My Orthognathic Journey

The Braces are off!

2009-03-05T20:37:00.021-06:00

First, I have to apologize for not posting for a couple months. It is amazing ... a few months after my orthognathic surgery, life does not revolve around my mouth anymore! It is true ... there is life after orthognathic surgery ... and it does not consume my every waking thought anymore (or while I'm sleeping for that matter)! So, unfortunately, I am quite sure I will leave out a few of the details in my brief recount of the last couple of months, but the meat of my blog I really do believe is during the 6 weeks post-op recovery period, anyway. I do apologize for all my spelling errors and typos during the first couple weeks after surgery, but I didn't want to go back and edit because I was reminded by the blurred vision, so my horrific writing is a true reflection of a part of my post-op recovery.

So, January was relatively uneventful orthodontically. I traveled quite a bit for work, so that made the month fly by. I had a couple of migraines, but not alcohol induced. They were most likely hormonal, given the timing. I guess I need to be more diligent about taking my magnesium again. On February 2nd, I had another orthodontist appointment. Got a powerchain all the way across the top, and no longer on the bottom. Elastics only on the right side at night. Here is a progress pic from that appointment:

The following day, I had an appointment with my OS. Everything looked good, except my ROM, which I expected. I was only at about 30 mm, and I don't think I've progressed much more since then. So, I am not released yet from his care until I get up to at least 40 mm. I have a follow-up appointment for May, at which time I hope to be to where I need! I will be working on it daily, as I am afraid that if I don't I will loose it. He doesn't want me to do tongue retractors or put anything physically in there, for fear I could damage my teeth. So, stretching exercises it will be.

At some point in February, I thought I had a piece of food stuck in between my tooth/band on my upper left side, so I started digging with a toothpick. Well, I don't have the feeling back in my upper gums, so little did I know that I was actually picking at my gums. I made a mess out of them, and with the band around the tooth, it didn't allow it to heal very well, so it is still a bit of a mess. Things should get better now, though.

One week before debanding, I had a DOUBLE power chain put on my upper teeth, one below the archwire and one over top of it. That was fun. While putting it on, one bracket popped off my upper right tooth. We got the bracket repositioned and back on, and wouldn't you know, the other bracket popped off the upper left tooth. Geez! The objective of this torturous dual powerchain configuration was to close the gaps next to my upper canines. Soon after the visit, the one on the left was closed. But the stubborn one on the right persisted, and I was incredulous that I would really get my braces off yesterday. So, skeptically, I went to my debanding appointment.

I am not going to sugar coat it. It was a painful experience. With the feeling starting to come back in my upper gums, everything is ultra-sensitive. I used to love brushing with my sonic care, and even that was not a pleasant experience any more. The vibration against the brackets is annoying. The wierdest part, when sanding off the glue, the feeling is criss-crossed along the gumline above my top front teeth. My bottom teeth didn't like the pressure when taking off the lower brackets, either. I felt bad for the hygienist. She was trying so hard to be gentle, but I felt like somewhat of a baby. I usually have a pretty good threshold for pain. But, I got through it, and I was willing to endure ANYTHING to get those babies off. Before getting the brackets off, she put a double power chain on the upper front teeth to close the remaining gap. It opened back up after taking off the chains, but the tooth is mobile, so the retainer will put it in its place.

I need to forewarn those who have bands on their back teeth. Although I felt I've kept very good hygiene throughout this process (except for the weeks post-op when I wasn't allowed to brush), there was a very disturbing stench when taking those bands off. Luckily, the hygienist wears a mask, otherwise I would have fully expected her to gag.

Since debanding, I do have to admit I have been obsessively narcissistic, looking in the mirror incessantly at my new shiny teeth and bite. "This isn't my mouth!" I exclaimed when I had my first look. The results, using the words of my orthodontist ... "Perfect".

So, now that I have completed the majority of this process, I feel that it is high time to give due credit to the amazing team of professionals that have gotten me to this point. I have added a list on the left side of this page that includes a hyperlink to my OS, OD, and dentist. I wouldn't have started on this journey if it wasn't for my dentist, Dr. Villwock, referring me to see an orthodontist. From there, Dr. Lin, my OD, took over and diagnosed me with vertical maxillary excess with mandibular AP hypoplasia. Dr. Lin referred me to Dr. Parmar, my OS, who is the most empathetic surgeon I could ever ask for! Combined, they have provided me with a result far superior to what I could have ever envisioned. I am so grateful for their expertise, patience, and professionalism. I wouldn't change a thing about any part of my treatment. I was and am truly blessed. And, I could never forget everyone at their offices who were always my biggest cheerleaders, along with my family, friends, and of course all of my fellow ortho bloggers! Cindy, Lisa, and Traci at Bellevue Family Dentistry have always been wonderful to me, and especially through this process! The countless number of techs at Orthodontic Specialists who worked on me and always had positive and encouraging things to say. And the receptionists at Bay Oral office who I got to know very well since I was there once a week for oh so many weeks post-op while waiting for that exposed plate to heal over. Sorry if this sounds like an Oscar acceptance speech, but I am forever grateful to everyone involved in this process, the results have been truly amazing. Now, when I place my hands on each TMJ and open my mouth, I no longer hear the cracking in the right joint and feel the popping out of the left joint. I can actually see my bottom teeth when my teeth are together, and at the same time I can feel the back of my upper teeth with my tongue! There are so many functional differences, not to mention the relief that I am not continuing to wear down my joints. The cosmetic improvements were a very positive side-effect. This was all so worth it.

So, I am sure you want to see pictures of my naked teeth! I'll start off with a picture of Dr. Lin and I, freshly de-braced!

Below are my before and after photos. The befores were taken in June, 2007, and afters in March, 2009. I now introduce you to my Class I bite!:

Front view, no smile. Notice the lack of lip incompetence! No more puckering of the chin when my lips cme together. Also, the nose has changed. I didn't think I wanted my nose to change from this surgery, but I definately think I like my new nose better!

Front view, smile. No more gummy smile! I no longer need to posture my jaw forward so I don't have a double chin!

Right profile. I have a chin! Nuff said. Also, look at the difference in the angle of my upper lip. Dramatic difference.

Front teeth, closed. My lower teeth are now visible ... no more deep bite!

Front teeth, slightly open. Dramatic difference in the crowding of the lowers.

Left and right occlusion. Check out that Class I relationship. No more overjet or overbite. Very swollen gums from lots of torture, but an extremely satisfied patient!!

Upper Arch. Check out how much it widened and rounded out.

Lower Arch, a picture is worth a thousand words.

For retention, I have a fixed lingual retainer on the bottom, and an essix retainer on the top. I am to wear the essix day and night for 3 months, until instructed otherwise. My gums are too swollen at this point to get floss in at my gumline on my lower teeth, so I need to allow the swelling to reduce and work on that with some oral pix. I plan to give my mouth a rest for a while, and next year I need to have one of my molars crowned due to a large filling, and will slowly get my metal fillings replaced by composite ones.

I will post again soon with some of my reflections on this whole process. I still follow all of your blogs, and look forward to your updates. Hopefully, my blog will serve to educate future orthognathic surgery patients as your blogs have educated me! In the process, it has been incredibly therapeutic and I have created a diary of my journey along the way.

4 months post-op

2009-01-05T20:24:00.003-06:00

I received my early Christmas present a few days before Christmas ... a call from the dentist's office that there was a cancellation and I could get my teeth cleaned the next day! The gals are always so cheery when I go in there, so it is always a treat to see them as well. Hi Ladies if you're reading! :)

Today I had an ortho appointment with Dr. Lin ... he looked in my mouth and said everything looked excellent. I got a new upper and lower wire, and kept the power chain on the bottom but only have a power chain on the front four teeth on the top. I need to now wear an elastic on the left side of my mouth 24/7, and on the right just at night. The best news of all ... I have a debanding date!! March 4th and I will be brace free! I couldn't believe it ... I still can't. That will mean I will be de-braced just a few days shy of my 6 month mark post surgery.

My teeth are sore tonight from my adjustment, but I don't care ... I have a debanding date!!

In other news, I did have 2 migraines over the holidays, but I must confess they were purely alchohol induced. I figured it was too good to be true that I wouldn't even get a migraine from drinking. At least that is something I can control myself though.

I will have new progress pics taken at my next OD appointment at the beginning of February, which I will post at that time. I am making progress very slowly on my ROM, I can get my index finger and middle finger in sideways up to my first knuckle. Dr. L mentioned that he has referred several of his surgical patients to my web-site, so if any of you are reading, know that you are in great hands with Dr. L and Dr. P!

3 months post-op and exciting news!!

2008-12-09T23:25:00.009-06:00

Recovery from the plate removal was much better than I expected. I had absolutely no swelling, and I didn't need to take any pain meds, not even OTC. By the next day, I was feeling absolutely normal.

Today I am 3 months post-op. I had an ortho appointment, which went very well. Dr. L looked at my bite, and could tell I have been very diligent about wearing my bands, because my bite is almost perfect! He said that we won't even need to put in the TADS anymore to pull my bite back! So we can close up the space that was just opened with the coil. He said that in the "old" days, when they used the splint, it could actually work against the orthodontics if the splint wasn't exactly in the right position, and the orthodontist is basically SOL. But now, without the splint, he can get started much earlier with elastics to move things into place before they set. I believe I read on Archwire that teeth are more mobile than usual in the couple of months post-surgery, due to the prostaglandins that are released around the damaged tissue. The OD can make the most of this by getting a lot of movement done in those few months. And it looks like that held true for me!

Given the good news on my progress, I finally had the courage to ask about a potential debanding date. The news that followed made my day, and was honestly much better than I ever had hoped. He said I could expect to get my braces off in 4 months, which would put me at April! I have been in braces for just over a year now, so I can handle another four months. I am so excited ... I really didn't expect to get them off so soon.

I now only need to wear my bands after dinner and at night, just to keep my bite wear it is. I got my power chain replaced on my upper teeth, and a new power chain on my lowers. The coil came out as we are going to close up that hole between my molers now that we don't need the TADS. I also asked about my airway, so Dr. L ordered a Lateral Ceph so we could compare. Below are the side-by-side images ... it is amazing how much my airway opened up!

In addition to the wider airway, there is a dramatic difference in the soft tissue around my chin in the above x-ray. When I got my plate removed last Thursday, I mentioned to Dr. P that I haven't had any migraines. He mentioned that coventional wisdom points to my now stable occlusion and less load on the joints, however he also has been reviewing some recent research on airway and I believe he said fibramyalgia. Basically, these studies show that there is a correlation between pain and small airway. When the airway is opened, the patient many times doesn't experience some of the pain they suffered from before. This could also be something that is helping to reduce my migraines, in addition to to my TMJ's being much more stable now. The piece I don't really understand is why I used to get migraines when I drank alcohol, and now it seems that alcohol does not trigger a migraine for me anymore. I was hoping for my migraines to be reduced with the surgery, but I honestly didn't think they'd be eliminated completely because I never thought it would prevent me from getting one when I drank. In the end, I guess I don't need to understand it, I am just elated that they have been almost non-existant! I just hope it stays that way!

Below are my 3 month before and after pictures. I am so happy I went through this. It has been worth it in every way and I am very pleased with the results thus far, on all accounts.

Here is my panoramic x-ray, so you can see all of my hardware. You can also see the gaps in my bones from where my mandible was advanced.

