Tuesday, October 21, 2008

2 more weeks of liquid/blended diet ...

I had my weekly OS appointment today, and was "hoping" I would get cleared for soft chew ... but in the back of my mind I guess I had a gut feeling that wasn't going to happen. Dr. P took a look at my plate, and said indeed it seems to continue to be closing up, although he said again that it would take a small miracle to heal over completely. Since I am healing up so nicely ... my reward is ... 2 more weeks of liquids! He fears if I move to soft chew it could rub the incision and prevent further healing. Oh well ... I've gone 6 weeks, what's another 2? (that is my attempt to be positive :) ) . Everything else looked good, yesterday I got cleared from my OD to use my Sonicare and water pic, and I guess it showed because Dr. P commented that my hygiene looked very good.

I ventured to ask about the plate removal procedure, if/when it takes place around week 10. It will be an in office procedure, using IV sedation, and I'll be in and out within an hour or so. He'll precribe me some of the heavier artillary drugs if I have excessive pain, but hopefully I will be able to get by on OTC meds. If we do the procedure on a Friday, I should be back to work the following Monday. I will only have to go back on liquids for a day or 2, and it won't have to be clear liquids, as the plate removal procedure is much less invasive than my original surgery. So that was good news.

We talked about my range of motion ... he doesn't think I'll progress too much more as long as I am in the bands still 24/7 ... although he did say that I may get some more ROM when I move to soft chew and have my bands out for 1 to 1.5 hours each time I eat. He said that it can take up to a year to get my ROM back, his ROM is less than before he had his surgery and since it has been over a year now he doesn't think he will get it back to what it was pre-op.

He will be in Canada next week, so I will not see him, but he still wants me to meet with one of the other doctors just to check on the plate, but so far everything is still looking good.

Monday, October 20, 2008

6 weeks post-op

I am back from Paris, and I can say it went pretty well for my first trip since surgery. Although I was feeling like my energy levels were pretty good and mostly back to normal (if I even know what "normal" is now), I wasn't sure if the time change and change of pace was going to kick my butt. But, adjusted very well going over, as well as coming back. I even managed to squeeze in some sight seeing since I had Saturday free. Since I've already seen the main sights of Paris, and I was staying near Versailles, I went to the Palace of Versaille which I must say was amazing. I highly recommend it if anyone has the time to explore beyond the confines of Paris while in France. The city is also very quaint and unique.

O.K., back to my mouth. On the way out at airport security, they accepted my letter very easily from my OS regarding my liquid nutritional suppliments. I had a tight schedule when arriving to Paris, so I had carried all 18 nutritional suppliments (I hoped I would find other alternatives, but you never know so I was prepared), plus my liquid tylenol and my Peridex, in my carry-on with me without checking any luggage. I knew I would have more of an issue on the way home (they can be very strict in Paris!), so I only brought the liquid tylenol, Peridex, and one Ensure on the plain with me, and the rest I checked. They held me up for about 30 minutes, because they needed about 5 levels of approvals before they would let me through! Part of the problem was that they were looking specifically for the name of the products on the letter from my OS, and he of course was very general in stating nutritional supplements. Plus, I don't think the language barrier helped. But I made it through and am back now.

Today, I had my first appointment with my OD where we were going to start moving and changing things. I was scheduled for 1 hour, but it ended up lasting about 2 hours 45 minutes! Lots of new information though.

First, I asked if the fact that Dr. P could not get all of the movements necessary in surgery because of my tight tissue would alter my outcome. Dr. L doesn't think so, he said it should be no problem to get the expansion I need in the back orthodontically. I also asked about my overjet, as it seems larger to me than it should. Dr. L agreed and said that is why he suggested the band configuration I had when I first started changing my bands. We have some work to go, my lower teeth will pretty much stay where they are, but we can push my upper teeth back some, which will reduce my overjet.

