Day 2 post-op

Now we're up to the present. I've been taking it easy, dozing in between medication alarms. I haven't felt hungry yet, but I've drank two chocolate protein drinks. Yesterday early morning was my last dose of medication stronger than ibuprofen, so this morning I was able to nurse my son which felt like such a relief.

My eye is doing marginally better, and I expect tomorrow it shouldn't bother me hardly at all.

Here's a list of medications/remedies I'm currently taking:

--antibiotic eye drops

--general antibiotic

--liquid ibuprofen

--liquid tylenol

--petroleum for my lips

--nasal spray

--eye ointment

Later on I also plan to add in my fish oil and my liquid vitamins.

I have these available but have not used them:

--hydrocodone

--liquid sudafed

--liquid anti-constipation stuff

Day 1 post-op

Sleeping overnight after the surgery wasn't too bad. Of course I got woken up every few hours to have my vital signs checked, but I got back to sleep quickly each time. I was a bit annoyed because my roommate had her television on all night which did not help for restfulness. Since it wasn't a private room, neither of our husbands could stay overnight--they both slept out in their respective vehicles. Because of this I did not get help pumping or eating until I saw my husband again at noon. I wasn't hungry, but my breasts were beginning to feel uncomfortable from the unused milk.

I had a trip to the oral surgeon's office for x-rays and a mini exam. They said everything looks great and that my teeth are going together well. During this whole morning I mostly kept my eyes closed because of my corneal abrasion.

After the OS, I was sent to see an opthomologist who agreed that it was a corneal abrasion and measured it and gave me information and medication for it. I hadn't brought my glasses with me, so he (the resident) was a little worried about how bad my vision was. They couldn't get it up high enough with a little hand-held device to say for sure that my eyes weren't really screwed up. I told him I remembered my contacts prescription, though, which allowed him to use his machine to show that I can see normally with the right lenses. During this time he also put in some numbing drops which felt heavenly. But you can only use those once because after that it starts to do its own damage.

After the opthomologist, I was wheeled into their waiting room and supposed to wait for someone to take me back to my room. I don't know how much time passed, but it seemed like way too long so I went to the desk to ask about it. They called again for some help, and finally I was on my way again. Back on my floor, they were trying to determine what room I was in. Someone said, "Michael?" which I thought referred to my husband being there, so I nodded. Instead, they thought that was my name (I guess a swollen face really makes you look less feminine), and they put me in Michael's room. I drank a little of his water before they figured out the mistake and got me to the right room.

After that I had some education on feeding myself, and got some discharge papers, and we were on our way!

Getting home was really nice, especially being able to hug my children. I let everyone gawk at me for a while, then got to take a long nice nap, and rest the rest of the evening. My dear husband set up a series of alarms that would tell me when to take my various medications and the like.

Day of surgery

My surgery was scheduled for 11:30 on the 26th of October. The day before the surgeon had called and let me know that he would probably only have to operate on the top jaw (though he reserved the right to do the bottom if necessary).

An 11:30 surgery meant a 9:30 check-in time. I had my own little private waiting room, where I was given disposable cloths with antibacterial stuff on them. I had to basically give myself a sponge bath with them, then air dry until I could put on the hospital gown.

A nurse came in to start an IV, but my vein 'rolled' on her the first try and my body did a protective thing where I started feeling faint, sound was echoey, and I felt hot. She decided to let the anestheologist put the IV in in the operating room. From my waiting room I was escorted to a bed (Mike and I parted ways at this point), and wheeled through some halls to my operating room. I scootched from my transport bed to my operative bed. I asked the anestheseologist some questions (such as why you needed leg pump circulation things during the surgery and not when you're sleeping--apparently your blood is more likely to coagulate during surgery). She then put a mask over my face and told me to breathe deeply. This was not comfortable because it felt like I could not get enough air in, but I was out so fast that it didn't bother me for long.

Next thing I knew I was being wheeled through more hallways and being told that the surgery went fine. Right away it felt like there was something in my eye and I was trying to rub it to get it out. I spent some time in the recovery ward, but don't remember much from there except nice nurses checking on me periodically.

After that I got wheeled into my room and was reunited with my husband, Mike. At first he thought the tears streaming down my face was from pain, but it was really due to the eye thing. Even now, the worst part of it all has been the eye. It turned out to be a corneal abrasion about 3x5 mm. Most of the rest of the day was spent complaining about my eye and learning to drink water with my mouth messed up.