I will post more pics of my teeth and bite later this week. My teeth were somewhat sore after my ortho appointment today, I don't know if it is because that space is already trying to close up, or because I was really aggressive with chewing today. I am hoping my ROM will start to increasing at a faster rate now that I am only in bands at night.

Plate Removal Successful ...

2008-12-04T13:00:00.003-06:00

I am back home, everything went very well, in fact I believe I was awake for most of the procedure and remember most of it, but felt nothing. I had to stop on the way home for my antibiotics, but at this point no pain and no swelling as far as I can tell. Hopefully it will stay that way! I have to be on the Peridex another 2 weeks which is when I will see him next, and hopefully after that I can schedule a cleaning!

I forgot to mention yesterday on my post that when I run my fingers along my lower jaw line on both sides, I can feel the gaps from where they advanced my jaw! He took another x ray today after the plate removal and I am down to 7 plates now, 39 screws. The sutures should disolve much more quickly this time, within a week or so. I am hoping I will be feeling this well later when the IV sedation wears off ... so far a piece of cake!

Plate Removal Tomorrow and Before and After Pics

2008-12-04T00:34:00.007-06:00

I thought since I will be puffed up tomorrow on my left side from my plate removal procedure, I should put some before and after photos from the month before surgery to 12 weeks post-op. You can really see a difference in my nose. I think there is still some swelling in my nose because my nostrals are uneven, so it will be interesting to see how things settle out. You can also see a big difference in my lip incompetence, no more gummy smile, and a more defined profile.

Lately I have been getting a lot of food stuck in between my last two molars on my upper right side. The other day, I took a toothpick and usually the end would tightly wedge in between the two teeth. Well, I forgot about the coil that was creating a gap in between the two teeth, so the toothpick went right in and stabbed me. I put my tongue up there and a siqeable gap has opened up. So, that's good news. I have also been flossing for the last few weeks ... I can feel the floss in between my lower teeth, but I can't in between my upper teeth. If my teeth have even a tiny gap between them so the floss doesn't "click" between them, I keep putting pressure waiting to hear the click, and then realize that the floss is already on my gums. They don't bleed, though, I think because the surgery cut off the blood supply and all of those blood vessels have not reconnected and regenerated yet.

My lower incisors have dark stain marks on them from the Peridex. I am hoping things heal up quickly from my plate removal so I can go in and have a cleaning. Hopefully I won't have to keep taking it. That would be a great Christmas present, my pearly whites back!!

I'll post an update after tomorrow's procedure ...

Pics - 10.5 Weeks Post Op

2008-11-23T00:31:00.010-06:00

It's hard to believe, over 10 weeks since surgery. Here are my pics from today ...

Plate Removal Scheduled

2008-11-22T11:31:00.003-06:00

I saw my OS on Thursday. He asked me how soft chew was going, I said good ... I can just about eat anything as long as it is small enough to get between my teeth. No pain what-so-ever. That's what we were waiting for to remove the plate. Everything appears to be solid, plus I will still have the other plate that will still be in the side they remove it from, so there shouldn't be any risk of relapse. He will also cut away some of the over growth from my cheek at the same time so i am not chewing on my cheek.

I scheduled to have it removed on Thursday, December 4th. I was hoping to do it on a Friday so I had the weekend to recover, but that didn't work out so I took off on the 5th. If I don't have to take the heavy duty pain meds after (I will try to get away with just OTC if I can, but certainly will take the heavier ones if needed), I may try to go in to work the next day, we'll just play it by ear.

As far as the procedure goes, I will be sedated with a cocktail of Versed, Fentanyl, and a steroid to reduce the swelling. You are half awake, half asleep for the procedure, but 95% of people don't remember. Hopefully the fentanyl won't affect my vision again, I guess it is just temporary if it does, although I'm not sure if it was my anti-nausea patch or the fentanyl patch that blurred my vision so much after my bimax surgery . The procedure will last about 45 minutes. Pretty straight forward and MUCH less invasive than the last time.

Recovery wise, it shouldn't be too bad, I will just need to keep away from the stiches and incision site again. I am prepared for the lopsided swelling, but hope it doesn't linger too long so I am back to normal by Christmas and New Years. It should be pretty good after a week. It could limit my ROM some, we'll have to wait and see. I can get 1 finger in there now, vertically, all the way back to the back knuckle, so I still have a ways to go. I think I was able to get 3 fingers in before surgery.

I'll post if anything happens before my plate removal, but no appointments between now and then. I'll try to get some new pictures up before plate removal.

Soft Chew!!!

2008-11-15T17:46:00.003-06:00

Sorry that I haven't posted and left you all hanging ... I am in Argentina right now and going to Brazil tomorrow ... so I haven't had much time to post. I did get the ok for soft chew on week 8 as I was hoping, and I have been really enjoying it! I was upgraded on my flight here, and they give you mixed nuts before your meal. I was shocked that I could actually eat the cashews! The biggest pain is getting them out of the braces. I actually think I can eat about anything right now if I have the patience to chew it. The most limiting factor for me is my range of motion, I can only open about a finger and a half, so it is not like I can just bite into things and start chomping. I also have to try to just chew on my right side so I don't get a ton of food stuck in the gap where my exposed plate is. I have my next appointment with my OS this Thursday, so I have a feeling we will be discussing at that time when we will take the plate out. At my last appoinment, my OS held my forhead firmly and torqued on my maxila and then on my mandible. No mobility what-so-ever, so it looks like thinks are pretty solid at this point. When I go through airports and crowded areas, though, I am still a little gun-shy, afraid that someone is going to elbow me in the jaw and knock something out of place.

I am almost at 10 weeks right now, and still have some residual swelling. On my right side along my jaw line, I can feel a lump there, I am not sure if it is just more swollen there than on the other side, or if it is scar tissue, but it definately feels different. It is also a little tender in that area when I touch it. Strange, since I would have expected that to happen more on the side where the plate is exposed.

Still no migraines ... I just can't tell you how happy I am about that. Over ten years of suffering from them ... I don't want to speak prematurely because who knows what could happen once I get my range of motion back, but if they are truley a part of my past I will be more grateful than you can ever imagine for having this surgery. I still get the occasional ear pains, but they usually go away and don't last too long.

I can't wait until I can stop using the Peridex. My teeth are now very dingy looking and I am looking forward to getting them cleaned, even if the hygienist can only get the outsides and can't get inside my mouth.

I don't think I mentioned this before, but my cheek is basically healing over my lower left bracket. It is almost completely covered now. My OS told me last week that the same thing happened to him. It is like that on the right side, too, but not nearly as bad as the left. Not too fun, unless you like chewing on your own cheek.

Well, that is about it for now, I will post more after my appointment Thursday.

8 weeks post-op ...

2008-11-01T18:42:00.011-05:00

Well, I am just shy of 8 weeks post-op ... day 53 to be exact. And I am long over due for some photos, so finally I took some new ones today. I believe I have just a bit of residual swelling left, but pretty minimal by this point, mostly around my nose area.

I still get some shooting pains in my ear now and then, but it is manageable. What I am most pleased about is that I used to get migraines every time I would have a few cocktails, and the few times I have had drinks over the fast few weeks have not resulted in a mind boggling migraine. I haven't really had them period ... so I am hoping this lasts.

So ... here are the latest pics ... I am definately pleased with the results so far ... we have some work to do yet on my bite but actually having a side profile, plus (hopefully) reducing the migraines ... has made this whole process all worth while.

I have an appointment with my OS on Wednesday, I am hoping to get cleared for soft chew, so cross your fingers for me!!

2 more weeks of liquid/blended diet ...

2008-10-21T21:21:00.003-05:00

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.

6 weeks post-op

2008-10-20T14:47:00.003-05:00

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.

A virus and a fever ...

2008-10-16T08:35:00.004-05:00

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!

Plates and Screws, insurance and bills ...

2008-10-10T15:13:00.006-05:00

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!

Back to blending ...

2008-10-09T21:47:00.005-05:00

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!

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

2008-10-08T21:35:00.006-05:00

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.

3.5 weeks post-op ... Day 25

2008-10-04T10:22:00.007-05:00

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 :)

Day 23 post-op

2008-10-02T16:26:00.004-05:00

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.

Day 19 post-op

2008-09-28T18:21:00.007-05:00

Wow ... what a weekend. On Friday, our house was like a revolving door. The cleaning people were here, and then the window washer came. The phone rang a couple times to ask for directions for a couple of deliveries??? I received a beautiful ficus tree from my godmother for my recovery, and some beautiful sunflowers from my boss and his wife. The morning was starting off to be a good one. Then, around noon, I was on working on my computer, and all of a sudden my mom showed up at my house with my best friend and her husband! They flew in from Denver ... apparantly they had been planning this with my husband for several months. It was a VERY nice surprise!!

Last night, we were out on the patio hanging out and chatting, and there were a few times I was just cracking up laughing. I had to hold my upper lip so I didn't smile too much as I was worried I'd pop a stitch. I ended up getting sharp pains in my ear, I think all of the tension in my jaw from laughing got to me. I swelled up considerably. Everything in moderation I guess.

I can only open my mouth up about one finger, I was able to get my vitamins and a bromelain pill in. When I open and do my jaw exercises, it feels almost like something is preventing the left joint from opening further, it's so wierd.

As for my bands, I spoke too soon after my last post. The second time I had to put my bands on, it was an absolute nightmare. I took about 30 minutes to get my lower left one in, and thought I would never get it. I was so swollen after that, it was ridiculous. The next couple times were a little better, but now I think I have the hang of it. Definately not fun at first.

Here are some pics from today, day 19. I can't believe it has almost been 3 weeks ...

Day 16 post-op

2008-09-25T21:52:00.003-05:00

Today I had my 2nd appointment with my OS, and lots happened today. First, when my OS was checking out my mouth, he said that my mid-line has shifted to the left on my upper jaw, and it was right where it should have been when he saw me last week. So, we are going to have to use rubber bands to get it back to where it should be. When I looked in the mirror, wow, it is way off ... I didn't measure but I would venture much more than before my surgery (I was 2 mm to the left) ... I think I am about 5 mm to the left right now. Yikes.

Then he saw the exposed plate. He said that wasn't exposed last week either! So, he has me doing Peridex twice a day now for the next couple weeks, apparantly it will help skin heal over the plate hopefully. I cringed when I heard him say Peridex because I know it stains the teeth, but he said only when used long term, so hopefully my teeth won't get too dingy from a couple of weeks of use.

He showed me how to change my bands, and tonight I changed them for the first time. I did it in about 15 minutes! I thought I would take much longer, but I have to say, the one on my lower left back molar is so hard bacause the hook is so close to the gum. Since I can't feel my gums, makes it a lot harder to try to hook the band on, and you don't know if you are beating your gums up. But, I did it, so I was happy. I also can brush my front upper and lower teeth, along with my upper molars. He won't let me brush my lower molars yet because of the sutures.

I am also cleared now for a blended diet and I can eat dairy now! So, after leaving my OS's office, I got a Vanilla shake from McDonald's and sucked it down. We stopped at the grocery store to get a few more things now that I am on blended, and I cooked up 3 strips of bacon and mixed them in the magic bullet with home-made black beans and beef broth. Wow, that was good, but it was so weird to eat something with particulates. Since I can't really open much, they didn't get into my mouth. Oh well ... the appetite is definately back and it was DELICIOUS!! I can't even describe how weird the eating process was, though. I envisioned moving to particulates much easier.

That's all I'll post for now. I should also mentioned that I lost all of the 8 lbs that I gained inicially and I am now down 9 lbs. from where I started. That seems more normal!

