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!

Day 11

I tried to do a real smile, but both
husband and sister told me I looked
scary!

On a positive note, I noticed that when I bite my teeth together BOTH the right AND left upper AND lower molars ALL Touch! ... At The Same Time!!! Isn't that amazing?  Imagine the kinds of foods a person could eat if their teeth actually fit together?  It certainly gives me something to look forward to after all the pain & swelling (finally) go away and the bones heal up!

Day 10: Almost a Smile

I decided not to let today get the best of me so I woke up, showered, put some mascara on, and did not put my hair in a ponytail.  Tom and I were going to try to see a movie (figured it would be a relaxed outing), but we missed the movie showing so we just walked around the bookstore a bit. I still tired more quickly than I hoped for, but it was nice to get outside of the house.

almost a smile!

It is so bizarre to have lost proprioception and sensation in my lips.  They feel like they are ice-cold all the time, when really it is just numbness.  I've been working on my face exercises and have found that if I slow down and focus on my lips I can enunciate a little better. And along with slightly improved speech, I was working in the mirror and found that I could almost smile.  The left side of my face is still rather swollen though which makes most of my facial expressions odd and...lumpy? Regardless of the proper adjective I'm afraid that I may still scare the kids at work...

Status Update:
Pain: 6/10 (trying to take as little narcotics as possible)
Nausea: gone!
Drooling: improving with muscle control
Eating: still just through syringes and with small sips from dixie cups
Fatigue: High
 

Day 9

Today was another rough one, I didn't see much progress and I just felt exhausted all day.  My jaw really, really aches. Just a constant, gnawing ache that isn't relieved with warmed up facecloths or cold ice packs. Looking down to work on my puzzle or read just increases the pressure in my face and makes it all the worse. Tom also seemed to have more trouble understanding me today, maybe I was mumbling more from the effort? But because of all this, I called work today and told them that I would not be ready to return at my exact 2 week date of this coming Tuesday, but that I will still shoot for the end of next week.  They knew this was a possibility, but I still feel like I let them down. I know it is silly in that I can't control how quickly I heal, but never the less I know that they will now need to scramble to cover my patient load and I hate inconveniencing others.

One bright spot in my day was my sweet husband who spent time with me and made me an amazing peanut butter ice cream milkshake (with some protein powder thrown in) for lots of calories!

Day 8: Fatigue

So I think I overdid with moving around yesterday.  I really didn't feel like I did much, but Tom says that I was puttering around too much and then we went for a walk on the beach (oh the salt air was wonderful!). Either way I am absolutely wiped today. I just feel fatigued down to my bones and even with a long nap, I still feel unsteady on my feet.

Crockpot-beer-cheese-soup

Some of it I'm sure is the abrupt change in diet. I've officially lost 10 lbs. already.  I have not had much of an appetite, which I'm blaming on the narcotics because I cannot remember ever not having a an appetite. OR second theory is that maybe its a lack of appetite because there is no cheese in my diet.  So I've decided to rectify it by making cheese soup for dinner... I just wish I could make (eat) the pretzel rolls too!

I do have some good news though!  I would like to announce the re-emergence of my right cheek bone!  The left side is still pretty swollen, but the left was always my more painful (and longer) side so I imagine there was a little more surgical work done there.

Yea for cheekbones! 

Day 7: Pucker, Purse, & Scrunch

Starting my "exercise regime" today per MD I should be doing these multiple times per hour.

• Pucker : kissy-face
• Purse : pulling lips as far back as possible
• Scrunch : scrunching my face and nose centrally as much as possible.

Have you ever worn a mud mask on your face?  It starts off feeling like that, like my skin is stiff and it is that discomfort/ borderline painful to begin to move. Then the underlying musculature starts to yell. If I hadn't had such an intensive anatomy course I probably would not really remember facial muscles, but I swear I can feel each individual one as it starts to contract.  The upper lip  and nose muscles are actually the most painful, so I'm nerding out a little trying to figure out if it is the levator anguli oris, the levator labii superioris, or the levator labii superioris alaeque nasi (spelled that one without looking Dr. Swanson, boo-yah!)

A little bit of Grey's Anatomy for your enjoyment.

On another progress note, I also slept in my own bed last night!  I was still propped up and had a giant pillow buffer between me and my husband (out of both our fears to keep my head elevated and out of harms way). Unfortunately, I still only slept for 4 hours increments (still waking up as soon as the pain meds start to wear off :-/), but psyche -wise it made me feel a little more myself to be in a real bed after a week of sleeping in the reclining chair in the middle of the living room.

