per day to eat (I'm really all about the food)

Day 25

#3 I'm also curious to hear what he says about the swelling around the middle of my face and when it typically resolves.  I no longer see a complete stranger when I look in the mirror, but I still look funny to myself and I feel just a bit surprised when I catch my own reflection and it's not quite right to me.

Day 23: Eggs!

I was a little desperate for solid food this morning so I thought I would give scrambled eggs a try.  Have you ever fed a baby who has just transitioned from milk to food?  They have no idea how to get food into their mouths from the spoon and haven't coordinating opening lips & gums -> closing  -> swallowing.  Well that's about how I looked this morning!  I even had a mirror so that I could aim for the tiny opening my teeth could make, but most of the eggs ended up mashed on the outside of my braces, all over my lips, and of course on the floor. (My dog loved the food on the floor and I think he may have actually eaten more of the eggs than I did.)  Of the little bit that I managed to get inside my mouth, I swallowed it whole, no chewing yet (!).  Overall I probably ate somewhere between 0.5 -1 whole egg and it took me about 25 mins to manage that much! So it wasn't much a nutritional win and it made my jaw really sore to fight against those rubber bands for that long, but I feel like it was a psychological win.  I won't try that again for a few days at least, but it made me feel better knowing that I could manage a little something semi-solid.

I am still making it through the work week.  One of the hardest things is still the amount of talking I do. I knew I talked a lot, but I REALLY talk a lot.  I am so happy when I get 5 mins between patients and can just sit and be quiet.   I am also finding it difficult to eat at work.  I have been drinking about 3 protein shakes throughout the day, but I always feel hungry.  Yesterday I brought in a pre-blended soup and sat in one of our back treatment rooms and syringed it into my mouth (that's something no one wants to see or hear!).  I felt a little more satisfied, but unfortunately having that time and space is not always an option.  One more day until the weekend!

Day 21: The Sneezing!

It is only noon and I am already talked out today!  I wish I knew sign language (actually that is on my bucket list to learn), but still I have 6 more hours to go before I have the option to NOT talk. Oh my aching jaw bones!!

Someone asked me how sneezing was so I thought I'd share it here.  I have been taking my allergy pills religiously since the surgery so that it wouldn't be a real issue, but this weekend I forgot to take my pill and I had my first sneeze, followed by another and another...   I am "allowed" to sneeze only if I place my finger between my teeth and sneeze through my mouth. This is to prevent any back pressure from blowing a stitch into my sinuses. Well I didn't know I was going to sneeze the first time, so I didn't prop my jaw apart and it made me anxious that something got messed up somewhere inside of there.  (everything seems ok) And I have sneezed since then, one sneeze at a time is really no big deal.  Multiple sneezes however, cause my jaw muscles to cramp up and it actually takes me about a hot minute to recover. So needless to say I've been better about taking my allergy pill!

Day 21!

Day 20: Back to Work

I'm not going to lie to you, I was pretty apprehensive about returning to work today. I mean, I still talk funny, I smile weird, I feel like I don't look like myself, and I have very low endurance to activity. Also important to consider is my job typical involves being on my feet 8-9 hrs, doing actual sports exercises, and talking to kids and their parents. I absolutely love my job and today was the very first time I was dreading going in.
 

Day 20: Left side still swollen.

But I made it through!  I did take advantage of our hot packs every chance I had and I tried to rest a few minutes whenever I could. I am grateful that I have a supportive work team that did their best to mitigate my workload today, but it was still a hard and exhausting day.  The good news is that most of the kids understood me, but I did feel bad for my one evaluation today, normally I do a lot more talking and explaining, but today I kept it as short as possible. Despite trying to keep my talking to a minimum, this was probably the most conversation I've had since my surgery and my jaw is screaming at me right now. I walked in my door tonight and immediately took a muscle relaxer pill, hopefully it kicks in soon and I'll drift off to sleep.  I suspect, as exhausted as I feel through my whole body, that I am going to have my first great night's sleep tonight in 3 weeks!

As a side note: I am so grateful to Dr. M for making me take that 3rd week off. I can't imagine doing all that I did today with where I was at health-wise a week ago.  If anyone out there is having this surgery, seriously consider taking off as much time as your surgeon recommends!

Day 18: KT tape & Eating

So my friend and fellow PT stopped by for a visit yesterday and did some KT-tape to assist the lymphatic drainage from my face. (The theory is that it helps decrease the swelling by improving drainage)

It was great to have a visitor and really helped with my ever increasing cabin fever. I have left the house for short excursions, but the last couple of days the pain has been worse so I haven't been able to do much without a hot or ice pack on hand.  