As of Tuesday morning, I was off all pain meds, including children's motring (ibuprophen). I took some tonight beacause my teeth are a bit tender from the new band configuration.

13 days post op ...

2008-09-22T17:38:00.002-05:00

Last night, I coughed in the middle of the night and popped the band on my front teeth, so I called today and they had me come in, although I was going to see another doctor, not Dr. P. First I had my Ortho appointment. He checked everything out, and said things looked very good, although Dr. P had mentioned to him that he had a very hard time stretching my pallet (the tight skin issue). He said that I would be very happy with my progress by the 4 week mark, and that my profile was settling in very nicely. They took a few pictures (no lip retractors, but they had to stretch my mouth with the assistant's fingers so she could get pics of both side of my bite) and I was on my way.

I saw Dr. L at the Oral Surgeon's office, and found out some new information that made me understand Dr. P's conservative approach to eating much better. When he started checking out my mouth, he said to me that I need to do a better job of brushing. My mom and I glared at him and we both blurted out that I had strict orders from Dr. P NOT to brush, that I wasn't to disturb my sutures in any way. He wasn't sure why Dr. P wouldn't let me brush yet, and started looking around my mouth, and said "ah ... I see now. It looks like you have an exposed plate". What??? I guess that kind of freaked me out. He said that happens occasionally, that the skin will not stretch completely over the plate. The skin very well may grow over it while it is healing, if not, I can have it removed down the road. He said there was one gentleman that had been one gentleman who recently came in that had an exposed plate for 2 years now, he was just getting sick of food getting stuck there so had it removed, but otherwise caused him no problem. I will definately be asking Dr. P about this at Thursday's appointment. But it explains why he doesn't want me to have anything with particulates. I also asked Dr. L about eating dairy ... he said the reason I shouldn't have dairy is because it leaves a thick film on the teeth, and since I am not allowed to clean them yet, not a good idea. So I am really crossing my fingers that on Thursday Dr. P gives me the ok to brush (I know I won't be able to brush my back teeth because of the exposed plate, but at least the front) and move on to a pureed diet.

In other news ... the last two nights I have woken up every hour to hour and a half, and have had a hard time getting back to sleep. I asked Dr. L about this today, and he said that this is common when you are coming off the pain meds as they can be a bit addictive, even though I didn't take them for that long. So, hopefully that will be short lived ... as it is quite annoying not getting a good night sleep.

I am going back to work tomorrow on a part-time basis, just for the week, and next week I will be back to full time, although I will be working from home. It will be good to get my mind back on work so I can start focussing on things other than my mouth again, hopefully it will make time start to go faster as I think I have been feeling the "blues" these last few days.

Day 12 post-op

2008-09-21T19:55:00.009-05:00

Sorry ... I've been a bit lax lately about posting. I have pics from most days but I will post just the ones from today. I am completely off all my meds now, except ibuprophen. My vision is slowly returning to normal, it is not perfect yet but gets better every hour. Here are today's pics:
I am starting to get some tingling in my left nostril and roof of my mouth as the feeling is begining to come back.

I occasionally get sharp pains in my ears. Tomorrow is my first appointment with my orthodontist. I am looking forward to Thursday's appointment with my OS because I am hoping to graduate to any blended food. I just don't have an appetite so it is hard to get things down, but I am trying to force myself so I atleast get some calories in.

Day 7 and 8 post-op

2008-09-17T20:25:00.011-05:00

I had my first post-op appointment with my OS yesterday. Everything looked good, and I've graduated from clear liquids to any liquids without particulates. So basically, I can eat any liquids as long as I strain them first to make them particulate free. That at least gives me a little more variety for the next week. I can't clean my teeth yet, only with peroxide/water/mouthwash and saltwater rinses which I do all day long. No matter how much I rinse, it still gets yucky up there. I can't wait until I can use a toothbrush!

Today I went for another session of Manual Lymphatic Drainage today. Since I just did it last Friday, she mixed in some Reiki this time and I really think it made a difference. Below are pictures I took this morning before the MLD/Reiki:

And here are the photos from after the MLD/Reiki session:

I have been slowly trying to reduce the use of meds, right now I just have my pain patch and anti-nausea patch which will last until Friday, and I haven't taken my Oxycodone since 7 am yesterday morning. I have taken liquid ibuprophen twice when I start feeling a bit of pain. I am hoping once the pain patch is gone I can just be on the ibuprophen.

I still feel like I have a considerable amount of swelling but I am making progress every day. I started taking some supplements, today I mixed in some soy protein and I crushed up some bromelaine tablets to put in my juice. I also had bought some Coromega (fish oil gel) ... I mixed it with a little bit of 7-up and put it in the Magic Bullet ... it was so good! It tasted like a "Dreamcicle"! I highly recommend that for those of you who want to get some Omega 3 in your diet if you can only take in liquids (I don't think opening a fishoil capsule would taste very good!). Tomorrow I will try crushing my Usana vitamins and mix in some L-Glutamine.

Day 6 post-op

2008-09-15T16:11:00.006-05:00

This morning I though my swelling had gone up since yesterday, but I think it is definately much better this afternoon. The thing that is causing me the most discomfort for me at this time is the congestion. My mom called Dr. P this morning because she had a few questions for him, and he suggested that I take Dimetapp instead of Sudafed, he though I might have had a bit of an alergic reaction to the Sudafed. In any case, he wants me to come in tomorrow vs. the Thursday appointment we had scheduled. Even though I have most of my feeling, I can really feel the tingles today, my lips feel a bit raw, and I seem to be more sensitive to cold than I was before. I wouldn't same I am in pain, it is just different, a wierd sensation.

As of this morning, I was back to the weight I originally was when I went in for surgery. So since last Tuesday, I gained 8 lbs and lost it. I definately expelled more liquids today than I took in, so I am thinking tomorrow morning I'll show some weight loss on the scale. I still feel very bloted though.

I have to really take it easy on talking, I think I've pushed myself to hard and now I am really stiff, so I "sound" much worse than I did before, but that is just because I am congested now and my lips have become more stiff when talking.

I have been pleasantly surprised that I don't feel like I am starving yet. I have been surviving on water, chicken and beef broth, vitamin water, sprite and apple juice, but I have been making sure to get lots of those down, so I haven't felt too hungry. I can be drinking all day, though, and still don't think I come close to 1000 calories. I wonder if he'll give me the ok tomorrow to go on the blended diet, or if I have to stay on the clear liquids another week.

My mom and I went for a walk this afternoon, and when we got home the owner of the Rottweiler was at my house. She appologized profusely and said they decided to put the dog down. It made me feel a lot better that they had remorse for the situation, because I didn't feel that way on Friday. I am also glad it won't have the opportunity to hurt anyone in our neighborhood. It has to be quarantined for 10 days (in a kennel), and then it will be put down. So now I can take a normal route on my walks vs. cutting through other people's lawns. Everyone in our neighborhood is breathing a sigh of relief right now.

So, here are the pics from day 6. The bruising on my face is almost gone, most of what I have now is on my neck and chest.

Day 5 post-op

2008-09-14T20:21:00.007-05:00

Here are my day 5 pictures, the swelling is gradually going down and the bruising is almost gone (I have been using arnica gel on my face, so I really think that has helped):

I got very congested again today, everything felt really tight in my face. I wanted to hold off on taking the Afrin because it can cause a rebound effect if you take it more than 4 days in a row., so I took liquid sudafed and that seemed to really do the trick. The sudacare tablets also seem to help in the shower, and the rice socks to apply heat to my face. I have a humidifier in my room to keep things moist. I also went 9 hours today without my oxycodone, I am thinking maybe tomorrow I will try to only take the oxycodone at night, and liquid tylenol during the day, so I can start weening myself off the heavy pain meds. I do still have the fentanyl patch for pain. I took a walk today, I had to cut through some neighbors lawns to get out to the main road, since I didn't want to walk past the neighbors house with the dogs.

So, overall, recovery is still going pretty well, all things considered. The one thing that amazes me is how my lip incompetence has been eliminated when my lips are at rest. My lips are pretty swollen right now, but it is such a cool feeling not to have them open 7 mm.

Day 4 pics

2008-09-13T21:28:00.008-05:00

Here are today's pics, taken at around , the swelling is gradually going down, I can't say for sure if it was due to the MLD theray or not, but it certainly couldn't have hurt. You can also see the bruises settling in, above the bridge of my nose and around my jaw-line. I have taken Afrin once on Thursday, Friday, and Saturday since my nose has been so clogged, todays dose hopefully did the trick because I took it around 2 pm and I still haven't gotten the congestion back.

Regarding the whole dog attack issue, My mom took Shelbyto the vet right away. She had many stitches and a tube put into her back to drain the blood so it wouldn't abcess. here's a photo of the injuries she sustained. They had to shave her fur see how much damage was done, and to stitch her up.:

They didn't even appologize for the incident. I would have expected them to come over to our house afterwards to see how thing are going, but they never even do that. I did speak with the police, and they said that unfortunately there wasn't much they could do about it, since no body has reported any prior offenses with their dog. I asked the policeman if we had to wait until the dog attacks a human before anything will be done about it? He said that unfortunately dogs have more rights than humans in these kind of situations. This dog has chased several neighbors down the road before, and most people around here won't walk by their house because they are afraid of the dog (s).They are always outside and the and just don't seem to care. Even though they have an electric invisible fence, the dogs still somehow get out. On several ocations, the Rotweiler has gone after another neighbors dog, He was just able to pick him up in time before anything happened. The police officer said that he would go talk to them, so I wanted to hear whet they had to say before pressing charges. I didn't hear back from him today, so we called, and it appears we can't find out any iinformation before then. If the plice don't/can't do anything about it, most of our neighbors have agreed to sign a petition to get that dog out of here. People should not be petrified to go for a walk in fear that a dog may attack them. I noticed I was clenching last night, which worries me, because I don't want my jaw to pull apart everything that is fixed in place. clinching for me is many times induced by stress, So, now my mom is taken care of 2 patients.

Thanks again to everyone for your kind comments. I will respond to them when I am able to see/read better.

Oh - I almost forgot ... I stepped on the scale this morning, and I was 4 pounds lighter than yesterday, so I am still up 4 lbs from surgery, but anticipate hat will change over the next few days/weeks.

My clear liquid diet has consisted of ice water, apple juice, beef and chicken broth ad sprite. Luckily, I haven't been hungry up to this point, so I've been getting along frine on the clear liquid diet. I am constantly drinking so I know I am getting more than enough liquids, but calories are probably still on the low side. It's really hard to drink 1000 calories/day of only clear liquids.

I'll post again tomorrow with more pics, I hope i have better vision then so I can actually read when I am posting, as well as check out the updates you all have been posting.

Pain wise i am doing well, as long as I keep on top of the meds. My first appointment with my OS is next Thursday.

Day 3 pics

2008-09-13T21:06:00.006-05:00

I have to keep my posts to a minimum tonight becaue my vision is so blurry (just for reading, I can see things well far away. The doctor says it is most likely from the anti n nausea patch.

The first 2 postsare from early in theday yesterday, before I did my MLS tratment.:

This second set of photos wastaken yeserday after my MLD treatment;

Day 3 ...