They took out my wires today and repositioned most of my brackets on my upper teeth. For about 20 minutes, I had naked teeth! It gave me a preview of what I had to look forward to on de-banding date, and I can tell you, I liked what I saw ... and that is with still having a bit of work to go! On the lowers, they put my same Sure-Smile wire back in -- minus the surgical hooks (yeah!). As for my upper teeth, I believe I won't get the Sure-Smile wires back in anymore, and Dr. L will finish things off with traditional wires.

The techs had a really hard time with my upper wire. My ROM is still pretty limited, I can get my thumb in there and maybe a tiny bit more, so they had a hard time turning in the wire in the back on both sides. On my left side, they didn't turn it in because of my exposed plate, we didn't want to mess around too much there. So, she cut the wire short so it hopefully wouldn't bother me. On the right side, they put a coil/spring in between my last two molars to open up some space, because in several months (probably 3-4 months) I will get a TAD (temporary anchorage device) put back there, and we will pull my teeth back. So, she couldn't clip that wire too short because it needs some excess for when that space opens up, and since I am still pretty swollen in there the wire was really jabbing. When she tried to turn the wire in, the tool was too big and I couldn't open enough, so it would rub against my stiches and caused some bleeding. I told her I would deal with that pain at the moment because I would rather have that than 7 weeks of a poking wire. Finally, she got it, but I felt like I really stressed the techs out today because they didn't want to hurt me. It was uncomfortable, but I am just glad she was able to get the wire turned in.

So, on my right side I am 95% Class I (Yeah!) ... so just some tweeking to do there. On my left side, I am still Class II, but with the coil and the TAD we should be able to correct that. Overjet, Dr. L will push my upper teeth back to take care of that. My mid-line is still about 2 mm to the left, so we have that to correct that as well. I got a new elastic configuration today (no more box config on the front!). The elastics are much lighter, and I have just 2 bands. I will wear them 24/7, take them out to eat, and at night I have to double up on the elastics on my right side. I believe that will help work on the mid-line.

I think that covers most of my appointment ... at the end Dr. L told me he found out about my blog and has taken a look at it. I asked him if it was from the my Dentist's office (I had sent the gals a link to my blog to follow my progress), and he said no, that he found out from someone (I assume a colleague or professional acquaintance) in Texas. Apparantly, there are not a lot of Sure-Smile patients yet that have been through this surgery. So, between my reference to that in my blog, and my references to Dr. L and Dr. P, and the fact that I am in Green Bay ... they put it all together. So, Dr. L ... if your reading ... thanks to you and Dr. P for all of your hard work to give me a functional bite and beautiful smile!

In other news ... it looks like my plate continues to heal over, although it doesn't seem like anyone is optimistic that it will heal over completely. The good news is that there is no visible bone which means that the chance of infection is much less. I have an appointment with Dr. P (OS) tomorrow so I will update more on that if necessary.

Lastly, kind of a random thought ... but it has been so strange for me to see the way I open my mouth now. I felt in the past like my jaw opened like a hinge, whereas now, with the lower jaw rotation, the top opens paralell to the bottom ... like an eel. It is just so different as your perception of normal changes ... apparantly that is how most people open their mouth!

I know ... I need to post some new photos. I will have my husband take new ones of me in the next couple days. I feel pretty swollen now from this morning's appoinment ... but tomorrow should be better. Today is my last day of working from home ... I will go into the office daily from now on. It should be much better now that I have a much more manageable band configuration.

Thursday, October 16, 2008

A virus and a fever ...

The last couple of days have been a bit rough for me. On Sunday I started to feel achy all over, then came down with a sore throat on Sunday night. By the time Monday night came around, I had a fever of 102, so I called the on-call doctor and he had me start taking the antibiotics my surgeon had prescribed for Paris. The worst was the shooting pains that I started to get in my ear late Monday night … they continued and were much more than I have felt before, I would get sharp pains many times a minute, and also had some constant pain in there as well. I went to see my surgeon Tuesday, and the plate is looking good, he said it has healed over a bit since last time he saw me, although he does not think it will heal over completely. He said around week 10 we will make a decision if we should remove it (I am at 5 weeks right now). Then, I went to urgent care to see what was going on with my throat and ears. He looked in my ears, and said everything looked 100%, but often people come in complaining of ear problems when it is really their throat that is the problem. He looked at my throat and said he saw the irritation, but said that it looked viral, so it just has to run its course. If it is strep, however, the antibiotic I am taking works well on that too, so it will take care of it. So, I’ve been taking Tylenol to help with the ear pains, which has made it much better, although it seems like my worst time of day is 3-6 pm. For some reason, everything just culminates around that time and I feel like crap. It is so strange to me, that after all I’ve been through with breaking both jaws and being banded shut, that a sore throat and earache would be my worst pain of it all! Amazing, isn’t it?

