Sunday, July 31, 2011

Day 2

So I've been staying at my friend Meg's house and she has been so nice about everything and has taken care of me so well.

Today was definitely harder than yesterday because my swelling is much much worse so I couldn't even make a video because it hurts to talk :(.  The pressure in my face is a very weird feeling and it hurts bc I feel so stretched.  The feeling is coming back to the top part of my face and it feels really prickly and tingly all the time and isn't pleasant at all.

I didn't take the percocet a lot today and may just use it to help me sleep from now on.  I don't like that it just knocks me out because I need to be drinking and brushing and taking other meds all the time.  Today I basically just watched tv and dozed in and out all day.  I don't feel as out of it as I did yesterday so that's good.  I spelled so many things wrong yesterday it was funny.

Today I've been pretty much able to take care of myself.  I've made myself food, refilled my ice packs, and taken my meds on schedule.  The biggest challenge today was showering.  I had heard of someone who fainted from it on another blog so I was scared.  I told my friend to come check on me after about 5-10 mins.  At first it was fine and felt good, but then I started to get really light-headed and scared that I was going to pass out.  I can't really explain the feeling, but it was light-headedness mixed with exhaustion and a little bit of panic.  I got out of the shower and just wanted to lie down, but I didn't since I was in a bathroom.  I sat down and my friend eventually came down to check on me and then gave me water.  I slowly got dressed and then laid down. 

It definitely feels good to be clean and I think it may have cleared up my sinuses a little bit.  And seriously just a little bit, but at least my ears popped.  Today the TADs started to really irritate my lips and gums.  It's making me worry more about getting an infection.  I'm trying really hard to not get one bc I don't want to prolong my recovery time.  I've been swishing w salt water after every med I take and everything I drink that isn't water.  They want me to brush 6 times a day which I'm trying to work up to bc it hurts!  This morning when I brushed for the first time, I brushed way too hard on my top lip and idn what I did, but it hurt and has been really swollen since.

I'm really happy because I've been able to use cups so I haven't had to fuss with the syringes much.

Today was definitely a bigger struggle and I had to work to keep my spirits up.  I know how funny I look and I want to laugh about it, but it hurts.  And it's way harder to talk today so that was upsetting as well.  I'll take some pictures even though I'd never want to be seen like this so I'll probably put them up in a few days after it's gone down a little so I feel better about it.

Also ice is my favorite thing ever.  I wish I had a ski mask made of ice bc it's really hard to keep ice on all the different areas of my face.

Here's a video I made.  I wasn't originally planning on sharing it so I was pretty mumbly, but after rewatching it, I think it's a good video to show.  I put on subtitles so you can understand it.

my smile haha

lookin good...

my lovely necklace is made of the ice packs tied together.  the hospital gave me these

Home from hospital

Here are my super drugged up videos after coming home from the hospital.  I'm just about the worst story teller ever in these and the basic gist is that I didn't feel as bad as I thought I would and everyone was just sooooo nice!! hahaha enjoy. 

sorry I paused it bc my friends walked in and it created a new video

I don't know if you can tell, but my swelling goes up as I'm speaking in these.  I could feel it increasing.  

And here are some pictures from day 1:

you can see the blueish tint which is the beginning of the bruising

front teeth in front of bottom teeth!!! :) :)

2 of the TADs


such a great bite!!!

Friday, July 29, 2011

My Final Bites: T-5 hrs until jaw surgery

I'm so thirsty :(

My last meal:

so delicious.  steak burrito, guac, and chips
I've been avoiding soups and soft foods for a little bit now because I know I'm going to have soooooo many.  

My final bites: tortilla chips from chipotle, very crunchy!

I will upload this later.  It's coming out with audio/video sync issues so i have to edit it. 

And then my pre-op video:

Sunday, July 24, 2011

4 more days

          About two days ago I was looking at myself in the mirror at my 3/4 profile and I was thinking "maybe my jaw looks cool.  It's kind of different.  Maybe I don't have to be able to chew well.  I'm pretty much okay now.  It's annoying, but maybe it's okay..." Then I recognized what I was doing and how crazy those thoughts were hahah.  It was a weird moment.

        I got my jaw band today and just tried it on.  I look ridiculous and not as happy as the girls in the advertisements hahaha.  Ugh this is gonna be fun. 

       I also got some liquid food for after the surgery.  It's in a cluster in the kitchen and I was looking at it and it's just all so real.  It's crunch time after all of this waiting.  I can't believe it... My countdown says 4 days.  I remember when it was 148 and being so excited when it went into the double digits.  And now it says 4.
          It feels funny to write *deep breaths* but that's what I'm doing.

Thursday, July 21, 2011

it's so close.  I can't believe it

Wednesday, July 20, 2011

Just in Case

I haven't decided if I'm going to share this with my friends yet, but just in case I do, they're gonna be all sorts of confused about what I'm talking about.  So I'm just gonna explain a few things here.  Feel free to ignore if you're in the mix of this.