2008-09-12T18:07:00.002-05:00

I had my MLD massage at 11 today, they focus on the whole body, not just the face. It felt really nice, I am supposed to be drinking even more fluids than I was to flush the toxins out of me., and take some short walks. My mom and I just went out for a walk with Shelby, our dog (my parents had "adopted" the dog from me several years ago when I lived in Mexico). Two houses down, the family there has a Great Dane, a Golden Retriever, and a Rotweiler. They have an electric fense, but it doesn't seem to be very effective alon their driveway. When the dogs saw us waling by, they cam running, and the Rotweiler attached Shelby! It was all my mom could do to get Shelby out of there, but he had already punctured her skin and did some kind of damage to her leg. So, my mom just left to take her to the vet. I was helpless because I wasn't about to get in the middle of a fight wiht a Rotweiller, as I couldn0t take any chances with my jaw. The owners of the house came out and said they would take care of any vet bills, but jeez! They need to keep that thing on a tight leash with a muzzle or put it down! I love animals, but now I am so afraid to walk by that house. I think I am going to have my husband call the police when he gets home. I really don't need to worry about my safety or those of anyone visiting me, and since we are on a dead end road, that is the only way I can go to take a wald.

Ill post more later on when thins settle down, I just am in a bit of a shock right now that this happenedd

Princess Spud ...

2008-09-11T21:19:00.003-05:00

What do you guys think? See a resemblance?

My swelling continues to go up ... just when I couldn't imagine it getting any more swollen. I made an appointment for MLD Therapy tomorrow, so we'll see how that goes. I think the long walk today wore me out, so I have been taking it very easy since then. I have switched from the ice packs to heat packs (rice socks), they feel good on the face but I really don't think they help with the swelling.

For those of you who have gone through orthognathic surgery, did you gain weight before you lost it? I just find this so incredibly odd. Yesterday I was 6 lbs heavier than when I left my house for the hospital, and I have gained another pound since yesterday! I am drinking lots and lots of liquids, but it just seems crazy I seem to be retaining so much water. My mom called my OS to make sure that was Ok, and it seems that it is, I just have not seen it happen to anyone yet.

Bruising is minimal, I have 2 dark dots on the bottom of my chin, but I am not sure if that will continue to progress as time goes by. I have been keeping arnica gel on it, so hopefully that is keeping the black and blue at bay.

Day 1 and 2 post-op pics

2008-09-11T09:29:00.009-05:00

The first photos are in the hospital yesterday, day 1 post-op:

And here are today's pics (day 2 post-op) ... as you can see, I have LOTS of swelling. I have been keeping ice on my face at all times. I'm not sure if it is helping at all, but it feels good to have it on. After today I will switch to moist heat.
In the next one, I am trying to smile ...

And lastly, my side profile;

Do any of you remember the movie "Pure Luck" with Martin Short? That's who I feel like I look like right now, after he got stung by the bee and had an alergic reaction! I am going to make an appointment for MLD (Manual Lymphatic Drainage) for Saturday to see if that helps reduce some of the swelling. In a little while my mom and I will go for a walk ... it will be good to get outside and enjoy the fresh air a bit.

I am sorry if I have a lot of typos in my post-op posts ... looking around I can see fine, but I am seeing double when I look at my computer so I can't really tell if I make any errors when I am writing. I am guessing it is the oxycodone that is making my reading vision blurred.

Back at home!

2008-09-10T20:24:00.003-05:00

I saw Dr. P this morning, he stopped into see me around 6 am. Everything went very well with the surgery, but again, he said everything was so incredibly tight that he had a hard time with it. The bones in my mandible broke very nice for him for the BSSO, but again he had some trouble with the movement because of the tightness of the skin. He then splinted my lower jaw to move onto the upper jaw surgery, which usually takes only a few minutes but it took him around 25 minutes just to get the splint in. The 18 mm is not how much he moved the actual bone, but it is how much of a movement will be percieved with the rotation. He ended up just doing a one piece LeForte I because he was worried about doing more pieces with my tissue being so tight, but that should not affect my outcome. I guess I started swelling up quite a bit even during the surgery. Today my swelling is really strong, I've been keeping ice on it constantly, I'm not sure if it's helping or not but I have nothing to loose.

Total, I have 8 plates and 43 screws. We took a picture of my swelling today, but I'll take another one tomorrow and post them then.

I am feeling pretty good as long as I keep on top of my pain meds. I have been taking in a lot of fluids, 64 oz. since I got back from the hospital around 2 this afternoon. I don't think I'll even need to use the zip.n-squeeze bags, or the sippy cup, as I pretty much have all of my feeling in my upper and lower lips. so I am just drinking from a plastic cup. It is a little numb and tingly on the sides of my mouth, but Dr. P said that's most likely from the stretching and that will come back quickly. I am very surprised at how little numbness I do have ... I was expecting much worse ... but Dr. P did say that my alveolar nurves in the mandible were very well protected so he didn't have to touch them or move them at all, which explains the lack of numbness.

I stepped on the scale and I weigh 6 lbs more than I did yesterday before going into the hospital! I am guessing it's from the IV and all of the solution they pump through your body, but I just thought that was strange. Has anyone else gained weight in the first few days?

Nose Tube is out!

2008-09-09T20:16:00.002-05:00

Dr. P called again, and the nurse convinced him that my nose tube can come out! So, I have now been drinking water out of a cup. I really didn't think I'd be able to do that, since I thought my whole lip/chin area would be numb. Of couse, I have to be careful not to spill it all over me, but I don't think water ever tasted to good!!

Pics!

2008-09-09T18:48:00.006-05:00

So here we go ... the first picture is me in the "holding area", waiting ot go in for surgery ...

And this next one was taken about 2 hours afer surgery, once I got up to my room:

I still have the nose tube in, supposedly I am supposed to have it in until tomorrow. However, there is no new blood going into my stomach, and it appears that it all has been sucked out. Dr. P has called the hospital a few times to check in with the nurse who is taking care of me, and she is trying to convince him to let me take the nose tube out. I can't drink anything until it gets out of there, and my mouth is so dry! That is really my only discomfort ... I'm thirsty. Other than that, things are going very well. I got up to take a walk around 5, with the nurses help of course. Then I used the bathroom as long as I was up ... everything back to normal. I did get light headed by the end, though, so I just have to take it easy. I am so pleased with my progress so far (although I look like Mr. Potato Head, but that of course was expected).

Numbness is great. I have all my feeling in my chin, just a little tingly on the left side. I can feel my whole lower lip except it is tingly on the lower left side. Upper lip is mostly numb, but I have feeling in the middle. I am really doing so much better than expected. I would only classify my pain as a 2, if even that. I think I've used my morphine button about 3 times ... not too bad.

I have my handy-dandy jaw bra on now from Zip-n-Squeese, we just have to change out the ice quite frequently as it melts pretty fast.

I repeated to myself hundreds of times this morning "I am strong, I am healthy, I recover fast", and between that and the skill of my surgeon, I really feel like I have come through this with flying colors.

My mom cleared out my nose (the nostril with out the tube) with a q-tip and hydrogen peroxide, that felt really nice to get some of that gunk out of there. I am breathing through my nose very nicely.

So, that's where I'm at. I really don't think I could be any better than I am ... very pleaseed so far.

On the other side - less than 3 hours post-op!

2008-09-09T14:14:00.003-05:00

Hi everyone! I made it to the other side! I am feeling pretty good, they told my mom and husband that they advanced my lower 18 mm, not sure about the upper.

The surgery lasted around 4 hours 40 minutes, I have my nose tube in still because they are worried about blood in my stomach. I am so thirsty, though, and I don't think I'll get anything to dink until the nose tube comes out. Pain is pretty good .. I've hit my pain clicker once so far (morphine drip). Everyone here has been so nice. The anesthesiologist told me before surgery that it was going to fell like someone drove a truck up my nose. Nice, huh?

I'll post some pics later, swelling is there but actually better than I expected. Dr. P apparantly said I was one of his more difficult cases, not because my mouth was so small but because my tissue was so tight.

Thanks, everyone, for thinking about me. So far, it's gone better than expected. The best news? 2 different nusrses asked why I wasn't going to the pedriatric until ... they thoght I was under 19!! Not to bad for a 34 year old :)

Thank You!!

2008-09-08T23:19:00.001-05:00

I just wanted to THANK everyone for all of your well wishes! Less than 8 hours to go ... my hospital bag is packed ... and I'm as ready as I ever will be. I'll post as soon as I can on the other side. Thank you all again for the great tips, advice, and support.

2008-09-08T07:17:00.003-05:00

I met Dr. P in his office this morning at 6:15. He refit me with the wax impression we did of my bite, and everything looked good. He then fit me once again with the face-bow, and had me once again look into the horizon. He explained that studies have shown that if a patient moves there head up and down several times, and is then asked to look into the horizon, there is only a couple degree variation, statistically a very accurate measurment. This time he had me look into my reflection so I could see my eyes, and we did it several times, and it appears that this may have been the problem, that I possibly was not holding my head completely "horizontal" when we originally did the face-bow. He has done many surgeries, and this is the first time this has happened. He was happy, however, that the error was with the face-bow, not the x-ray, because if it was with the x-ray we would have had to reschedule my surgery because they have to start over. With the face-bow, as long as they know what the true measurements are on the x-ray, they can work with it.

I mentioned to him that I had been sick but was getting over it. He said that I should see how I feel tomorrow, he wants my immune system to be at 100%, this surgery is hard enough to recover from as it is, and you don't want to add a compromised immune system into that mix. I think I'll be fine, I still have a bit of a cough and a little drainage, but it has made leaps and bounds every day.

I had a dream last night that my surgery was cancelled. Not because of the whole face-bow/x-ray issue, but other issues. I was at the hospital, and a ton of people showed up from my work to support me. Dr. P then came in and made an announcement to everyone that after further review, they could not fix my bite surgically, only orthodontically with a compromised result. Needless to say, I was crushed. Luckily, I woke up.

In other news ... it appears I won't need the genioplasty. So good news there ...

Less than 24 hours and I will be in surgery.

An Unexpected Twist ...

2008-09-07T22:06:00.002-05:00

So I just got home tonight, and had a message from my OS waiting for me. He said he has been working on my surgery for the last few days, and things just aren't matching up right, so he needs me to come in. I called him back, and it appears that there are some discrepancies between my x-rays and the face-bo measurements. So he needs to figure out where the error is. The problem is, he is at his remote office tomorrow about an hour from here, so we have to do it in his local office either early in the morning or around 6 pm. The latter will not work out too well because his office is near the stadium, and there is a Packer game tomorrow night (that means pure chaos... Packer traffic is crazy!!). I'd rather get this all sorted out in the morning, anyway ... otherwise I am going to be stressing about it until surgery. So, I will meet him at his office at 6:15 am tomorrow morning, and hopefully he can figure out quickly what the discrepancy is. Whatever I need to do ... it's my face ... I want things to turn out right!!!

48 hours and counting down ...

2008-09-07T07:30:00.002-05:00

If all goes as planned, 48 hours from now I will be undergoing orthognathic surgery. I started to come down with a cold/sore throat on Thursday, and Friday I was feeling pretty rough. I couldn't stay home to fight it off because I have so much to get wrapped up at work. Yesterday, I stayed home all day and started to feel better, and today my congestion is much better, my throat a little sore but I am optimistic I am going to kick this. I am so frustrated I got sick, I haven't been sick with a cold or the flu since I started taking my pharmaceutical grade vitamins a year ago. I guess since I had to go off the vitamins 14 days before my surgery, and all of the stress I've had with work, my immune system was down. I don't want to have my surgery canceled because of this, I don't know how quickly they would be able to reschedule, and that would really screw things up. So, I am drinking a ton of juices and fluids, trying to flush this bug out of me.