Day 6: Surgeon Visit

 I had my 6 day follow-up appointment with the Surgeon today.  And I asked a few more questions about what he did for the operation.

• My mandible was brought forward 9.98mm 
• My maxillae was brought forward between 4-6mm on each side and the cant was corrected.
• The longer ramus was cut and angled to shorten the impact in the TMJ and correct the asymmetry.

Of course I wont be able to visualize these changes myself until the swelling goes down, but, overall Dr. M. was happy with the progress!  My midlines look a little off to me but he says that anything under a millimeter is negligible and they are less of landmark than the fact that my cuspids are lined up perfectly!!

Metal Mouth!!!

What else was there... oh I (only!) have two rubber bands that need to stay on my teeth all the time (this will help guide the jaw as it heals).  I was imaging a complex mesh-work of bands that clamped my teeth tight, but it is not that bad...

He told me that I need to switch from icing all the time to hot packs to assist the lymphatic drainage.
I also asked about using a straw, since it seems to be a huge no-no for many similar surgeries (negative pressure tearing up stitches), but he says that it is completely safe for me to use a straw.  I was so excited that we went straight to Tropical Smoothie from our appointment.  I stuck the straw into the smoothie aannndd nothing happened, my lips are too swollen to form a seal around the straw...ggrrr!

Overall

Pain: I ran out of pain meds before my appointment today and it increased to a 7/10 :(

Nausea: 0/10 (haven't taken a anti-emetic pill for 36 hrs!)

Exhaustion: pretty high

Main Frustrations: Drooling, numbness, fatigue, slow eating

Fresh juiced breakfast!

Day 5: it's all downhill

I feel like doing a little victory dance ( I won't because that much movement would surely hurt!) but everything the doctor said and majority of blogs I've read all say it gets easier and better from day 5 on!

I think the swelling is going down, but you can see the yellow bruising a little clearer today.

 Also I slept for a straight 5.5 hrs last night! That's the longest I've slept since surgery! Granted, I still needed my pain meds ASAP and some fresh new ice packs at 5:30am... But nothing like a good block of REM sleep. 

I also stepped on a scale this morning. I had forgotten to step on my home one prior to surgery, but it looks like I'm down 6lbs. That's certainly the quickest I've ever lost my holiday weight ;) I'm not worried as I'm sure a portion of it is simple dehydration and the other half is the extra weight I gained in December anticipating this surgery. So while it's been a quick loss, I hope I'll be better with mitigating it now that I am eating some more smoothies. AND my good friend dropped off her juicer yesterday(!) I'm excited to experiment and it'll be a great way to add veggies back into my diet!

My big goal for today was to go for a walk and my sister was kind enough to escort me around the block.  I really thought I'd make it further than ~250 yards, since I ran 3 miles this time last week. But like almost everyone post-op, I fatigued really quickly. Thank goodness my sister was there to make sure I didn't fall on my face as I staggered those last steps home.

Day 4: Hopefully the worst swellling

 The surgeon says that day 4-5 is the worst and its all better from here * Fingers crossed* as I'm not sure if my swollen face could actually contain any more fluid.  The pressure on my jaw is terrible.  The sinus pressure is also rough, my nose keeps stuffing up which is frustrating because I cannot really blow my nose or risk breaking loose a blood clot.  A steamy shower followed by Q-tips dipped in rubbing alcohol is all I can do to clean out my nose and does provide some relief. 

I drank from a cup this morning! I used a paper Dixie cup and probably spilled equal parts down my chin versus down my throat, but it is a start! Drinking from a cup should help increase my calorie count and we know that calories = strength. So its a step forward!

As far as sensation, my nose and upper lip feel numb, but I can still feel touch/pressure/pain.  My lower lip and chin are completely absent to sensation, but the surgeon says that there is a good chance that those sensory nerves should grow back. Motor nerves all appear to be intact, but truthfully it's hard to move much with the swelling.

Day 4 Swelling

As far as entertainment, thanks everyone for asking, but the medications are making it difficult to concentrate on even a 20 min cartoon before I fall asleep. So I haven't even had the chance to get bored yet!

Update:

Also I had to add this comparison pic of me the day before my surgery and me today. I feel like the swelling makes me look 10 years younger! Yay for no wrinkles?!?

Day 3:Ducky

Well I looked into the mirror today and saw a troll looking back at me.  Instead, Tom (the cutest person ever) swears I look like Ducky from the Land Before Time with my duck-billed lips.  Ducky is far cuter than a troll so I'll take it.   Today and tomorrow are suppose to be the worst swelling days. I hope so, I'm not sure where any more fluid can go in my head. As it is. I feel like my head weighs 50lbs and I could use a chin rest.

