Monday, September 1, 2008

Surgical Hooks and Pre-op appointment with OS

Last Wednesday (Aug. 27), I got my surgical hooks put on at Dr. L's office. I only have 2 on the uppers and 2 on the lowers, so it's not too bad. I just keep lots of wax on one of the lower ones because it rubs and caused a canker sore, but that's to be expected. As most have said, the most annoying part is all the food that gets stuck in them, they are harder to keep debris free. I asked Dr. L about the 2 predictions. He said that the first prediction was too masculine, so they softened it, so my result will more similar to the 3rd prediction picture in my last post. The projected movements, he said, were around 3.8 mm on my upper jaw (advancement), and 15 mm mm for my lower jaw, and around 3.5 mm for my genio (also advancements). As I processed this information, the math wasn't coming out right, given I started out with a 6 mm overjet and was supposedly going to be around 7 mm when I was ready for surgery (2 mm is ideal).

Thursday (Aug 28), I had my pre-op appointment with Dr. P, my OS. I had my mom come along since my husband is out of town in Europe. I had molds done at my pre-op appointment with my OD, so I wasn't expecting any new ones with my OS, but I was wrong. We had to take more pictures and molds. I was pleasantly surprised that everything came out pretty easily at my OD's office, but the trays at my OS's office were metal and had small holes all over them, so the back of the trays would get caught on my back brackets. Needless-to-say, I was happy when that was all over. Apparently my OS makes his molds into some stone material, so he could not use my OD's molds which are plaster. Prior to that appointment, I had my teeth cleaned, so by this point my joints were quite sore.

My OS had bimaxillary jaw surgery last year for obstructive sleep apnea, and I hadn't seen him since he had his surgery. I asked him who did his surgery, and he said an OS in Santa Barbara, CA. I said "Dr. Arnett"? He said yes. I believe he had his surgery last October or November, and he still has some residual numbness in his upper and lower lip.

He marked several black dots down the front of my face with a Sharpie marker, and pulled out the face-bo to take some final measurements. He pulled out his ruler and measured my gummy smile (4 mm of gingival tissue show when I smile, 9 mm from gum to top of lip). Also, my midlines are about 2 mm to the left (and chin as well). He said that a trained eye can usually pick up on a deviated mid-line at about 3 mm, and a lay-person when it is about 5 mm off. I truly didn't realize I was even off ... since both mid-lines are deviated the same way so they "look" like they line up. I also have a cant to my lower jaw. This will all be fixed during the surgery.

He still isn't certain how many segments my LeForte I will be, he will be sitting down with Dr. L one more time before my surgery to discuss my case and finalize the movements. He said that they may not even do the genioplasty. I asked him if someone could call me before the surgery to let me know the exact measurements of the movements they would be making, which he agreed to. I also asked him about the numbers Dr. L had given me, as 15 mm seemed like a huge movement for the BSSO. He said that was the approximate distance that my jaw would move including the rotation/leveling of my plane angle, but not necessarily how much they would be actually moving my mandible. So that makes much more sense. I am hoping I will find out beforehand the exact movements of the actual bones, I don't know why I am so interested, I guess I have read so much and it seems like most talk in terms of the movements of the bones vs overall movement, so it is easier to compare to others that way. In any case, if between my lower jaw and genioplasty, the overall movement is 18.5 mm ... that is 3/4 of an inch which will be a dramatic change! As I said to my OD, function first, aesthetics second ... but I sure would like to come out of this looking good. I do have to say, though, I have implicit trust in my OS and OD, they both have such a comforting demeanor and work so well together, so I have no doubt everything will turn out OK.

I asked had several questions for Dr. P, most related to supplements and post-op eating. I have to be on clear liquids for one to two weeks post op. Clear means see-though, so no milk, ensure, shakes, carrot juice, etc. That limits me to things like Sprite, apple-juice, chicken broth and gatorade. He did say I can have cranberry juice ... he considers that clear. I am hoping my sutures heal quickly so I can move on from the clear liquids after the first week. One week seems do-able, but 2??? Yikes! He very conservative on post-op eating, from what I have seen from others. He is very worried about infection, so doesn't want to take the chance of any particulates getting in to the incision site. He also is very cautious about getting sick (meaning vomiting), he said he has not had a patient get sick in 1.5 years. Therefore, as long as I am on the clear liquids, no supplements (even grinding up my vitamins or using liquid vitamins), no protein powder, no bromelain, no added fiber. I am not sure if it is all because he is worried about vomiting, or if some may be because he is worried about the particulates causing infection, but in any case ... no ... not until I have graduated from clear liquids. Well, I tried ... I was just looking for ways I could feel a little more full while on the clear liquids. I did pick up some of that K20 Protein water by Kellogg’s ... that way I will get in 5 g protein and 5 g fiber with each drink and I am not adding any supplements ... hopefully those will help a little my first week. The one thing that he did clear for me to do post-op is MLD (Manual Lymph Drainage), which I was very pleased. For those who do not know, MLD is a very gentle massage, it is a therapeutic method that uses massage-like manipulations to stimulate lymph movement. Lymph is the plasma-like fluid that maintains the body’s fluid balance and removes bacteria. Lymphatic drainage is said to beneficially affect the nervous, immune and muscular systems. The treatment consists of light touch massage that accelerates its movement and circulation. Lymph Drainage Massage strengthens the immune system and is for post-surgical patients, and for people with edema and seasonal allergies. It helps expel toxins from your system and ultimately will help with the post-op swelling.

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