I can't believe it's almost here!!

More pre-op photos ...

2008-09-01T14:58:00.005-05:00

I realized that all the photos I've posted on my blog were from my OD's office, so I thought I'd post some that are more "natural". The photos below were taken at my best friends wedding at the begining of August. I have a tendency to jut my lower jaw forward when posing for a photo to mask my recessive chin, so it may not seem quite as bad as in the other photos I've posted, but you can none-the-less still see my mandibular deficiency ...

On another note ... if anyone has any more ideas for clear liquids i can drink post-op that will make me feel full, that have no particulates, please let me know!!

T minus 8 days ...

2008-09-01T10:06:00.007-05:00

A week from tomorrow ... I will be undergoing orthognathic surgery. A lot of people have asked me if I am ready, and I guess I am as ready as I can be, at least for the parts I "can" prepare for. I have been researching and reading about this surgery for over a year now, so from a preparation standpoint, I don't know how I could be more prepared. Now we'll just have to see how I deal with it after the fact. But I know what to expect, so hopefully there will be very few surprises.

So, my "official" post-op supply list ... this is what I have bought thus far to get me through the first 1-2 weeks post-op, and in some cases beyond:

List of supplies pre and post op

1) Arnica Montana gel (to reduce bruising/swelling)
2) Bromelain tablets (pineapple extract) – reduce swelling
3) L-Glutamine
4) Aquaphor (for lips – found in baby section of pharmacy)
5) Zip n Squeeze bags for eating
6) Sippy Cups
7) Baby Spoons
8) Baster (another method of eating if I don’t get syringes w/catheter at the hospital)
9) Zip n Squeeze jaw wrap (“Cool-Jaw” Wrap) – can also be heated for when I move to moist heat
10) Protein Powder (soy and whey)
11) Boost/Ensure
12) Baby Toothbrush
13) Children’s Sudafed (Non drowsy)
14) Extra Strenth Tylenol (Adult Rapid Blast Liquid)
15) Waterpik (I had one already, can’t use until OS clears me)
16) Q-tips and hydrogen peroxide to clean out nose
17) Afrin (for nose congestion)
18) Saline Nasal Spray
19) Dry erase board
20) Small notebook for writing down meds and frequency, Larger notebook for communicating, pen
21) Hydrogen Peroxide for cleaning mouth, Biotene and salt water for rinsing mouth
22) SudaCare Shower Soothers
23) L-Glutamine
24) Baby suction (for sucking spit)
25) Magic Bullet
26) Pill Crusher
27) Humidifier (I already had one of these)
28) Flaxseed and Flaxseed oil
29) Fiber (in powdered form)
30) USANA vitamins (I have taken these for the last year and will resume as soon as cleared by my OS … I will crush them in pill crusher or coffee grinder)
31) Coromega (Omega-3 fishoil supplement in gel form)

Food:

1) Sprite
2) Apple Juice
3) Cranberry Juice
4) Kellogg’s K20 Protein Water
5) Gatorade (Orange, Grape, and Fruit Punch flavor)
6) Beef and Chicken Broth
7) Ensure and Boost for when I graduate from clear liquids (I bought chocolate, vanilla, and strawberry flavors)
8) Lean muscle milk from GNC (protein shakes)

… once I move on from clear liquids I will buy lots of frozen fruits (the seedless varieties) for smoothies, and blend regular food and soups.

I still need to pick up some more pillows for my bed to sleep upright. Other than that, I think I am pretty set, and maybe even excessive with everything I have bought. I have been searching for button up pijamas to bring to the hospital, but everything is so homely. If I can't find anything, I will just bring my robe, after all, I will only be in for one night.

Oh - and how could I forget! I picked up my post-op prescripions so here it goes:

One bottle of liquid Roxicet (generic of Percocet, which is oxycodone with acetaminophen)

4 bottles of liquid cleocin ped, which is the brand name for clindamycin, which is a lincomycin antibiotic used to treat bacterial infections. I believe my OS usually prescribes amoxicillin, however I am allergic to penicillin, which it is related to.

2 transderm patches -- these patches are placed on skin behind the ear every 72 hours to prevent nausea and vomiting

3 Fentanyl patches - Fentanyl is a narcotic, a member of the same group of drugs to which opium and morphine belong. It is said that it has an analgesic potency of 80 that of morphine. This narcotic analgesic is used to treat persistent moderate to severe chronic pain that requires around the clock administration and can not be relieved by non-steroidal analgesics (such as ibuprofen or naproxen), narcotic combinations analgesics (such as oxycodone or propoxyphene) or immediate-release opoids (such as morpine sulfate immediate release). The patch is to be applied to the skin every 72 hours, prefered placement is the chest, back, upper arm, or on the side of the stomach.

Last but not least, I will be receiving a PCA pump in the hospital post op, PCA stands for "Patient Controlled Anagesia". Dr. P said I probably shouldn't need it to much though, since I will have a patch on for pain, which I am guessing is the Fentanyl patch. That would make sense ... if the fentanyl is more potent than morphine ...

Dr. P also said I won't have to go back on the doxycycline post -op ... if it is causing me gastritis, it is not worth it. I have to say I am more than pleased with that decision.

2 more appointments to go next week, my pre-op physical and my pre-surgical evaluation.

Now I just need to get things in order at work. It seems like there are just a million things going on right now, and to top it all off, the assistant for our division resigned last Monday, and she reports to me. So now, I need to scramble to get someone hired by this Friday, and arrange for her training since I will not be there to assist. I am trying to have everything in order so I don't have to worry about anything work related during the first 2 weeks post-op, I have 5 more business days to get it all done so that is probably the biggest thing that is stressing me right now. In the end, I know it will all work out, or at least I will have done everything possible that is in my control so it does, so I just need to take a few deep breaths and relax ...

Surgical Hooks and Pre-op appointment with OS

2008-09-01T08:51:00.003-05:00

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.

Pre-Surgical Ortho Appointment

2008-08-25T19:30:00.015-05:00

On August 14th, I had my pre surgical ortho appointment. I anticipated the molds would be a lot harder than what they were, they came out pretty easily. I have heard so many nightmares about them so I guess I was prepared for the worst.

So here we go ... my progress pics from June 2007 vs August 2008 ...

And now for the mug shots ... I wasn't thinking and didn't wear make-up that day ... so they are about as "good" as they get ... :)

And lastly ... my profile predictions. The first one is from June 2007, the profile prediction before I started this whole process. The next 2 are predictions based on my pre-surgical photos. I am guessing that the first one is with genioplasty, and the 2nd one without genioplasty, but I am not sure. I have my pre-op appointment with my OS on Thursday, so I am guessing he will go over my options then. I think the 2nd set of photos looks a bit more harsh than the first profile prediction. But I will wait until I see my OS to make any judgement or determination ...

On Wednesday, I get my pre-surgical hooks placed, Thursday I get my teeth cleaned and after that is my pre-op with my OS. Next week I have my pre-op physical and pre-surgical evaluation at the hospital (they are 2 different appointments ... one with my physician and the other at the hospital ... geez ... do they think they can throw a few more appointments in???). Then, exactly 2 weeks from tomorrow, I will go under the chop! Yikes ... I can't believe it's almost here already! I did some more shopping over the weekend, so later this week I will post my full list of supplies. I probably will have a lot of things I never even use, but I guess I'd rather be over prepared than under.

Sleep Study ...

2008-08-25T19:07:00.005-05:00

I can't believe it's been almost a month since I've posted, time has gone so fast. On July 31st, I had a sleep study to determine if I had obstructive sleep apnea or any sleeping issues. I tend to be a very restless sleeper. I just had my follow-up appointment today, and I definately do not have any indication of issues related to apnea, my oxygen levels looked good and I had very few breathing related issues throughout the night. I did wake up significally more than is considered normal, and had less REM sleep than would be considered normal as well. He was going to fax the info over to my OS and advise that after surgery, instead of putting me back on the amitriptyline, that he puts me on another medication. This should prevent me from being so restless and help me get a better night sleep. I am ok with this as long as I have to be on the meds post-op, but after that year, I really prefer to be off all meds completely. That is, after all, one of the reasons I am going through all of this ... I want to reduce the amount of drugs I take long term and find more natural ways to deal with these things. Here are some photos of my sleep study ... I had 29 electrodes, plus a clip on my finger, tubes that look like oxygen tubes to measure my oxygen levels, and a microphone taped to my neck. It's amazing I slept at all!

I hope this isn't an indication ...

2008-07-27T14:20:00.004-05:00

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.

Wireless!

2008-07-26T11:01:00.003-05:00

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!!

Ortho Appt, ER and lots of photos ...

2008-07-20T22:10:00.022-05:00

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.

Post-Operative Care Instructions

2008-07-11T21:51:00.002-05:00

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.

I have a date!

2008-07-09T19:31:00.003-05:00

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 ...

2008-07-06T12:21:00.002-05:00

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 ...

Powerchains, Coils, and Interproximal Redction ... And an early September Surgery Date to Boot!!!

2008-05-08T21:28:00.004-05:00

What a day for me orthodontically, I don't know where to start. I went in for my sure smile appointment, and didn't know exactly what to expect from the SureSmile wires, but it was very interesting to see them. It is not at all like the wire I had before. This one was pre-programmed by a robot, so before it was put in you could see all the curves, twists, and bends in the wire. Apparantly, these bends in the wire will take my teeth directly to their desired state. And before they even closed the doors on my self-ligating brackets, boy could I feel the pressure, the most yet since I've got the braces on. I say ... bring it on! Get those teeth lined up as quickly as possible ... no pain, no gain, right? At least that is the attitude I am "trying" to have throughout this whole process. Then came the power chain ... my first one yet! They put it on my lowers. On my uppers, I have the priveledge of two coils on each side. The purpose ... to open things up before surgery, about 3/4 of an inch on each side. At this point, things are going to start to look much worse before they look better. As you can see in the photo below, Dr. L did some interproximal reduction today leaving me with a small gap between my lower incisors. A bit unsightly, but look where I started from. I just have to keep my eye on the end goal. The objective is to make more room so they can keep pushing the lowers back. I already have a recessed chin! Like I said ... things will get worse before they get better. I started out with a 6 mm overjet, and come surgery time I should be around 7 mm.

The best news of the day ... I will definately be ready for surgery early September! I can't schedule it yet with my OS because he is only booking through August right now, but I spoke with the gal at my OS's office today and she said to call her on June 16th and we will try to schedule on September 4th. There shouldn't be a problem because kids are already back in school, so it is considered the "slow" time. So ... in a month I should have a confirmed date ... and for now I will hope I can get my surgeon and the OR on that date.

So, other than my teeth being a little sore, things are good. I have my next OD appointment on July 14th, and I will have another appoinment with my OD mid August for surgical photos and molds, and then another to get my surgical wires on ... so only 3 OD appointments before my surgery! It is amazing to think that, if everything works out as planned (which it should) ... I will be having my surgery in less than 4 months!

So here are my teeth in all their glory, with the lovely new interproximal reduction induced gaps in my lowers, the cute little springy coils on the uppers, and the almighty power chain. You can still see the bends some from the SureSmile wire ... it will be interesting to see how quickly things move ...

