Sunday, September 7, 2008

48 hours and counting down ...

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!!

Monday, September 1, 2008

More pre-op photos ...

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 ...

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

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.

Monday, August 25, 2008

Pre-Surgical Ortho Appointment

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 ...

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!





Sunday, July 27, 2008

I hope this isn't an indication ...

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

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

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

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

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

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


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

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