When I drink liquids I feel a bit like a lizard. I get the liquid into my mouth, then do a large gulp to get it down my throat.

Pre-op video

Pre-Op Appointment

Last Friday I had my pre-op appointment with the surgeon. The orthodontists had implied that the surgeon might still decide that my mouth wasn't ready for surgery, but the surgeon said it was definitely a go--it wasn't even a question for him. So the surgery is on! The only thing that could derail it now is if I were to get sick. The last day or two I started to feel a bit iffy, so I slept extra and took loads of vitamins and today I'm feeling better. C'mon body, just a few more days!

At the appointment we did a number of things:

• took two molds of the upper and lower jaws
• did measurements with the face bow
• took x-rays from all sides
• took pictures from all sides (including one where I put a stick in my mouth, in case my jaw was slanted)
• got a prescription for steroids to take the night before
• answered all my questions
• got blood drawn (hematocrit and hemoglobin)

The surgeon doesn't think any of the alternative medicines for pain would really work. He also says most people get by with ibuprofen and Tylenol. So my current plan is to do what I can to not take any stronger medications after I'm home. He says it's a pump-n-dump situation for 24 hours after taking anything stronger. I'm not happy about this. We'll have to see how it goes.

They are not going to be doing huge changes to my jaws--maybe 5 mm at most in any one direction.

He says right from the start I'm going to be on a 'no chew' diet, and this will last 4-6 weeks. He says there's no restriction on using a straw. I probably won't have to use a splint, either. So it sounds like if I'm able I'll be able to eat a wide variety of things rather quickly.

On Monday I went to get my surgical hooks put in. My orthodontists have their main office in a town that's 25 miles away, and each week they come to my town as a satellite office. The disadvantages of this model became apparent as they discovered that they did not have enough surgical hooks to completely wire me up. Oops! So the end result is I'm going to stop by their main office after an unrelated appointment in the Big City (an hour away), and one of the orthodontists is going to come in special to put the surgical hooks on. I feel a bit bad about making her come in on an off day, but it's not my fault they were out of hooks!

A few more things bought

Last night I bought a baby toothbrush, and some prune juice. Just about everyone recommends the baby toothbrush for post-surgery cleaning, and many have mentioned constipation due to the pain medications. Well now I'm prepared on both fronts!

In the next day or two I'm going to try napping in one of our recliners to see if I need a neck pillow, and which one I'm going to use during my recovery.

Waking up is hard to do

In honor of my impending surgery, my father-in-law forwarded me this video made by five Minnesotan anesthesologists.

Via http://nottotallyrad.blogspot.com/2009/11/waking-up-is-hard-to-do.html

Liquid vitamins

After stocking up on regular vitamins I remembered/realized that I probably wouldn't be able to get a pill into my mouth for at least the first week post-surgery, and that I didn't really relish the idea of getting them in there chopped up (let alone asking someone to chop it!). So I picked up some liquid vitamins. I got the Centrum liquid multi-vitamin, and some Emergen-C Immune Defense formula. The box says it is a "Ruby lemon honey flavored fizzy drink mix."

On the different jaw surgery blogs I've read, there's a wide range of practices from doing nothing special to having acupuncture or lymph massage. Everyone takes different vitamins.

My family doctor just wants me to take extra vitamin C after the surgery. Dr. John Berardi has an article about healing after sports injuries, and he recommends Vitamins A and C, and copper and zinc, along with fish oil.

This is what I'm going to do, and it will have to be good enough:

Immediately post-surgery (before I can swallow pills):

• two doses of the liquid multivitamin
• one dose of the Emergen-c Immune Defense
• one tablespoon of fish oil

Once I can swallow pills, up to a month after the surgery:

• Vitamin A
• Vitamin C
• Vitamin D
• Two multivitamins

I might try to find copper somewhere in the big city this weekend. I already have my fish oil which I take every day.

Medications and breastfeeding

I am still nursing my fifteen month old son, and plan to continue doing so for the time being. This then poses a bit of a problem because I'm going to be in the hospital for at least a day after the surgery is complete. After that, I have to consider how any medications I take my impact him.

I don't plan to have my son brought to the hospital post-surgery, so it doesn't really matter what anesthesia is used--it will be out of my system by the time I feel well enough to pump. But after that point, I'd like to pump and save the milk rather than dumping it (breast milk has been called liquid gold), and resume nursing my son without any problems.