I managed to eat some yogurt today, maybe 20 oz.  Beside broth it was the first semi-solid food I've eaten since Monday. But it took so much effort! I had to take a nap afterward.  I also managed a shower again today.  I'm trying to get back into a "normal" pattern, but there really isnt anything normal about any of this...

Day 2: home

Came home from the hospital  about 10:00 last night. Tom and my sister scrambled to get me all set up and ensconced  in the rocking chair. Warm blankets on the feet, ice packs on the face, humidifier next to my head. 

It's about noon now and I think I've been awake for a total of 60mins. I did manage to take a short shower. The steam felt wonderful and I found some random tape left over from the surgery so despite my appearance I was feeling a little better. But I still took another 3hour nap, until the pain killers wore off again and here I am. 

I plan to drink a little milk and fluids now.. Yea nutrition! Then take another nap until it's time to go to the Surgeon's office for my first follow up.

Day 2 picture: swollen up with ice packs

Pain 7/10

Nausea 2/10

Overall Discomfort 8/10

 

Day 1

 I'm awake! I don't think I'll write much today as it's a bit hard to focus with all the medication. But doc seems happy with how the surgery went and he'll check in late this afternoon to decide if I go home today or not. 

Right now pain is at a 5/10 and nausea is at a 4/10. Swelling and bruising are moderate, expect both to get worse over the next 3 days. 

T-0: pre-op

All checked in. Here goes!

T-1: Eeeek!

I woke up at 06:00 this morning in a panic that today was the day of my surgery and I had missed my 05:30 check-in time!  Unfortunately, this does not bode well for a restful night of sleep tonight!

Obviously I am nervous about tomorrow, so I just used about half of my lunch break to run a couple miles and knock out a quick ab-workout.  Endorphins vs Cortisol aaand...GO!   I have no idea when the next time is that I will be able to go for a run.  I know that I am restricted to lifting < 24lbs for 4-5weeks so not sure how that will translate to ground reaction/impact forces...  Regardless, I'm sure I will have some major re-conditioning work ahead of me once I'm cleared!

Also I ate just about EVERYTHING yesterday.  My friends & family brought the most food I think I have seen anywhere!  I feasted until I was sick and then ate some more!  I really ought to step on a scale before surgery tomorrow just to have a baseline #.  I think I've succeeded on putting on between 5-7 lbs since early December which should make the 10% body weight loss less obvious :)

T-2: Party Time!

Today is going to be an awesome day!

Last night before bed my phone white-screened, As I was falling asleep I was trying to plot out a time to make it to the AT&T store, but this morning I plugged it into my computer and it turned on. HUZZAH! (I'm backing it up right now!)

Today is also going to be an awesome day because today, I am hosting a food binge party!  My dear friends are coming over and bringing the one food/dish that they would miss the most if they could not eat solid foods. So its a funny twist on a potluck, but this way I  have no food regrets and even more importantly I get to party with my friends.  ( I think it might be awhile after this!) I'm so excited to see everyone!

(update)
How can a girl possible be upset about what's ahead when she has awesome friends like this right now? :)

T-3: Getting all Pretty

3 days, oh boy!

I can't describe the mix of emotions I am feeling except to say just about every definition of anxiety covers it.  I am anxious to get this over with and move on with my life.  I am nervous about the recovery and the difficulties I will have over the next 6 months.  I am frustrated at the lack of control I will have in the next 2 weeks. I am excited to have an improved jaw/mouth and leave much of my chronic pain nothing but a distant memory.  I am exhausted, as the worrying is actually waking me up in the middle of the night and doesn't let me go back to sleep. Finally I am still hopeful that many of the blogs I have read exaggerated the difficulty of recovery and I will skate through this like its nothing.

But tonight, I get an amazing date night with my fabulous husband.  We received (incredible!) tickets to a musical for tonight as a Christmas present. So I am getting all dressed up and feeling as pretty as possible, for what will probably be the last time in awhile... and I am hoping that my husband can hold on to that image when he's taking care of the drooling, sloppy mess I'm about to become.

T-5: Hooks!

I feel like I need to start with a quote from Captain Hook, but I couldn't find the perfect one, so on to my status update...

I started my morning headed to the hospital (it was an eerie foreshadow of next week).  Where I submitted several vials of blood for testing to clear me for anesthesia and I guess to gain final clearance for surgery... hope my blood tests well!    