Lastly, I asked my OS about my midlines, because I noticed after the interproximal reduction they were slightly off. He said not to worry. The upper will be spot on, they will make sure that one is perfect. The lowers, they will try there best, but in the end, the most important is the oclussion, so we might have to sacrifice the lower midline a bit for the best oclussion possible. He said that with adult patients, there generally is a lot of wearing so that can make it more difficult to get things matched up. I new this before I asked him, but I just want to know things up front so I can prepare myself mentally. I truly do hope I can have my midlines match up, but at the end of the day, if they don't match perfect, I will be happy as long as my bite is healthy and balanced.

Photos from Endoscopy

2008-04-28T11:24:00.009-05:00

A month later ... but I'm finally getting around to posting a couple of photos from my endoscopy. In the first photo, you can see several of the ulcers basically in a ring around my esophagus ...

In this photo, you can see another large ulcer in another area of the esophagus.

In all, they took about 8 days to heal up. Lesson learned ... take doxy in middle of day, with LOTS and LOTS of water, and make sure I'm upright. I was off the doxy for a couple weeks but I am back on now, so far so good. If I forget to take it during the day I will just skip it from now on, I don't ever want to go through the esophageal again!

On another note, a week from Thursday I go in to get my SureSmile wire on. Although I can't visualize what changes the wire will bring about, I can only imagine I will get some major torquing and twisting of my teeth, getting them in line for surgery. I am wondering how bad my bite will be as I get close to surgery ... only time will tell.

I am looking forward to my SureSmile date because this is supposedly when my OD will tell me I can schedule my surgery! I can't believe I am getting close enough to schedule ... YIKES! But I am prepared for what lies ahead, and just looking forward to getting on with the process to be able to put this chapter of my life behind me, although I know it is a long haul uphill before I get there.

Back from the GI Department ...

2008-03-27T16:56:00.002-05:00

Well, I'm back from the doctor, and he confirmed what I thought. I have about 5 or 6 ulcers in my esophagus, drug induced. I really need to do a better job at taking my pills. So, he prescribed me some lidocaine to help with the pain. He wants me off my meds until I heal, but I can resume taking them in 7-10 days, but I must make sure I take a full glass of water before and after taking them. As far as the blood in the stool goes, he saw no issues there, it must have been coincidental and could have been a hemorrhoid or something, but since I've never had one before, I didn't know.

If anything good came out of this, I was terrified of the IV for my jaw surgery. I had one today and it wasn't so bad, so that is one less worry I have for my upcoming surgery.

Problems with Meds ... a minor setback ...

2008-03-25T20:43:00.003-05:00

I mentioned in a previous post that I am on a protocol of meds which my OS has me on pre and post op to stabilize my TMJ's, but I haven't gotten the feeling from the boards I read or the blogs I read that too many people follow the same protocol. I did considerable research before I started taking them to know what I was getting myself into.

One of the meds I am on is doxycycline, although it is an antibiotic it apparantly has a secondary effect of joint stabilization. One of the things I had learned in my research that the OS or pharmacist did not tell me was that you have to be very careful when taking this medication, you should not take it before you lay down (and it was prescribed to take at bedtime).

To make a long story short, I have been on the meds since November and usually try to take the doxy during the day, but sometimes I forget and take it at night along with my vitamins and the amitriptyline. The feldene I usually take during the day as well but I take it at night if I miss my daytime dose.

Well, last night I started to get pain in my chest, it felt like something was clogged in my esophagus. It was uncomfortable all through the night and when I woke up this morning. So I called the gastroenterology department at the clinic I go to and they couldn't get me in for an appointment until next Thursday, which is 9 days away. From everything I've read, if it is what I suspect it is, my issue will be cleared up in 7-10 days if I stop taking the medication. I believe the doxycycline has formed an ulcer in my esophogus, this is commonly referred to as drug-induced esophagitis. I had read this from another patient that was on the med for joint stabilization before I started taking it, and today I did some more searching and indeed this appears that this does happen with doxycycline.

Well, tonight before I went home from work, I went to the restroom and have a considerable amount of blood in my stool. This freaked me out, so I called the after-hours line at my clinic to see if I should go to urgent care or what. Usually they can't do much and ask you to see a specialist anyway. The triage nurse told me to call the gastroenterologist back tomorrow and tell them about my new syptoms and they would probably get me in tomorrow.

I know I am self-diagnosing here, and of course I could be wrong which is why I will make sure I get in to see the doctor tomorrow. I just wanted to give warnings to anyone out there reading my blog who is also taking doxycycline. I have read this can happen and it really is preventable, you just need to take plenty of water each time you take the pill and make sure that you are up-right for at least 10-15 minutes after taking it to prevent it from lodging in your esophogus.

I will post an update after I get in to see a specialist, in the mean time I continue to feel the uncomfortable pain in my chest but other than that I feel ok.

3.5 month progress ...

2008-03-12T21:23:00.009-05:00

Well, I think the pictures speak for themselves ... I continue to be pleased with my progress and movement. I had my teeth cleaned on March 5th, the first time since I've had my braces on. I decided to get them cleaned every 3 months vs. every 6. I went to the ortho on March 10th for my Sure Smile Scan and they took new photos. So, here are my 3.5 month progess photos, of the front view (look in particular how much my lowers have moved!), my upper arch and my lower arch:

Because I have such a large filling on one of my upper molers, the had to do the sure smile scan manually versus the imaging that they typically do. Apparantly it causes a reflection that screws up the imaging. So they had to apply alchohol to each individual tooth to take the shine off and give them a matte finish ... and boy did that hurt on my upper and lower front gum area. Now I have a nice canker sore way up in my upper and lower gum area. Since I never get canker sores there, I'm quite certain it was from the alchohol.

Dr. L didn't change my wires, he kept the same ones on, but he did do a little more shaving and shaping on both my uppers and lowers. I couldn't believe what a difference it made on the lowers. There are still a couple of teeth on my lowers that sit high on the gum line, but the shaping really smoothed things out.

So, I'll get my Sure Smile wires on April 19th. Dr. L said I should call my OS's office in two o three months to get my surgery on the schedule. He said Dr. P will schedule a few months out because he knows that people have to plan things around it. So that answered my questions, he does not need to see my molds before he will let me schedule surgery. He will trust Dr. L's opinion on when I will be surgery ready.

Prior to surgery, they will take all of the new x-rays, molds, and digital images. It sounds like Dr. P performs the operation electronically. I have heard of OS's performing the operation on the molds, but not digitally. That is when I will know exactly what movements they will be making and the size of the movements.

I have a feeling that from this point forward I won't see a lot of change, it is more just fine tuning until my surgery. It is weird to think that I am only 6 months out from surgery ... only 3.5 months ago I was thinking it would be a year. That time has flown by, as I know the next 6 months will too.

X-ray Panoramic

2008-02-02T08:09:00.000-06:00

Below is my X-ray pan of my teeth:

You can see my numerous fillings in my molars. I can't wait to get them replaced after this all is over with white fillings vs. the metal ones. I hate looking at the pictures with all the metal back there. My front teeth are crowns, I had an accident in high school where I broke one of my front teeth and they bonded it. The other tooth was slightly cracked and barely visible. About every 4-5 years after I got the tooth bonded, the bonding would come off and I had to get it re-done, usually at really inconvenient times. You can imagine how I looked missing half of my front tooth! So I finally decided to get a crown a few years ago, and he also did the one that had the slight crack in it. I am really hoping I don't have to get them re-done after all this!! The thought of them sticking the novocane needles up in the roof of my mouth again ... ugh! I felt the darn things in my nose! It was horrible ... I am hoping to avoid that.

Small Airway

2008-02-02T08:03:00.000-06:00

Below you will see my digitized lateral ceph. My OS pointed out in my first consultation how small my airway is, one of the smallest he's seen. He said this is something he needs to take into consideration when moving my jaws, the advancement will hopefully help open up my airway.

Fun on the Ortho Site!

2008-02-02T07:57:00.001-06:00

OK, so I admit I officially am a dork. I discovered yesterday that all my pictures, cephs, x-rays, and pans are uploaded onto my ortho's web-site (password protected of course so only the patient can view them). Some of the images I have not seen before ... I just cannot believe how far they have come with technology these days. Below is my favorite image ...Probably not something for kids to view ... kind of scary ... I just thought it was so cool that they could make a 3 dimentional digital image of my skull!

Missing Ligs

2008-01-31T18:58:00.000-06:00

I have 4 brackets on my lowers that are not self ligating. I called my OD's office today because I didn't see the ligatures on them, so I wanted to make sure that was supposed to be the case, or if the tech forgot to put them on. The tech called me back and said she was sure she put them on. I got in for a last minute appointment at the end of the day. Sure enough, she forgot to put them on. This time, instead of the little rubber band ligatures, I got the metal ties. I think they are better anyway ... they have less risk of falling off, they are very thin and discreet, and they don't stain like the bands. I am glad I called ... I don't want to slow anything down ... I set on getting this done in September!

Heavy Wires and Early Fall Surgery Estimate!

2008-01-28T21:33:00.000-06:00

Ok, so I went into my wire change appointment today, standard operating procedure. She accidently cracked one of my brackets when opening the door to get the wire out, so Dr. L had to take that one off and reposition it back on. Then he repositioned the one on the back tooth. I got my heavier wires. The best part was at the end, he told me I would need to make an appointment to get my Sure Smile wires on, which I scheduled for April 29th. I have my Sure Smile Scan on March 10th. I asked when he would be able to estimate when I would be ready for surgery. He said that things were moving very nicely, and he expects I will be ready by early fall, however he will be able to give me a definate time-frame once the Sure Smile wires are on! So it sounds like maybe September, but for sure October, I will be surgery ready!! And I should be able to schedule in May! I am just so happy that it looks like we've shaved a few months off my original timeline. That is so much better than tacking a few months on.

Not too much else to report ... my teeth aren't too sore yet from the wire change. My cheecks are catching on the new wires, but they will get used to it soon enough.

Overjet ...

2008-01-26T14:16:00.001-06:00

I managed to get a picture of my overjet ... all 6 mm of it ...

I also took a side profile pic to show my overjet from the side:

I will be anxious to see the difference post-op ... I think I may have even been posturing my lower jaw forward a bit in this pic which is something I tend to do.

I'll post more after my appointment on Monday!

8 week progress ... WOW!

2008-01-26T14:03:00.000-06:00

Since I have my first appointent on Monday for a wire change, I thought I'd post my progress since I am at the 8 week mark. It is truley amazing how much my teeth have moved in 8 weeks! Below you can see my "before pictures vs. my current picture:

I am definately happy with the progress I have made ... although I am still waiting for the middle lowers to unravel ... but a lot of the original overlap is gone! I still have a ways to go ... but 2 months ... I never thought they would move that quickly. When I had braces when I was younger, I didn't pay attention to the speed of the movement like I am now, and I certainly didn't have the tools to document it. Below are my progression pictures ... from before up to this point ... you can see the progression over the last 2 months ...

So there you have it ... I am ready for my appointment on Monday ... bring it on! Let's get some heavier wires and keep these things-a-movin'!

Not much to report otherwise ... I haven't had any canker sores lately and things have been pretty comfortable in my mouth since they have fixed that pokey wire.

Naked Tooth!

2008-01-05T16:12:00.000-06:00

I went to Mexico over New Year’s, and that darn bracket on my lower molar all the way in the back came loose again. So, by the time I got back and was able to get into the ortho, it was about 5 days already. It was already pretty ripped up back there from the wire, and I could never really get the wax to stick so I gave up and figured I would just deal with it. I am sure that the bracket coming loose didn’t help, as the wire had more liberty to move around back there and rip things up more.