I have gotten more proficient with drinking from a cup and a little bit more with using a straw. I do still use the syringe for thicker soups since I can't pour them into my mouth easily. I am REALLY missing solid foods and am completely over all my liquid meals.  By the way there are way too many pizza commercials on TV, I think they are just trying to torture me!  

For some perspective, here is a pic of how far I can open my mouth. This is a Tylenol capsule for scale, so as you can see there is no fitting a spoon in there. And unfortunately for just the short time to take this picture both my masseter muscles painfully cramped up, so there's no tolerance for the repetition needed for actual eating yet. :(  

Day 15: A Straw!

Today I was able to successfully use a straw! It was easier with a mirror, but I was able to purse my lips enough to form a seal around the straw.  In the end, it isn't super convenient yet because as soon as I get the beverage into my mouth it abruptly runs into my teeth.  I do not have quite the motor control yet to hold my teeth apart (the slightly apart the rubber bands allow) and still form a seal around the straw, but its a step forward!  By the way, I am doing my facial exercises multiple times a day and they are getting progressively less painful.  The muscles are still stiff and reluctant to move, but it is getting a little better every day.

To further progress my return to real life, I went to the gym today. Don't worry, I just sat my butt down in a recumbent bike for 20 mins. AND felt exhausted afterwards! I always tell my post-op patients that muscle atrophy and aerobic deconditioning are normal following surgery and rest, but it is really difficult to accept when I'm on the other side. I am still a little shocked at the effort it took me to reach the 20 min mark...I was running several miles just 3 weeks ago!

Day 15. You can see my left cheekbone!

Below, I marked where I have numbness and sensation loss.  The yellow is coming back the quickest and feels like its just dulled sensation now.  The Orange is all pins and needles to the lightest touch. The Red is completely absent to light & firm pressure and hot/cold sensation, which is part of the reason why drinking from a cup is difficult!

Day 13: Part II- Follow-up appmt

Dr. M. instructed me to wait until Monday to return to work.  I have a little mixed feelings about it.  I feel like I must have messed up somewhere that my recovery is taking longer than I wanted it to.   But to be honest, I’m also a little relieved since my face is still swollen, my speech is so impaired, and I’m so tired all the time…  (He did seem surprised at how swollen I still am... he told me that I look like Cindy-Lou Who)

I also told him about the sharp muscle spasms. He wrote me a prescription for a non-narcotic pain medicine, decreased the resistance on my rubber bands (from 6 oz to 3 oz), and told me that if it is not better in a few days he’ll write me a prescription for a muscle relaxant.

Otherwise, he is still happy with my bite and how quickly the bruising is fading.  

Left profile shot; you can see a more defined jaw line!

He also told me that I can start chewing soft foods any time I want!  I think he meant this as a little joke since my teeth can only open mere millimeters apart and there is not a chance of anything non-liquid fitting between them.  But it is nice to know that I have his clearance as soon as I think its worth an attempt.  In the meantime I have some blended (to a lovely liquid consistency) chili con carne for dinner… you know your’re jealous!

Day 13: Part 1

I am anxious to get back to work and my “normal” life, but I've woken up the last couple of mornings feeling swollen and stiff and in pain.  My first thought this morning was that I could not imagine getting dressed and working 8-9 hours today. I went with Tom to Home Depot yesterday, walking around/standing for ~1.5 hrs and I was truly exhausted afterwards.  I see the Dr. M later today so I’m hopeful he has a better idea of what I can anticipate in terms of recovery, because these last few days I feel stagnated, but I can’t imagine pushing it any more than I am already.    My speech is still very nasally and mumble-ly and I’m curious how much of that is from the swelling & pain and how much will get better once I get the splint out of the roof of my mouth.  I also get significant muscle spasms along the left side of the mandible, they take my breath away when they come, but I still have the steady ache along both sides of my jaw line.  If I had a desk job, I could see trying return to work sooner, but between my stilted speech and my inability to smile I’m truly afraid I’m going to startle the kids I work with.  In fact, I cannot imagine evaluating a new patient and telling them that I will be taking care of them when I don’t look like I can take care of myself right now. L

On the positive side, I am getting better with a cup!  I can drink out of most cups with a smaller circumference with intense concentration.  I’m going to try sipping a soup from a cup today to see if I can throw out my syringes.  I can’t imagine eating from a syringe at work, so if I can get nutrition without a syringe I’ll feel one step closer to humanity!

Day 12. You can see how crooked my
nose looks from the swelling!