Then it was straight to the orthodontist. Dr. R and his amazing technician Hope were awesome as usual.  They both did their best to put me at ease and reassure me that it was not really going to be as bad as all that.  Well, at least they were honest and told me that it wasn't going to be a fun experience, but that it was something that I was not going to regret.  Dr. R told me that he has never had anyone come back from this surgery (with my surgeon) and regret the results.  He did say that some people have even told him it wasn't as bad as having their wisdom teeth pulled. (yea right!)
They then added the surgical hooks on to my wires for the rubber bands.. Why you ask, did they add more metal onto my teeth to jab into my cheeks and cut up the inside of my mouth just days before my surgery?  Well as the surgeon will not actually hardwire me shut after the operation, these are used instead to put lots of rubber bands on all these tiny hooks and keep me from opening my mouth too wide and screwing up all the surgeon's hard work.


Up close picture of my teeth, you can see the hooks.
They are the extra bit of metal posts between each of the teeth.

And that is hopefully it for the pre-op doctor visits!  My remaining plan is to continue eating as much as I feel like for the next few days. I do feel a smidge guilty about this with my work colleagues on their New Years Resolution diets eating itty bitty salads for lunch while I scarf pizza in front of them...whoops!

T-6 : Pre-Op Surgeon Visit

So Tom & I met with my surgeon today. I forgot just how laid back he was about everything!  He's been doing maxillofacial surgery for about 35 years and he pretty much told me that this was a "routine"  surgery. (ha!) But he definitely calmed me down on some of my worries. 

I have probably read about 15 blogs from other people who have had double jaw surgery so I had a big list of questions and concerns from some of their rough patches with their surgeries & recoveries. And to many things that were so urgent and awful to [other people in] their blogs, my surgeon said "no problem." Some of them were...

• "So I can't drink out of straw?" - Sure you can.
• "So I can't blow my nose?" - Sure you can, just keep your mouth open when you blow your nose, sneeze or cough.
• "How swollen will I get?'  - I'll be able to tell you after the surgery, but it will increase after your leave the hospital. 
• "When will I be able to talk." -As soon as you wake up after surgery.
• "When will I be able to run again?" -As soon as you can tolerate it.
• "Will I have one of those awful splints wired into my mouth?" - Yes, but it isn't that invasive.  (I'm not sure about this one though, a lot of other people who had this surgery said this was the worst part and their best day when it came out.)

He also gave me a super fun looking book called Dinner Through a Straw; A Handbook for Maxillary Trauma.  I'll let you know if there are any good highlights! 

 

And then one of my biggest worries about this appointment...he then showed me a computer rendition of what my facial profile will/might look like after the swelling goes down.  And I have to say it  was AWFUL! It made me look like a Bulldog. (which as Tom gleefully pointed out is technically my high school mascot, making me already a bulldog...it was a well timed joke and cut off my anxiety).  So I'm choosing to pretend that I never saw that terrible picture and we'll just see what comes out at the end of all of this!

Tomorrow I get my pre-op labs done for the hospital and then go to the orthodontist for the last time before surgery to get my surgical hooks applied to my braces...more wires! It feels like its all happening so fast all of a sudden!

T-7 Days

This morning I woke up with pain in my left jaw from stress clenching my teeth all night.  I am definitely getting nervous about this operation.  (Actually I am not all that nervous about the operation itself, I'll be happily sedated for that portion!) I'm really getting worried about the recovery process and how rough the next 6 months- 1 year will be for my mouth/face/life.

I will meet with the surgeon for my pre-op appointment tomorrow.  Tom will be coming with me so that he can get all my post-op instructions and details on how he can/ will need to take care of me.  I truly have the best, most supportive husband, but it is downright terrifying to me to think that I will be completely dependent on others for 1-2 weeks.

Tomorrow the surgeon will go into detail of exactly how many times and in how many places will be breaking my jaw and realigning it to correct all its imbalances.  I have a good idea of what to expect, but I will find out in gross detail just how extensive this will be.  Also he promised me a computer simulation of what my face will look like post-surgery.  I have to admit this is pretty intimidating!  I try not to be vain, but its so weird to think that the face that has stared back at me in the mirror for 32 years will be different. I'm trying to believe that I'll still look largely like me, this isn't after all a cosmetic surgery, and the doc did promise to make everything look as aesthetically pleasing as possible. However it is a huge unknown and I'm a little nervous to see that image on the screen. 

So to sum it up, I have a empty pit in the middle of my stomach, when I think about tomorrow's appointment.... Wish me luck!



I'm still not very good with the selfies, but in case I forget later here are a couple "before" pics. 1/6/2015