Okay here we go:

  • malocclusion: basically an occlusion is a correct bite so malocclusion is a bad bite. easy!
    • class II malocclusion: this is an overbite, when the top jaw is vertically over your bottom jaw.  There's also something called overjet which is a horizontal overlap.  These kind of confused me for a while, but now I get it.  An overbite is a deep bite, the bottom of the top teeth go down too low onto the lower teeth.  The overjet is just having them too far ahead of the lower teeth.
    • class III malocclusion:  this is an underbite, lower jaw in front of top jaw.  This is me!
    • class I occlusion: beautiful! perfect bite, everything is where it should be :)
  • osteotomy:   a surgery in which a bone is cut.  It can be to lengthen, shorten, or change an alignment.  
    • the prefix osteo=bone
  • Le Fort osteotomy: this is an osteotomy of the facial bones.  There are 3 different procedures that I'm familiar with.  Each of them break the bone in different parts of the face.  I'm getting a le fort I (the one on the left). 
    • Le Fort 1 osteotomy: basically they break the bone a little bit above the base of the nose so that they can reposition the top jaw.  Most incisions are done through the mouth cavity so there are little to no scars.  It can impact the shape of the nose, upper lip, and of course, the upper jaw.   It can be used to fix a gummy smile, an underbite, sleep apnea (by opening the airways), an overbite, and a cant in the jaw (a tilt).  If the jaw is pushed forward, the nose typically widens and nostrils can looked flared due to the tip of the nose being pushed upwards.  There are maneuvers and special stitches that surgeons can use to try to prevent these changes (VY stitch, alar base cinch suture, projecting the jaw in a certain direction up/down).  The soft tissue changes after a le fort 1 are moderately unpredictable and vary from person to person.  Sometimes the upper lip can collapse and recede, but I'm hoping that doesn't happen to me!  There is less chance of nerve damage with just the le fort 1 procedure when compared to a BSSO.  
      • I'll find some more detailed photos later
      • I'm sorry, I don't know a lot about the other 2 le fort procedures. 
  • orthognathic:  can't believe I forgot to mention this one first.  This is the type of surgery I'll be having.  orthognathic comes from the greek words ortho meaning straight and gnathic meaning jaws.  so literally: straight jaws! and who doesn't want that?!
  • just to mention, my surgeon is an oral and maxillofacial surgeon and is certified by AAOMS as most doctors should be if they perform this type of surgery. 
  • BSSO: bilateral sagittal split osteotomy
    • well we already learned osteotomy= bone break so that's easy
    • bilateral: both sides of the jaw
    • sagittal split: sagittal refers to the place on the mandible where the split is made
    • this is not the procedure I am having as long as my le fort 1 is sufficient.  If I were to have it, it would be cut and brought back.  This can be used to correct an underbite, overbite, sleep apnea (by opening the airways), and a cant in the jaw.  There's more risk of nerve damage as there's a nerve that will be screwed into if internal rigid fixation is used.  The alternative to risking that damage is to have the patient remain wired tightly shut to support that jaw until the bone has had sufficient time to heal.  (at least 6 weeks eek!)  My surgeon really didn't want to risk the nerve damage. 
      • The nerves at risk are sensory nerves so a patient who loses feeling in these nerves will not appear to be a stroke victim.  They just may dribble on their chin and not feel it or chew their lip and not feel it; things like that.  The chances of not regaining full feeling back into that area is high enough to be negligible (I want to say 20%, but look it up!!) and increases with age.  Full feeling is said to return between 6 months to a year after surgery and what the patient is left with after about a year is likely to be permanent and has a name starting with a p... paresthesia? 
    • There are also variations on this BSSO, there's bilateral sagittal split ramus osteotomy and a few others I've come across, but I'm not sure of what they entail because my research has centered on the le fort 1 procedure
  • maxilla: this is the upper jaw
  • mandible: lower jaw

I just found this site that has some good information, visuals, and case studies:

Leave me a comment if you're confused about something and I'll try to update when I think of other terms that might be helpful. 

disclaimer: I really want to stress that this was all written by me, an untrained college student who has scoured the internet, medical journals and case studies, and asked my doctors for all of this information.  I have no training in maxillofacial surgery so please don't quote me on any of this as it could be wrong.
However, it is factual to the best of my knowledge :)

Some Background

I just posted all that info about my workup, but I just realized that I've jumped into this blog in the middle of the let me take a few steps back and fill you in on what's going on.  (scroll to the bottom for a summary...this got really long)