Sorry for the negative post ... just haven't felt the greatest the past few days, but I think I mostly have the pain under control now. I am leaving for Paris this afternoon, so I was particularly worried about my ears because of the flights. There is nothing worse then having congestion or an ear infection and going up to 30,000 feet! It's the way down that's painful ... OUCH! Luckily, I haven't gotten congested, although the doctor I saw said this could be just the start. I hope not!

In better news, I got my toothbrush inside my mouth yesterday! I was so excited ... although just because it is in there doesn't mean you can brush like "normal". But, I got my tongue and the insides of my teeth the best I could. When I tried again last night, I couldn't repeat, but at least this means I've made a little progress on the ROM.

I will try to get up some new pictures when I get back from Paris, I feel like my swelling hasn't been going down much at all anymore. It is mostly concentrated above my upper lip, around my nose, and in my "jowls". I know ... I need to be patient. Patience, grasshoppa ... patience.

All right, I'll update more when I get back from my trip ... Au revoir mes amis!

Friday, October 10, 2008

Plates and Screws, insurance and bills ...

I tried to take a picture of my exposed plate and screws since Kam asked! It is really hard to get the right lighting inside the mouth and the camera to get the right focus for the pictures to turn out right, so I appologize that they are not the best, but you can at least get an idea. The plate is silver, and the screws are actually a gold/bronze color. Hopefully you can make sense of it ...

The bottom two pictures probably best show the gold screws, but the first pic turned out the clearest.
I forgot to post the other day about my insurance. I was reviewing my EOB's that starting coming in (not all have come in yet), and they were processing my surgery claims as out of network! Which meant that they were only covering 70%. I hadn't planned on this, and I had verified several times before hand that my surgeon was in network. So, I called, and the rep I talked to made several phone calls, and their internal information wasn't up-to-date, so he said that all claims would be re-adjusted to in-network coverage. "Good for you for following up on this and not just letting it go!" he said. Jeeeez ... we are talking about a lot of money to just let it go! He was a very nice and helpful guy, though. With all of the bills coming in, I just wanted to verify what applied to my out of pocket max and what I actually had to pay. We got it all sorted out, and he took the time to anser all my questions.
So, when in doubt, call! Make sure you understand your plan beforehand, and go over EVERYTHING with a fine tooth comb to make sure it was processed correctly. In this case, it saved me many THOUSANDS of dollars!

Thursday, October 9, 2008

Back to blending ...

I had my appointment today with Dr. P. He took a peek at my mouth, said everything looked good, the plate is still as visible as day but the tissue around it looks healthy and pink, no infection. I reminded him that I would be going to Paris in a week so he wrote me a prescription, and also for my joint medications which I will start taking again (the Feldene and Amitriptyline, not the doxycycline since it caused me so many problems). I mentioned to him that I had eaten a fried egg ... I didn't chew ... just slurped it into my mouth and he said no ... I have to stick to the liquid diet because if a piece of what I eat gets caught in the incision, it could cause infection :( So I had my few days of bliss ... but it looks like I have to go back to blending things again into minute particles.

