My name is Bridget and I am currently undergoing a 3 year process to correct my dental malocclusion, which as it turns out is the root cause of my severe TMJD pain and chronic headaches.
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!
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!
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. :(
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!
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.
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.
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
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?!?
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...
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 :)
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? :)
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.
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!
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!
I had my braces adjusted on Monday. The Orthodontist popped off and reapplied a couple brackets and upped the wire strength on the bottom teeth. Not too bad actually. I'm back to eating soft foods, but not baby food... Thank goodness!
But every time I go back to the orthodontist or tell someone new why I have braces in my 30's, I start the whole anxiety spiral over the surgery all over again. Its not just that I have a black hole in my calendar between September and January where I can't make plans (which IS really annoying!). Its more the thought of someone cutting up my face terrifies me and that I am voluntarily letting them. Sure its for quality life, decreasing chronic pain, and ensuring that I have good nutrition by being able to chew food in the future... however this surgery is not like an emergency appendectomy where the doctors go to work and I am not sitting around anticipating it for 2 years.
So as a habit, after I start getting anxious I scour the web to find someone who had had this same procedure and how they survived/thrived with it. Most of the videos on youtube.com that I find are done by ~17 yr old girls in the UK who had a severe under-bite, which is close to what I'm expecting but not quite my problem or my recovery path. I found this one (below) today.
The video is designed by an Australian surgeon, but the video is of a girl who has very, very similar bite occlusion and jaw pain as I do. And the positive results she seems to of found are reassuring. It reminds me as to the reasons that I am torturing myself (and draining my bank account)! So if anyone reading this is wondering why I am doing all this work and willing putting up with all this discomfort check out the video:
PS. It also inspires me to do a video blog. Don't worry I won't torture you all this far out, but I'll probably record a few pre- and post- surgery videos.
Sorry I haven't written in a few months. My orthodontist decided not to change my wires in December which has actually lead to a wonderful 15- weeks of no changes to my mouth. Well any relative changes... I have noticed that my teeth have gotten straighter on the bottom and I am starting to get some gaps between a few teeth on the top. Not hillbilly gaps yet, but I believe I will get there before this stage is done!
The headaches are starting to return a bit, I never thought for a minute I would miss that chunk of plastic splint, but I guess I didn't appreciate it enough until I had my first 3-day migraine in a year. Too bad it wasn't a permanent fix!
But truly the best part in the last 15 months has been these past 3 weeks, my teeth have really dialed down on the soreness and I have been able to chew many more foods that have been challenging for the past year. My front teeth still do not touch (and I don't expect them too until after the surgery) so there is no biting into a sandwich, but I've really been able to chew again with my back right teeth. I've even been able to eat lettuce/salads and pizza this week! Unfortunately its back to the orthodontist in another week, so I plan to eat everything under the sun in case the teeth sensitivity flare up again. But I'm hopeful that maybe it was just so awful because it was the initial 6 months of braces and that the rest of this year will be a cakewalk...well that is until THE surgery.
Yesterday I had my first consultation with my maxillofacial surgeon. I know its early out! I just got my braces on 2 months ago and I was told to expect at least 1 -1.5 years before my teeth/bite/mouth are ready for surgery. BUT... I just needed to talk to him. All the website, journal articles, and blog research has only left me with more questions about what exactly will be happening to me personally and what I can expect as my prognosis. I also really feel that its important to encourage my healthcare providers to act as a team. To further that, I feel like if I'm on everyone's radar (or just somewhere in their patient files) they are going to watch out for me and something I may need is less likely to slip through the cracks.
So I met with the surgeon who actually put on gloves and looked at my mouth and my bite. He then sat down and reviewed my x-rays with me. And wow was that a shocker! I knew I had a dental malocclusion and I thought that I had understood why this malocclusion led to my TMJ dysfunction. But what a difference an educated discussion made on my understanding!
Turns out I will need double jaw surgery.
There are typically 4 reasons someone needs this surgery (a part from trauma) and I've got 3 of the 4! I've got the overbite, the overjet/open bite, and the asymmetry....wheee! The only one I am missing is the underbite, which would be awfully hard to have at the same time as an overbite. The Dr gave me a brochure that looks like its from the 1980's "Your Orthognathic Surgery" I'll have to upload some pages next chance I get. Essentially: 1. Serious Operation with all inherent risks 2. Inpatient hospital stay ~ 2-3 nights 3. I'll be out of work for 2-3 weeks 4. Liquid -> soft food diet for several months 5. My face/profile will change Apparently I am still rather upset about the double jaw surgery, because I am really struggling and find myself reluctant to write tonight. But I have about 1 year to a 1.5 years before the orthodontics will have done their work and my teeth will be where they should be for the surgery, so that should be plenty of time to come to terms with everything.
