Sunday, July 27, 2008

I hope this isn't an indication ...

of the bruising I will have post-op. Yikes! On Friday, I was mowing the lawn on our riding lawn mower, and we live on a big hill. On part of the hill, the tractor wanted to jerk to the right for some reason, and threw me off in the process. Luckily, it has a safety feature and shuts off automatically as soon as there is no weight on the seat. I'm not sure if I brushed against the side of the tractor, or if it was from the impact of hitting the ground, but I have a huge bruise on the back of my thigh. My husband had me put a steak on it Friday night and I actually think that helped quite a bit to reduce the swelling.

Anyway, I bruise pretty easily, at least this one I can hide behind a pair of jeans. If this is an indication of how my face will bruise after surgery, I will look like a human punching bag! Needless-to-say, I am now forbidden from mowing the lawn, at least that part of it. I don't think I'd want to take the chance post-op anyway of getting thrown off again.

On another note, I went shopping yesterday to start picking up some "supplies". So, I got one of those trusty magic bullets, since I've heard such rave reviews about them. Between that and the blender and juicer we already have, I should be set for mixing up many post-op concoctions.

I picked up a 6 pack of soft-bite spoons for infants, 3 sippy cups, and a baster. I also ordered and received the zip-n-squeeze bags, so I am hoping that between all of these feeding methods, I should have my bases covered given I will be banded for 6-8 weeks. Plus, I am guessing I will get some syringes in the hospital.

I picked up 2 notebooks, one for writing (communicating) and another for my meds journal. I also picked up 2 bottles of hydrogen peroxide (this is my OS's preferred method of rinsing my mouth - 3 parts water to 1 part peroxide), Afrin, non-drowsy children's Sudafed (liquid), Sudacare shower soothers (vaporizing shower tablets), and Ferro-Sequels High Potency Iron Supplement (recommended by my OS to take one month pre-op). And I bought one of those baby suctions, thanks to Rachel's post ... to keep some of that post-op drool under control.

Last, but not least, I picked up some All-Bran Fiber Drink Mix (pink lemonade flavor), whch packs 10 g dietary fiber into a 16 oz drink:

I'll try it this week to see how it takes ... I was thinking I might be able to incorporate it into some smoothies post-op to keep my fiber up.

I still have quite a few other things on the list, but it's a start. I don't want to be stressed the week before and have to pick everything up at the last minute. Thanks everone for all of your tips on what is needed ... it really helps to be prepared.

Saturday, July 26, 2008


No ... don't get excited ... I didn't get my braces off ... nor will it be happening anytime in the near future. I just called the hospital where I will be having my surgery to check if they will have internet access. The gentleman I spoke to said "I believe we have wireless access" that is available free of charge to the patients. So, if I feel up to it, I will be sending an update from the hospital. Please excuse me if I am somewhat incoherent in my first post-op post ... I think you all understand those drugs can make for some creative writing :) Wow ... only six weeks from Tuesday!!

Sunday, July 20, 2008

Ortho Appt, ER and lots of photos ...

Well, this week has been interesting to say the least. I went to my OD appointment on Monday, they took some progress pics and moved my wire half a mm to the right in an attempt to close up the gap on my lowers. My OD wasn't worried about it being closed for my surgery, but said sometimes plaque can build up on the wire inside the bracket and prevent it from moving. 2 days later, my gap was closed! They put a new powerchain on, but basically the same one as I had when I went in. When I left and checked everthing out in the mirror, I noticed my chain wasn't completely covering one bracket on the bottom lowers, so I went back and asked if that was ok. Well, it turned out the door on my self ligating bracket was kind of bent, preventing the chain from going completely around that bracket. So she checked with Dr. L and he said to bust off the door, put a wire tie around the bracket and put the chain back on. She ended up doing that to both lowers. He will decide at my pre-surgical appointment in August if he will reposition the brackets at that time or wait for after surgery. So here is my before picture compared to current as of Monday, July 14th:

6 days later, this is how the lower gap looks closed up ...
Tuesday afternoon, I went to go get my dress altered for my best friend's wedding in a few weeks. As I was standing there, I started to feel dizzy so I had to set down for a few minutes. She finished up tacking up my dress and I went home. I had that achy all over feeling, and occational sharp pains in my abdominal and chest region. My husband came home and I got up to go in the kitchen with him, and while he was making dinner I felt extreme pain in my abdominal/chest region that woudn't go away. He asked if he should call the hospital and I asked him to take me to the ER (the chest pain scared me because you don't know if the heart is involved). I was gasping for air from the pain, not hyperventilating but the pain made it hard to breath. It lasted for about 5 minutes, and the pain started to subside, but since we were already in route we decided to still go to see what was going on. They took the normal bloodwork and urinalysis, an EKG, and a upper body x-ray. The x-ray showed that I had severe inflamation of the lining of my stomach, technically termed gastritis. They also showed I had a bladder infection, unrelated to my pain but that explained the achy all over feeling. All of my bloodwork, blood pressure, EKG etc. came out good, but I did have a small fever.
So, it looks like the doxycycline struck again. I have been so vigilent to take it with sufficient water, and no where near anytime I will be laying down. It never said that I had to take it with food, so I am guessing this is what happened, I am just particularly sensitive to the medication and it irritated the lining of my stomach one day when there wasn't a lot of food in my tummy. Ugh ... 8 months on this medication and my 2nd major issue. I will be glad when I am off of it, but it looks like I will be on it for another 14 months as I need to take it for 12 months post op. When I got home that night, it was already pretty late but I thought I should try to eat something, so I had a tortilla with cheese and a yogurt. The yogurt didn't seem to sit well when it was going down so I stopped. About 40 minutes later I was doubled over in pain again, and it lasted about an hour. It was so bad, I couldn't concentrate on anything else, but at least I knew what it was this time. I advised my surgeon's office so they know my stomach has been particularly sensitive to the doxy.
In the ER, they prescribed me an antibiotic for the bladder infection, and some other medication for the gastritis. The next day, the Pharmacist told me that my insurance wouldn't cover it unless the doctor called them to get it pre-approved, so either she could ask the doctor to do this, I could pay for it myself ($130!!!), or she could check if something OTC would work (i.e. prilosec). So she called the doctor (not the same one but another physician who reviewd my chart), and he said I could try the Prilosec, and if that doesn't work to call back and they will try to pre-approve with my insurance. I know prilosec is normally used for acid reflux, but I guess in this case it would neutralize the acid in my stomach. So, sick of taking so many pills and being a walking medicine cabinet, I thought I'd at least try to eat and see what happens, and if I had another bad episode I would definately buy the Prilosec. I was petrified to eat, in fear of the pain, but I had a granola bar, waited an hour, and ate a yoghurt, and nothing. That certainly seemed to clear itself up more quickly than the esophageal ulcers. So, at least I know what to try if and when this happens again. Hopefully it won't.

So that is how my week started out. I have also begun to process the psychological issues I am going to face after surgery. I am trying to maintain a positive attitude, but reality is setting in now that my date is set and quickly approaching. Luckily, my husband has been incredibly supportive of me throughout this whole ordeal, so have my family, friends, and work. I spoke with my boss about it and he told me to take the full 3 weeks off, and I could work at home for however long I needed when I come back to work, reducing my hours if necessary. So, I will play it by ear. I also told him I wouldn't be going to Paris, he was more than fine with that so I will just skip that trip this year.

I wanted to get your opinions on my overbite. It doesn't seem to be as deep as it was before. When I first went to my OD, he told me I had an 80% overbite, but check out the pictures below (pre-braces vs current):

Doesn't it look like maybe it's around 50% now? Ideal is 20%. On the otherhand, my overjet has definately gotten worse, not that it was pretty to start ...
Last but not least, my full front view, showcasing my gummy smile. I think this has gotten worse since getting the braces as well ... but I knew going into this that things would get worse before they get better ...