I didn't have the courage to ask him once I get the plate removed (not sure exactly when that will be yet) if I will have to go back on the clear liquid diet again for a week. Ugh ... I am torn now. The longer I wait to get the plate out, the longer I have to be on this blended diet because I have the open incision. But, the longer the plate stays in, the more time my bones have to fuse together and heal. Luckily, at least I can still feel somewhat satisfied on the blended diet. I was just hoping I would have a few more options when I go to Paris. Now it looks like it will be Ensure/Boost/Juice for most of the trip, unless I can find some good soups here and there. I guess I should be happy everything is looking healthy and infection free in my mouth given my open incision. And I am ... that is why I will take Dr. P's advise and stick with it. It is crazy looking at that plate in my mouth though ... you can see the screws.

My stitches are slowly starting to disolve, on the inside they "melt" into your tissue and on the outside they start to fray. Dr. P snipped a stitch for me today that was hanging down and wrapping around my braces.

A shout out to Holly who will be having her second surgery tomorrow. Good luck Holly ... I know you will do great!

Wednesday, October 8, 2008

4 weeks post op - ortho profile photo ... Before and After

I had an appointment with my ortho (Dr. L) on Monday, he just wanted to check out my midline and see how my bite was settling in. He said that he's not going to worry about the midline yet because there is still some swelling, things might look a bit different when the swelling goes down. The band configuration looked good, so no changes there. I thought I would post the before/after profile view to date since my ortho took a profile pic. The first picture is pre-braces, the second is a few weeks before surgery, and the third photo is just under 4 weeks post op:

The things that stand out to me are how my upper lip was lenghtened (it seems to come down further now), and the angle it sits at (it comes more straight across, versus how it sas very angled upwards before), which really does the trick in reducing my lip incompetence. And, of course, the stronger chin, which isn't nearly as strong as in the projections (they decided not to do the genio), but I do think I prefer the softer look.

My next appointment will be October 20th, 6 weeks post-op, and it will be about an hour. It sounds like he will be repositioning some brackets, so we will be re-initiating the orhtodontics. Let's go!

In other news ... I have been "eating" soft foods such as fried eggs, pudding, applesauce, yogurt, today I even cooked up some whole-grain pasta mixed with gravy, but had to break it up with my fingers to get it down. I am not chewing so I don't think my surgeon should take issue with it, just anything I can get in my mouth and break up with my tongue on the roof of my mouth that has texture is very inviting to me right now! I know I am not supposed to move to soft chew until 6-8 weeks, but I don't really consider it chewing if I am just slurping it in and swallowing, without chewing, so I don't think I'm cheating :) I have an appointment with Dr. P tomorrow so we'll see what he says. Tonight I picked up some cottage cheese and pineapple tidbits, also some whole grain pancake mix, so I might try that tomorrow.

Saturday, October 4, 2008

3.5 weeks post-op ... Day 25

Just a quick post this time with today's pics ... my smile looks a little crooked in the photos today so I must have some uneven swelling ...

My mother-in-law leaves today to go back to Mexico, so as of tomorrow life as we know it will be back to normal. I really was blessed to have so much post-op help ... I am so greatful to my mother and mother-in-law as they both helped to make my recovery so much easier :)

Thursday, October 2, 2008

Day 23 post-op

Today I received a call from my OD's office, they said that Dr. P had spoken with Dr. L regarding my situation, and Dr. L (OD) wanted to schedule an appointment with me before Oct. 20th when I was scheduled to see him next. So I have an ortho appointment now on Monday.

I saw Dr. P for my 3rd follow-up appointment since surgery. He said that the mid-lines look better than last week. He said instead of my maxilla moving, it may be that the swelling is creating an illusion. So, let's hope this is the case, and as the swelling goes down my midlines will be spot on! We'll see what Dr. L says on Monday.

