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!