Here is a link that summarizes the different pain medications and their safety levels for breastfeeding (and pregnancy): http://kellymom.com/health/meds/pain-meds.html

I'm bringing a print-out of this to my surgery consult on the 15th. Though I'm hopeful that stronger pain medications may not be necessary since a number of blogs I've read have only used Tylenol or ibuprofen.

In the meantime I've started pumping so that my son will have milk while I'm in the hospital. I really don't like pumping--I feel like such a cow! But I'm making measurable progress, so that eases the sting a little bit. Every day and a half or so I put away another 4 oz bag of milk into the freezer. However, I don't know how much he's going to drink, since I can't measure how much he consumes when he's nursing. I'm going to just keep going and probably have too much.

A few preparations

Currently I'm mostly killing time until my appointment on the 15th with the oral surgeon. At that point he'll do molds, give a final okay on going ahead with the surgery, and answer a lot of my questions. One thing I don't know is how long I'm going to be on a liquid diet.

I'm also thinking about requesting a tooth implant for a molar I had removed. That molar being destroyed was one of the things that convinced me to go ahead with this surgery. When I talked with the oral surgeon the first time (prior to having the molar removed), they said that most people don't mind having that tooth gone. But I am finding that I'm only chewing on one side because of the missing tooth. And if I'm going to spend all this money on fixing up my mouth, why not make it perfect? I don't want to have to favor one side of my mouth just to save a few bucks.

Every day I notice the muscle strain in my jaw. It's likely a combination of being more aware of the problem because of being more educated, and the muscles having a problem with the new position of my teeth from the braces. I am amused when I realize that different teeth touch at different points of the day, like my muscles are getting tired of holding onto one position.

I'm starting to buy things to prepare. This is extra motivation to push the surgeon to go ahead with the surgery :-) Things I have already:

• whiteboard - for writing if/when I can't talk
• two boxes (24 12 oz bottles) of Myoplex chocolate nutritional shake
• one pack (6 8 oz bottles) of Equate strawberry nutritional shake
• one pack (6 8 oz bottles) of Equate vanilla nutritional shake
• one bottle (64 oz) white grapefruit juice
• one bottle (64 oz) V-8 Splash Smoothie
• vitamin D
• vitamin A
• vitamin C
• multivitamins
• new bottle of Carlson's Finest fish oil
• powdered greens

I'm worried that I won't be able to get vitamins into my mouth at first. I guess I can try crushing them now and see how it goes.

My husband wants me to try sleeping in the recliners now so we know which one to bring downstairs and if I need to get some special or extra pillows. I had been planning to do that this weekend while my in-laws were away, but it looks like they're going to be staying. I'll have to work some nap time in soon to try them out, instead.

Chat with my orthodontist

The orthodontists (I work with a father/daughter team) wanted me to come in for an X-ray today. Apparently the surgery wasn't as certain in their minds, because it's happened rather rapidly. If they had their druthers, it probably wouldn't happen for another six months, but since the timing works very well for us, and they don't see any contraindications, they said, "Let's go for it!" Their basic conclusion after looking at me today is, "We think it will work. Let's see what the surgeon says at the pre-surgery appointment." Way to inspire confidence! :-) The pre-surgery meeting is October 15th.

Chat with my family doctor

Yesterday I had a chat with my family doctor, one of the topics being preparing and recovering from the surgery. He doesn't want me to do anything differently leading up to the surgery as far as supplements go (I'm taking a general multivitamin). I'm already doing pretty well on nutrition, so it's just a matter of eating well in terms of fruits and veggies and having a good diet in general.

I have a problem with seasonal depression, and most people have a depressive crash a couple weeks after this surgery. The stress of a liquid diet, the trauma of surgery, and the pace of recovery just send people into a bad spot. Every year I try to go without medication for as long as possible, and this year I had high hopes that I could make it with a very improved diet and other measures. But the doctor thinks it would be best if I just started medication a week before surgery (if I don't end up starting before that because of my symptoms), to prep for the post-surgery crash. I'm still going to be doing measures like supplementing vitamin D and having a very strong natural light lamp.

After the surgery the doctor would like me to supplement extra vitamin C, and continue with as good a diet as I can.

Pictures

Front, not smiling, not trying to hold my lips together (ie, natural position).

Front, smiling. Gummy smile.

Left profile.

Right profile.

Teeth close-up, showing open bite (I could not get them closer together than this).