In other news, he took a look at my plate, and said that it has opened up a bit since he last saw me. So that is bad news. It means it probably will not heal over on its own. So I will need to continue to do the Peridex treatment, he told me I could reduce it to only once a day, but I had to continue to reduce risk of infection. I asked him if he preferred me to do the rinse twice a day, and he said yes, but it will cause more discoloration to my teeth. I told him that if he wants me to do it twice a day, I will, because right now my primary concern is my health, and I can worry about the aesthetics of cleaning the dark film off my teeth later. He agreed, I am also to do 4-5 salt water rinses a day as well. Once I move to soft chew, which will be around the 6-8 week mark, we will give it a couple of weeks and decide at that time if I am ready to get the plate removed. He explained that in a human being, bones take about 56 weeks to heal. It would obviously be preferable to keep the plates in, but the risk is infection. So you need to weigh the better of two evils. At 8-10 weeks post-op, the bones are only semi healed, however I have 2 plates on each side of my jaw where the BSSO incisions are, and he will only remove one of the plates, the one that is exposed. So, I feel much better about this now. From all of the stories I have read, I wanted to keep those plates in as long as possible, to prevent relapse or non-union. But I feel a lot better if I reduce the risk of infection by removing the plate plus I keep one plate in. Many only have one plate on each side with the BSSO to begin with, so I am feeling pretty good about this. Obviously it would be nice to not have this complication, but when I decided to go though this process, I knew that I would have to do "whatever it takes" to get to the finish line and deal with whatever complications arise. Normally, he would clear his patients at this point to see them in 4 more weeks ... but given my exposed plate, I have to continue seeing him weekly (not that I mind).

I asked him what may have caused the exposed plate, he said it could have been a multitude of causes, but possibly, since when viewing my x-ray, the plates appear a bit higher on the left side than on the right, they could have been a bit to high (too close to the incisions).

I asked Dr. P about my sutures, he said that they are self-dissolving and should start to go away around the 5-8 week mark. The ones under my upper lip will take the longest. I am ready for them to go so I have the resemblance of a normal smile again!

I told him that I could open about as much as my pinky finger, and it felt like there was something stopping me in my left joint. He said that is normal, that it would take me months to get my ROM back, and the blockage that I feel could be from a variety of reasons such as swelling in that area or other factors.

he said my swelling has gone down nicely since my last appointment, particularly in my gums. He said the ones in the back are about a quarter of the size (swelling wise) of what they were last week. I have noticed that the swelling in there has gone down considerably as well. I wonder if the bromlain has had anything to do with that, or if that is just my body healing naturally.

He said my profile is coming in nicely, he is glad that he did not to the genioplasty because I will have a good profile without it. I concur, the projections were a little bit strong (masculine) looking, and I prefer the softer look, plus I believe it made my recovery much easier. Not to mention the finacial bennefit of not doing the genio.

He said I should see the swelling in my lower jaw to continue to come down, but the swelling behind my nose, under it, and along side it could take up to a year to diminish. I gues sthat is consistent with what I've read elsewhere ... and everyone heals a bit differently.

He asked me how I was feeling overall, and I told him that I prepared myself for the worst, and recovery has been "easier" than what I anticipated. The worst was the 2 full weeks of liquids no particulates. He empathised and talked a bit about his experience, how hard it was to choke sstuff down when nothing tastes good and you just loose your appetite.

I just can't say enough about my OS and OD. First, that they are in such close contact to ensure that I have an optimal result. And Dr. P takes the time to answer all my questions, calmly, and he's not put off by any question. He just has such a great bedside manner and explains everything in laymans terms so I am comfortable with it. I wonder if he was always that way, or if part of it is a result of him having undergone the surgery himself. Either way ... I feel pretty lucky to have such a competent team of medical professionals.

Lastly, my boss asked my yesterday if I would be able to go to Paris. Not for the food show that I was originally considering, but for a meeting which is taking place about the same time. I said I didn't think there was any reason I couldn't go, but I would get it cleared with my surgeon. The food show was completely out because how can I be on my feet for 5 days, 10 hours/day, talking with clients and potential clients all day long while still banded shut and on a blended diet. But, a 4 hour meeting seems perfectly acceptable, and my surgeon agreed. He just wants me to let him know before I go because he will put me on antibiotics, he doesn't want me to go to be in a foreign country and have an infection. I'll only be gone 2 or 3 days at the most, so I think I can survive on juice, Ensure, and Boost for that period of time.

Sorry for the long post ... I will update with more photos this weekend.