I wasn’t able to see Dr. L again, so a different ortho took care of me yesterday. The assistant told me that I should have clipped the wire since it was so torn up, there is no reason for me to be a human shish kabob. She did tell me I was taking impeccable care of my teeth, though. She said that it looked like they just put the braces on yesterday. That made me happy, since I know that the better I take care of them, the more quickly they will move. The ortho on duty took a look and decided not to put the bracket back on, since I have another appointment for a wire change at the end of the month and he wanted my cheek to heal up. He said Dr. L can place the bracket then. I was worried that it would delay my treatment plan, but he said that in no way would it compromise the speed of my treatment, he was actually very pleased when he looked at my before pictures to see how quickly things were moving. He even said that if Dr. L were there, he may even have wanted to change the wire. Darn, I wish Dr. L would have been there … I guess I just have to be patient and wait until the end of the month.

So, they buffed off the glue and snipped the wire, turned it in and left me with a naked tooth! The assistant told me to do several salt water rinses a day to help things heal. I also had her change a couple of the ligatures on the brackets that are not self ligating because they were stained. My mouth feels great! No canker sores, and I can feel the sores in the back healing up already.

I took a pic today to see the difference and how things moved. I can really see the movement now. Although they still have a ways to go, you can really see how they have moved apart, as they don’t overlap nearly as much as they did at first. So, 5 weeks into braces, I think I am doing pretty well!

I am posting another pic … I still don’t like how yellow my teeth look, but I just have to deal with it for now since I am taking as best care of them as I can. I will definitely go in every 3 months for a cleaning, though, vs. 6 and see if that helps any.

Pokey wire ...

2007-12-18T21:49:00.000-06:00

I finally was able to see last night what was going on in the back of my mouth. I tried to take a picture of it tonight, but I wasn't able to get my camera to focus on the back of my mouth. Basically, on the right lower, the wire is very neatly folded in behind my last tooth. On the lower left, she had just put the dab of glue on the tip of the wire, but that doesn't stop it from poking my cheek and creating a very nice sized sore in the back of my mouth. So I am trying to load it up with wax, which helps, but I can't always get it to stick on back there for very long. So now I need to figure out if I can deal with this until the end of January at my next adjustment, or if I need to go in. I have already been in twice since getting my braces on not even three weeks ago, and I don't want to be labeled as that "problem" patient ... so I am going to see if I can stick it out. I will need to get some more wax, though ... since I think I will be going through it pretty quickly! The good news is that the canker sores in the front of my mouth have healed up, so they luckily didn't take too long to go away ... now let's just hope they stay that way.

Minimal Progress ...

2007-12-18T21:06:00.001-06:00

I finally got a better picture with the braces. At almost 3 weeks, I don't see a lot of movement yet, but it looks like things are stretching out a bit on the lowers, trying to make some room.

I can't get over the difference in the color ... I am hoping it is just the lighting, or maybe the reflection of the clear brackets, because they just look horrible compared to my pre-braces photo and I have been very diligent about my brushing and flossing. After braces and surgery I will get all of my silver fillings replaced with composite ones so I can finally have a 100% white smile!

Appeal Letter from OD ...

2007-12-17T21:55:00.001-06:00

I thought I would post the appeal letter from my OD, first as an example for those who are seeking an appeal with their insurance company, and second, because it discusses in detail the issues I have with my jaw ...

To Whom It May Concern:

Stephanie is a very pleasant thirty-three years old female who initially visited our office for an orthodontic evaluation in July of 2001. Please let this letter serve as an appeal to denial of insurance coverage for the recommended surgery.

Clinically, Stephanie currently presents with a Class II division I subdivision left malocclusion in the permanent dentition stage. She has an overbite of eighty percent with six millimeters overjet. An increased mandibular curve of Spee exists. There are arch length deficiencies of five millimeters in the maxillary arch, and seven millimeters in the mandibular arch. Her maxillary and mandibualar arches are both asymmetric and tapered in arch form. In addition, her maxillary lateral incisors (7,10) are narrow in width.

Cephalometric measurements indicate a Class I skeletal relationship with ANB=9. Stephanie possesses a high mandibular plane angle that is indicative of an openbite skeletal pattern.

With the exception of the previous removed third molars (1,16,17, and 32) evaluation of Stephanie’s panoral film indicates all remaining permanent teeth present and accounted for with normal root form and structure and proper alveolar bone support.

Soft tissue profile evaluation indicates a slightly retrognathic profile with a recessive chin. Her upper and lower lips are both incompetent in their positions at repose with a seven-millimeter interlabial gap present. Her nasolabial angle is within normal limits at 130 degrees.

Evaluation of Stephanie’s upper smile line indicates a slightly high upper lip position with excessive gingival tissue displayed when smiling (four millimeters excess gingival tissue displayed when smiling). Evaluation of her lower smile line indicates an acceptable position of the lower lip with the maxillary dentition approximating the border of the lower lip. However, buccal corridors are evident upon smiling due to her asymmetric and tapered arch forms.

In addition to the above, Stephanie has had ongoing temporomandibular joint dysfunction concerns. Therefore, when Stephanie initially visited our office we recommended conservative measures for her TMJ discomfort which included: Aleve (2 tablets twice daily with food) or Ibuprofen (3 tablets three times daily with food), Glucosamine (as directed on package), moist heat applications (20 minutes two times daily), Soft diet (no gum, or sticky, chewy, crunchy foods), increased vitamin C (1,000 mg per day), journaling for one week, post-it notes and an increased awareness of her habits. When these conservative measures did not afford Stephanie relief, we fabricated a centric relation splint. Utilization of this appliance also did not prove to be successful in gaining Stephanie long-lasting relief from her TMJ symptoms. In addition, lower incisal wear has occurred. Stephanie relates that the right pre-auricular region of her TMJ’s has chronic discomfort. She also has migraine headaches, the right condyle is arthritic (indicated on the tomos we obtained), and her mandible deviates three millimeters to the right upon opening.

I have recommended treatment for Stephanie with full fixed orthodontic appliances in conjunction with a two-jaw surgical procedure with a maxillary advancement and impaction and mandibular advancement with chin augmentation. Stephanie does understand that while this comprehensive orthodontic/surgical treatment cannot guarantee a cure for her temporomandibular joint dysfunction, correcting her malocclusion may leave to improved symptoms.

Stephanie is aware that stellar elastic wear will be mandatory in order to reach her orthodontic goals. In order to address arch length deficiency, interproximal reduction in the mandibular arch will be necessary at the onset of her treatment.

The estimated length of treatment for Stephanie should be approximately twenty-four months. Upper pressdown and bonded mandibular lingual retainers will be utilized for retention. In addition, we may need to fabricate a centric-relation splint for retention, dependent upon the TMJ response to comprehensive orthodontic/surgical care.

Thank you very much again for consideration of insurance coverage for Stephanie’s surgery. In the absence of sugery Stephanie’s malocclusion puts her at increased risk for continued TMJ dysfunction and the potentioal for breakdown of her posterior detition (lower incisal wear is already noted). Should you have any questions or concerns in regards to my recommendations for Stephanie, or if we can provide additional diagnostics aside from those we have already submitted, etc., please do not hesitate to give me a call. I would be most happy to discuss the need for Stephanie’s surgery in conjunction with her comprehensive orthodontic care with you in person.

Oral Hygiene ...

2007-12-17T21:28:00.000-06:00

I read somewhere that plaque slows the movement of teeth when your braced. I never was an avid flosser before I got my braces on, but now i won't go a day without flossing ... I want to do everything possible to make sure that I am doing my part in making this process as speedy as possible, as well as ensuring optimal results. A lot of good it would do to have the surgery and a perfect bite if I didn't take care of my teeth.

The first day I flossed with my braces on, I think it took about 20 minutes. I bought some of the Superfloss and tried that, since I thought it would be much more convenient then using a threader and save some time. Well, it was convenient, but when I got back to my molars (especially where I had fillings), sometimes it was hard to get it between my teeth, and my teeth just shred it. So then I bought the Crest Glide Threader Floss. It is quite a bit more expensive than the Superfloss, but it is worth it! It is so easy, I can get it in between my teeth more easily, and it doesn't shred! So that is my plug for the day ...

Loose Hardware

2007-12-17T20:51:00.000-06:00

It will be 3 weeks on Thursday since I got my braces on. Last Friday, I had to go in to the ortho because one of my brackets came loose after brushing my teeth. It was on my lower left molar, all the way in the back. I was worried that one of the right ones would come off where my tooth came down on the bracket ... or one of my front teeth since they are crowns and brackets don't always bond with the crown. Hopefully that will be the only bracket that comes loose on me. So they put the new bracket on, and since the wire was too short to turn under like they had done the first time around, she put a dab of glue on the tip, but I feel like it is poking me. I have been getting one canker sore after another on my upper lip, and have another in the back where the bracket/wire is rubbing. I guess I should put some wax back there. The sides of my cheeks are pretty torn up right now, they get caught in between my back molars when I chew, and my bite now has changed where it feels like only my back molars touch when I bite down, provided I move move my cheeks out of the way first.

My TM Joints seem to be acting up as well. They are sore and achy. I don't know if it is from the increased clenching I seem to be having at night, or the fact that my bite is changing from the braces and straining my joints more.

So, other than the canker sores and achy joints, I think things are going pretty well.

Predicted Profile ...

2007-12-10T21:27:00.000-06:00

Although I am doing this for functional reasons, I can't help but look forward to the cosmetic result. Below is my current profile along with the predicted profile after surgery. What a difference a chin makes!

CURRENT PROFILE

PREDICTED PROFILE

I’m Braced!

2007-12-10T20:37:00.000-06:00

As soon as I received the approval from insurance, I scheduled an appointment to get my braces on, and called my OS to start my meds. The first day on the meds was a little strange, I think the muscle relaxer made me feel a little weird but it didn’t take too long to get used to. I decided to take the doxicyclene and feldene at noon, because I had read about someone getting ulcers in their throat if they took the doxy at night and laid down. You also should not have calcium within 2 hours of the doxycycline because it inhibits absorbtion. The amitriptyline should be taken at night to reduce clenching. So far so good on the meds, and I’ve been on them almost a month now.

The spacers went in on November 15th. The assistant had a hard time getting them in on my upper right because one of my fillings was creating a very tight space. She slipped and hit my upper palate pretty hard, and asked another assistant who is known for being able to place the “troublesome” ones. She tried a few times and finally got it in … I was a bit gun shy by that point and afraid of slipping. But she got them placed. I had some minor pain with the shifting of my teeth from the spacers, but so far so good. No pain no gain, right?

On November 29th, I got braced! I have clears on both uppers and lowers. Even though I had them before, it has been over 20 years and I didn’t particularly remember the details. I can really feel my lip incompetence exaggerated with the braces … I feel I have to stretch my lips over my braces to close my mouth. Overall, a week and a half into it, it hasn’t been so bad. Day 3 was my worst day … I was still trying to eat things like normal and finally gave up and realized I couldn’t. The most painful part at first was the hooks on the inside of the bands on my molars. I was told that they are normally filed off, but Dr. L (my orthodontist) wanted to keep them on because apparently he will need them when I get into elastics. Oh, joy. Overall, I can’t complain too much. They have not torn up the insides of my mouth too much, and I already can see some movement on my bottom teeth. I am still not eating as normal, but I figure I should be within the next week or so. Below are pictures the day before I got my braces on and the day after.