I thought I'd throw in a couple profile views for good measure ... they'll be good comparison photos for post-op:
So, that's my week in a nutshell. The gastritis seems to have cleared up and I haven't had any more pain. I took myself off the doxy for a week so I will start it again in a few days, trying to make sure to eat with it from now on to prevent that from happening again. My next appointment with my OD is mid August and will be my pre-surgical appointment. I have an appoinment with the sleep and respiratory center next week so I will let you all know if anything comes out of that.

Friday, July 11, 2008

Post-Operative Care Instructions

I received my packet of information today from my OS with Post-Operative Care Instructions, and was pleasantly surprised with the thouroughness of the information. It looks like I will have to have a weekly appointment with my OS for 8 weeks after surgery, and then will move to an appointment every 2 to 4 weeks through week 16. My first orthodontic appointment will be determined by my OS and OD.

My 1st week, I'll be on strained liquids any color, particles cause infections. After 7 days particles in liquids is OK unless incision is open.

Week 1 though end of week 6 I will have full time elastic wear, and I'll start changing elastics after my 2nd post-op visit after surgery. I will then change elastics twice a day and do jaw exercises for 15 minutes with elastics out twice a day, replacing elastics. The elastics will be on nights only after the completion of the 6th-8th week.

Very short walks the week after surgery are mandatory. I can start light exercise (light weights, easy bike riding, golf, long walks, easy jogs) at 5 weeks post op. Hot tubs are to be avoided for 6 weeks. Avoid clenching with exercise for 10 weeks (disrupts healing of bones). No underwater swimming for 8 weeks, contact sports can be resumed 16 weeks post-op. Freestyle swimming is to be avoided for 6 months (exaggerated jaw movements associated with freestyle breathing can cause bite relapse). Snorkels and musical instruments – avoid prolonged biting on the front teeth for 12 months; these activities can cause relapse of the bite. Protective helmets (i.e. motorcycle) which puts pressure on the chin may cause lower jaw relapse for 12 months.

It mentions that hooks/screw(s) prevent jaws from relapsing, and are removed at 10-16 weeks. I am sure this does not refer to the rigid fixation screws, but possibly some microscrews used as anchorage devices. I guess this means I could have my surgical hooks in up to 4 months L.

For mouth care, I am to soak mouth in salt water (1 tsp per 8 oz water) 8 times per day. I should add peroxide to water for 2 of the 8 rinses (3 parts water to 1 part peroxide). Add mouthwash to water if desired. No vigorous mouth swishing, will open incisions. No toothbrushing until surgeon gives OK, usually at 2nd appointment post-op. Start modified toothbrushing when given the OK at 2nd appointment, do not brush lower back teeth which may open lower incision. Start normal brushing at day 21, include lower back teeth, Waterpik OK to use at day 21 and thereafter.

Another thing I saw in the materials that I thought was interesting is that he says pregnancy should be avoided for 12 months postsurgery because hormones associated with pregnancy can cause joint changes leading to relapse of lower jaw advancements. This was the first time I had seen hormonal changes as the reason to delay pregnancy.

Weight loss he mentions 10-15 lbs. There is a lot more information in the packet of information which I won’t outline here, but I tried to post the most interesting tidbits. My OS actually had BSSO last November for Obstructive Sleep Apnea, so I wonder if the completeness of his post-op instructions happened before or after his own experience with it. My dentist did tell me that he significantly changed his post-op protocol after his own surgery. The last time I saw my OS was before his surgery so it will be interesting to see him at my pre-op appointment.

I thought it might be interesting for some, although I know that every OS has their own opinion and theory regarding post operative care.

There was a lot of pre-op info as well, such as to stop taking all vitamin and herbal formulations 14 days pre-op, as well as aspirin, ibuprofen, Celebrex, vitamin E, and vitamin K. There was a long list of herbal/homeopathic preparations that are known to increase the risk of bleeding, including arnica flower, bromelain, onion and garlic. Interesting. I will save arnica and bromelain for post-op but clear with my OS when I can start taking it. I have to start taking an over-the-counter iron supplement one month before surgery.