Some terms defined

In my last post I posted the letter my surgeon wrote to my insurance company. It used a lot of medical-ese terms that I'm going to define and clarify here.

mandibular - lower jaw

maxillary - upper jaw

hyperplasia - overgrowth

Class III dentoskeletal deformity - This basically means that my jaw grew wrong such that I'm left with an underbite--my bottom jaw is too far forward.

maxillary vertical hyperplasia - This is the 'gummy' smile previously mentioned. This also means, "cannot create a lip seal without mentalis strain"--ie, my lips don't close unless I work on doing it, so they are almost always open.

maxillary transverse deficiency - This means my upper jaw is too narrow for my lower jaw. I can attest to this one because if my teeth are together I can feel the bottom of my upper tee

th with my tongue--they stick out into my mouth.

mandibular sagittal hyperplasia - This means my bottom jaw is too far forward.

osteotomy - A surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment.

LeFort I osteotomy - Le Fort was a surgeon who pioneered these surgeries. The LeFort I surgery is a horizontal cut in the bone along the top jaw. See the pretty graphic of a skull for a visual.

mandibular osteotomy setback - This basically means they are going to cut out a chunk of my bottom jaw and move the front part backwards.

Reasons Why

I am going through with this surgery in the hope that it will improve several quality-of-life issues that I have. There is no guarantee on many of these, but 'a significant chance' for most of them. Things that I hope will improve:

• headaches - I have a lot more headaches than your average person. They may be due to my muscles being tense because of my jaw not being in the right place.
• breathing - I cannot breathe out of my nose very easily. It feels like I'm breathing through a very long, thin tube if I try.
• chewing - I chew in very limited places in my mouth because I don't have all that many teeth which touch.
• cleaning - Things like flossing have been challenging because of teeth crowding and placement.
• tooth destruction - The improper placement of my jaws is leading to my teeth being destroyed. There is pressure being placed on the teeth that shouldn't be there, and already this year I lost one tooth because of it. Other teeth would follow one at a time if this were not corrected.
• aesthetics - This is last of all because I didn't/don't really think I have a problem with my appearance. I didn't like having crooked teeth, but the braces could have fixed that if it were the only issue. After talking with the surgeon I'm aware now of my 'gummy' smile that is a sign of what's wrong with my jaw, but if that were the only issue I would NOT be going through with this.

This is part of the letter that the surgeon wrote to the insurance company. I hadn't realized how bad off I was until I read this letter! It's funny how dire my case sounds when you put it in the medical-ese. It's also interesting to me that I should have an improvement in my ability to speak, according to the surgeon. I've always sounded very nasal-y. I wonder if that's going to improve! Also sometimes I feel like I don't speak very clearly, but I always attributed that to being sloppy and lazy with my mouth. It would be interesting if that would improve, as well.

Misty is a 30-year old female presenting with a Class III dentoskeletal deformity. Of note she presents with maxillary vertical hyperplasia 524.01, maxillary transverse deficiency 524.03 and mandibular sagittal hyperplasia 524.02. These medical diagnoses when combined create a significant anterior open bite and dentoskeletal deformity. They cannot be corrected without surgical intervention.

....

A multiple piece LeFort I osteotomy.... This will be combined with a mandibular osteotomy setback.

....

Misty has no esthetic complaints and is seeking the jaw surgery to allow a stable dentoskeletal relationship. She will have a decided improvement in her ability to chew, speak and breathe following surgery....

Jaw surgery

Good morning!

I'm writing this blog because I will be undergoing double jaw surgery at the end of October (the 26th, to be precise), under six weeks from now. It's a major event in my life, and it's taking a lot of mental processing power to prepare for everything. Writing a blog will help me process it, and it will also help those who are going to go through the same thing. I know I've been helped tremendously by the blogs of those who have undergone this surgery.

There is at least one thing that is different about me that I haven't read about in the jaw surgery blogs yet, so maybe I can add to the collective experience and tips. I am still nursing my youngest baby, who will be almost 16 months at the time of the surgery. I also have an almost four-year-old daughter, and a baby (who is taking a bottle) who will be 14 months at the time of the surgery. We live with my in-laws, and my mother-in-law watches the kids during the day, so it isn't going to be as stressful as it could be having three young children post-surgery. But still I can imagine there will be some challenges associated with this situation.

Later today I'll post details on the procedure I'll be having, as well as why I'm going through with this surgical jawnt.

Yours,

Misty

PS: I know it's a horrible pun, but I had to do it.