The bottom picture is a little blury ... but the lower wire and brackets look like a roller coaster ride. I guess for now I can be happy to have an 80% overbite to hide them while they are straightening out.

I did go to see my OD a week after I got them on, because I started clenching at night again and my teeth were hitting a bracket on the right side, so the left side did not close. Well, with all of the changes going on in my mouth, the clenching was not uncommon, and the amitriptyline should help. And not to worry about biting down on the bracket ... if it breaks off he will fix it ... and my bite is sure to get worse before it gets better. I can expect to have times where my bite does not fit together at all.

My next appointment is January 28th, and I am looking forward to it! Let’s get these babies moving!

The Details ...

2007-12-10T20:21:00.000-06:00

Since I had read so much about the surgery, I had many more questions than answers on the surgery specific to me. So I scheduled an appointment with my OS to go over my case. Below are the photos of my bite and teeth.

I assumed I would be having a LeForte I and BSSO based on what I had read, and the fact that I would be banded but not wired. But I had a lot of questions about all of the details in between. So here it goes. I have a 6 mm overjet, ideal is considered 2 mm. 7 mm of crowding on my lower teeth, and 80% overbite (ideal is 20%). I was particularly concerned with my nose, as I had read some comments by people who have had Le Forte I advancement and they were not happy with the change to their nose. He confirmed that he does a stitch (I believe it is the alar stitch) so the nose doesn’t widen, however it is a bit unpredictable if the nose will turn up with the Le Forte, and they don’t always know until they get in there. He said that once I get the orthodontics and my teeth are in place, he will have a better idea what he will do with my upper jaw. Right now, my Le Forte could be any where between 2 to 4 pieces, and he will possibly do palate expansion as well. But he won’t know exactly what his procedure will be on the upper until my teeth are in place, so I will have to wait. So the official list of procedures I will have done are: two to four piece Leforte I (upper impaction and advancement, with possible palate expansion), Bilateral Sagittal Split Osteotomy (Lower Advancement), and Genioplasty (Chin Augmentation). He won’t know the actual movements in mm until closer to the surgery when my teeth are in place.

I asked about the meds I would have to take pre and post op, because in my prior consult he mentioned I would need to be on long term meds (6-12 months before and after surgery) to stabilize my TM joints, since I have a degenerative right condyle. He told me I would be on low doses of Feldene, Doxycycline, and Amitriptyline. This is the protocol Dr. Arnett uses, and he told me that he puts all of his female patients on these meds that have TMJ problems to stabilize the joints. Otherwise, you run the risk of relapse, in my specific case if the TM joint continues to degenerate it could cause me to have an open bite. He spoke of resorption, that I am at high risk for significant boney changes, thus the meds. Specifically, doxycycline is an antibiotic (100 mg – it apparently has a secondary effect of joint stabilization), feldene is an anti-inflammatory (20 mg), and amitriptyline is a muscle relaxant (10 mg – has a secondary effect of reducing clenching at night). He also will put me on Vitamins C and E, which I am already taking anyway.

My procedure should take about 4-6 hours, but again this depends on the actual procedure he performs. He does require a catheter for all patients who have upper and lower, but it will be inserted after I am out and before I wake up.

He performs one surgery per week in the summer months, and one every two weeks the rest of the year.

I knew that I was not going to be wired, that I would only be banded. But I was very happy to know that I will not have a splint! They will have to put one in during the surgery but it willbe out before I wake up. It is amazing to me that he can make so many cuts and not need a splint. He explained that Dr. Arnett's procedure is to do the lower jaw first, and then the upper.Sometimes with the splint on the upper, it actually works against the surgery with an advancement because it pulls things back. They will also place 4 TADS (temporaryanchorage devices) in my gums, 2 on the upper, 2 on the lower. They are little screws that some of the bands will be connected to, so they are pulling on bone vs. my teeth. Otherwise there is some risk that when my braces come off, my teeth will move as they settle back into the bone. The idea is for the bone to be in the right place, which keeps the teeth in the right place. It sounds like I will be banded for a couple months, and maybe after that can wear them just at night.

The steroid they will use for surgery is Decadron, 16 mg. My ortho will have to put on the surgical hooks pre-surgery.

We also discussed the letter of medical necessity for my insurance company, and what I thought he should be sure to put in there. It sounds like he's had to write quite a few of these before, so hopefully it will do the trick! Total treatment time is estimated to be 2 years, with surgery around the 12 month mark.

Insurance Woes ...

2007-12-10T19:26:00.000-06:00

And so the process begins … my OS’ office submitted the paperwork to insurance at the end of July. After much back and forth between the insurance company, my OS’ office and my OD’s office to receive X-ray, molds, etc., I finally received a response on September 20th, stating coverage denied. The most disturbing part of the denial letter was that my case was reviewed by “a physician reviewer specialized in general surgery”. The surgery was deemed cosmetic because the physician specialized in general surgery did not feel that the proposed procedures would alter my documented symptoms.

So thus began my appeal. Since my meeting mid-July with my treatment coordinator, I had begun to do extensive research on the surgery as well as insurance. I pretty much expected a denial letter, so I wanted to understand what insurance companies look for to make sure that my appeal was as complete as possible. Two sites (The orthognathic surgery support site on Yahoo and the Archwire site) have been very helpful to me in understanding what patients go through, the risks involved, the rollercoaster of emotions through this process, the ins-and-outs of the insurance process (thanks Shayna :)), and tons of questions to ask my OS and OD on how specifically things apply to my situation.

I learned the following relative to the appeal:

*Request review by an Oral and Maxillofacial surgeon specialized in these procedures, they are the only professionals qualified to make a determination in your case.
*Outline that the condition is caused by a congenital deformity and the purpose of the procedure is to control pain and minimize further deterioration.
*Send a letter from your OS, your OD, and yourself (it is best if these letters arrive together)
*Establish medical necessity. Outline all problems that have been caused by your malocclusion (in my case, wearing of the condyles, TMJ dysfunction, lower incisor wear, migraine headaches).
*Illustrate the potential complications if you do not have the surgery (such as tooth loss, further degeneration of the condyles, increased TMJ dysfunction, continuation of migraines)
*Explain that you understand that the surgery may not cure TMJ dysfunction, but correcting the malocclusion may lead to improved symptoms.
*Show that non-surgical treatment (conservative treatment) was unsuccessful.
*Make reference to any other health professionals you have visited to improve symptoms (migraine specialist, chiropractor, etc.)

The letter from my OD was brilliant. It was very detailed and addressed many of the points listed above. My OS’ letter was much shorter and to the point, but it did the trick! I received the approval on November 9th for my upper and lower jaw surgeries. The genio was denied (this was expected) along with the temporary anchoring devices, which were considered “unbundled” from the main surgery.

Oral and Maxillofacial Consult …

2007-12-10T19:24:00.000-06:00

My orthodontist only works with one Oral Surgeon. Apparently the two of them have been to many seminars by Dr. William Arnett in Santa Barbara who is a leader in the field of orthognathic surgery, so they are very much on the same page in terms of treatment and procedure. This gives me confidence that they are working together as a team, which ultimately can only be to my benefit. Coincidently, Dr. P, the surgeon he referred me to, is a network provider in my insurance plan. That will at least help to reduce out-of-pocket expenses if I can get my surgery approved.

I was able to get in for a consult about a week after being referred, so I was excited to get the process moving.

Doctor P went over my tomo with me and showed me my airway … he said it is one of the smallest he has seen. He explained the surgery to me in layman’s terms, the upper surgery would help to reduce my “gummy” smile, and the lower surgery along with genioplasty (movement, in my case extension, of the chin) would correct my recessed chin. Ultimately, the goal is to correct my Class II Malocclusion, while also taking into consideration aesthetics and balance of my facial features.

I would need to be on three different meds for a year prior to the surgery as well as a year after. This is because I have an increased chance for relapse as I have TMJ dysfunction. The meds help to stabilize the jaw before and after surgery.

He explained that he was the only oral surgeon in the area that did not wire the jaws together after surgery, I would be banded instead but still would need to be on a liquid diet for about 6 weeks after surgery.

My Journey Begins ...

2007-12-10T19:12:00.000-06:00

So here I am, after reading countless blogs from others embarking on the orthognathic surgery journey, I have decided to start one of my own. My reasons are two-fold: one because I think that writing about the experience may be therapeutic in itself, and it will help me remember details and progress. Secondly, reading about the experience of others has been incredibly educational to me, and hopefully my story can help others.

For those of you who do not know, “orthognathic” is derived from the greek words “ortho”, meaning straight, and “gnathos”, meaning jaws. Orthognathic surgery is surgery performed on the bones of the jaws to change their positions.

So how did all of this start? It started about seven years ago, when I was speaking with my general dentist after a routine cleaning. I had been having some minor issues with TMJ dysfunction, and was not pleased aesthetically with my lower teeth, despite having worn braces for several years as a child. He referred me to an orthodontist, who I went to visit.

After taking molds and x-rays, the orthodontist presented me with two options. The first was a combination of orthodontics (braces) and lower jaw surgery. The second option was orthodontics only, but he would need to tilt my lower teeth forward which could increase the probability I would need some bone grafting done in the future, which would not be the optimal solution. He referred me to an oral surgeon, and I went for a consult.

To make a long story short, the oral surgeon submitted the procedure to my insurance, and they denied coverage. My orthodontist fitted me with a splint to ease my TMJ dysfunction and minimize clenching and grinding when I sleep. The splint to me was incredibly uncomfortable because it held my jaws in what was an “unnatural” position … although that is where my bite actually fit together the best. What I have learned now is that I have been most likely “posturing” my lower jaw forward for many years, even though this led to my bite not fitting together properly. The splint was really just a temporary “fix”, but it certainly did not address the root cause of the problem. I was not at a point in my life to consider paying for surgery out of pocket, so I moved on.

Now fast forward about six and a half years. Over time, I have developed crippling migraines and significant pain associated with my TMJ dysfunction. I can hear grinding in the right TMJ joint, and my left TMJ pops when I open my mouth wide. At times I get a sharp pain in my ear, but I have also found out this has nothing to do with infection, but is most likely a result of my TMJ dysfunction as well. After another routine dental exam in May 2007, my dentist again mentioned that technology has changed much over the last several years, and gave me another referral to the orthodontist. He referred me to the same practice, but a different orthodontist this time … one that my husband had recently been to and would be getting his braces on within the next few weeks.

They were quick to get me in for an appointment just two days later, and in mid June took some molds, x-rays and tomos. In mid-July, I had my consult to go over my treatment plan. I was only presented with one option this time, which was orthodontics combined with both upper and lower jaw surgery. My treatment coordinator showed me my tomo (a cranial scan that shows the joints from different angles), and I was able to see the significant deterioration of my right condyle.

The condyle is basically the bone connecting your mandible (lower jaw) to your skull. Where these connect is called the tempomandibular joint (TMJ). It is similar to a ball and socket … the ball being the condyle and the socket where it connects to your skull, known as the fossa. A healthy condyle is rounded, whereas my right one has been worn flat from the constant grinding. This happens because my occlusion (bite) is not balanced. By correcting my malocclusion (bad bite), my jaw will be in balance which should reduce my TMJ dysfunction. I also was showing wear on my lower incisors, which eventually could lead to tooth loss.

So … my journey begins. After seeing the deterioration in my joint over the last several years, I had decided that with or without insurance, I was going to pursue to correct this … after all it is my health and I own it!