So given the info I received today, I am thinking Paris is off. If I will be banded 24/7 up to 6-8 weeks post-op, I don't think I can even consider being at a trade show for 5 days at 5 weeks post op. Plus, it sounds like I wouldn't even be on soft chew by then. I don't think I will have enough energy to get through it, they are very long intense days, I am usually exhausted when I am in 100% good health by the end of the trip so with this new information I don't think it will be in my best interest. I will wait to hear my OS' determination, but for now I am going to think it's not an option.

Did anyone give blood before surgery? My OS originally said it shouldn't be necessary, but the materials they sent said I can choose to do it if I want , even though a transfusion is not usually needed after jaw surgery. I was thinking just testing my blood type to see if my dad has the same kind. My mom is RH negative, very rare, and I know I don't have her same blood type. Is there an over the counter kit you can buy to test your blood? If I have a close family member that is a match, I won't consider giving blood.

Things are moving along now ... I have an OD appointment on Monday so I am sure I'll have more to post then.

Wednesday, July 9, 2008

I have a date!

Tuesday, September 9th, it's official. My surgery will be at 7 am, I have to be to the hospital by 5:30 am. The hospital requires that I have a pre-op physical the week before, and my pre-op appointment with my OS is August 28. I will have my surgical hooks put on the day before my pre-op with my OS, which means I will have them on for almost 2 weeks. I won't meet with the anesthesiologist until the day of surgery, so I may call the hospital and speak with an anesthesiologist before hand to make surethey don't have a problem with me taking arnica and bromelaine after surgery, since I will want to buy those beforehand.

My surgical coordinator advised that she would be sending me a large packet of information in the mail this week, and not to be too overwhelmed by its size. I told her that I have been doing a lot of reading on the subject for the last year, so I welcome any and all information! I got my Zip-n-Squeeze products on Monday, so now I will have to start picking up the rest of my post-op supplies because I know the next 2 months will fly!

More info to follow after I receive the packet from the OS in the mail ...

Sunday, July 6, 2008

Sorry I haven't posted too much lately, I don't have much of an update but I thought I'd make a quick post. It doesn't seem like a whole lot has happened with my teeth since my last post, I still have the gap on the lowers but I do feel they may have moved back some. The springs on the top did open up the space they were supposed to ... visually you can't really see it too much but I definately feel the space when I floss. I had to go in about a week ago to get my power chain changed because it had broke on one side. They decided to put a stronger one on since I was in. I was supposed to call my OS's office mid June to schedule my surgery for September, but she told me at that time that Dr. P's agenda was not opened up for September yet. So I have been calling back every week, and still nothing confirmed. I am hoping for September 4th as my date ... I will call again tomorrow and see what they say. When I called last week she said it would probably be at least 2 more weeks so I won't get my hopes up. I just want to know at this point, since it is potentially less than 2 weeks away. Patience ... I know ... that is what I need to keep telling myself through this whole process.

The reason I am so set on September 4th is because I have a trade show to attend in Paris mid October. If I have surgery on the 4th, I would be at 6 weeks post op when I leave for the show. Of course, everything depends on how I heal if I will actually go or not. If I am swollen and not able to speak well, of course I will not even consider it. There would be nothing worse than having to smile all day and talk to clients and potential clients if I am not far enough down the road to healing. We'll play it by ear, my OD has already said that I should probably be ok by then, but I am ok with cancelling if I have to. I can't have the surgery any earlier in the week because my husband will be in Europe and gets back on September 2nd. I couldn't imagine going under the knife without knowing he was there at the hospital waiting for me when I get out.

I ordered my Zip-n-Squeeze products on June 26th. I had seen quite a few postings that they are not being responsive right now and orders are taking a while to get there, so I thought I'd give it plenty of time so I have them in time for my surgery. I ordered 2 hospital kits, 2 "cool jaw" wraps, and the recipe guidebook. I am going to slowly start picking the rest of my supplies up, as time in the summer goes so fast and I don't want to leave everything for the last minute.

I have been taking advantage of the good weather lately and going on a daily 10 mile bike ride. I hate to be in the gym when it is so nice out, so it is a good compromise. I figure the better shape I am in for the surgery, the more quickly I'll heal.

My next ortho appointment is on July 14th ... hopefully I will have my surgery locked in by then as well. I will let you know what happens ...