       I got braces when I was 11 or 12, at the normal age.  I don't think I'd ever been so excited for anything in my young life.  So weird... I used to wish I had glasses too.  Before I got my braces on, I had a retainer with a palate expander and key.  I turned it with the key to increase the width of my upper jaw.  I'm so thankful that I did this when I was young because I shudder to think of going through SARPE (surgically assisted rapid palate expansion) and that gap afterwards.  Also, there's NOOO way I could imagine my ortho doing that with invisalign.  Okay, so I got my braces off when I was 12.  Wait, I must've gotten them on earlier 12=7th grade, 11=6th, 10=5th, 9=4th.  Okay I have some memory of a retainer in fourth grade so let's go with 9 as my beginning of orthodontia.  I only had actual braces for 9 months I think and looking back, I'm pretty sure my mom must have hustled the shit out of them to get them off before my bat mitzvah. 
          Anyways, I have vague memories of them saying if my jaws continued to grow, and duh they would, I was 12, that I'd need surgery to correct it.  I remember thinking "surgery? what? whatever that's ridiculous."  It was way past my scope of perception then because I was a kid.  So I continued on my merry way for a couple of years until it came time to get my wisdom teeth removed. 
         First off, omg that sucked.  Getting them removed was nothing, but they were SO SO SO painful right before I got them out.  They grew in literally sideways, pushing straight into my back molars.  Ugh the xrays were horrifying.  I couldn't say the "s" sound, couldn't chew gum, could hardly eat, and had problems closing my mouth right before they came out.  Getting them out, however, was the easiest thing ever.  I slept all that day and a lot of the next day (bc I had stayed up all night the night before) and then went out that night, had a bonfire and a great time.  No swelling, no nothing.  I got a pretty nasty infection that sucked, but it was gone in a flash. My point of this story, is that the surgeon who removed those told me about this surgery with this funny name I couldn't ever remember.  He showed me before and after pictures, told me how it would improve my bite and make things easier as I got older, said it would enhance the aesthetics of my face, but that I was, of course, already beautiful blah blah blah...  and then he said it was at least $20,000.  I think I considered it for the walk to the car and it was gone... $20,000?!?! hahaha yeah right. 
          Then I went to the dentist in September of 2010, so about a year ago.  I had noticed my teeth had started to wear down in abnormal places, I was annoyed because I couldn't sleep comfortably, only 2 of my molars on one side made contact when chewing...  I remembered that $20,000 surgery.  I tried to research it, but couldn't remember that silly name he had said.  Eventually, after many google "did you mean..." corrections, I found the name, and began adamantly researching the topic.  And I mean adamantly.  No actually, I mean obsessively.   It took me until my winter break, December 2010 to find the name and start my search.  I watched countless videos on youtube and was shocked at what a profound effect it had on these people.  I was also stunned by the post op experiences, but as I continued to see more and more people who had endured it, I knew I could too.  So I called my insurance one day and to my pleasant surprise, the lady on the other end of the phone said, "we cover it completely, you don't even need a referral."  I was in shock, I clarified, "for orthognathic surgery?  For an underbite?"  Again she said, "yes, you're completely covered".  I felt such an air of happiness, that there was something that I could actually do to fix my bite.  I was in utter disbelief and couldn't wait to tell someone. That was such an incredible moment that those are the actual words that were said in that conversation and my fragments of questions were, honestly, all I could muster in my elation and shock. 
          Naturally, I started another branch of research.  Cross referencing Baltimore's best doctors list with my insurance's in-network providers.  I eventually found two after soooo many phone calls that told me the doctor doesn't do that anymore.  I later found out that this was because it's a difficult surgery and not profitable enough when compared to wisdom teeth extractions and procedures like that.  Unfortunately, the first surgeon's first appointment was March 3rd.  March 3rd?!?! it was December, maybe early January!!  "Yes, we're sorry, he doesn't have anything sooner, he only comes in on Thursdays...But he's really the best."  I made that appointment, but kept looking.  I found another doctor who was able to schedule me for February.  I jumped at that appointment and excitedly awaited my February and March appointments.  The day of my february consult rolls around and we get a blizzard.  I wake up to a message saying that I'd have to reschedule.  Ugh! It was torture already waiting so long, but no big deal, I called back, and of course, their next appt was March 4th.  March 4th was after my original ridiculously late appointment!!! It was a very upsetting phone call. 

Let me quickly stop and say sorry for writing a novel.  I didn't plan on this, but I guess it's been a lot of work to get to where I am now...9 days pre op. yikes.

          Okay so at this point, I had stumbled upon a groupon (by the way everyone seriously has to sign up for it.  It's the best thing ever...EVER! It just sends you an email of local deals and it's SO much money off of things you may never have thought you could afford.  They have deals for spa treatments, haircuts, home improvement stuff, magazines, random websites, sky diving, paint balling, vacations, gyms, restaurants, clothes, it's seriously amazing.  I've gotten so much stuff through there.  I'll give you my referral code haha:  If I refer people, I get $10 when they make their first purchase so help a broke college girl out :). and it's free to get the alerts.  I know this may sound funny that I'm recommending them so much, but I say these exact things to my friends.  I really love groupon.)  Okay so I started talking about them because one day I got an email that said 1,000 dollars off invisalign treatment and initial consultation, xrays, and molds for $60!! I said $1,000 - seriously groupon's amazing.  And it was with my childhood orthodontists!!! I researched a bit about invisalign, but I knew I had to buy this, it was just too perfect.  So I met with them and I saw one of the Drs at the practice who I didn't see as much when I was younger.  He said he would be willing to do the orthodontic work with the invisalign as long as the surgeon said it was okay.  So I had to wait for my consults with the surgeons to find out.
          The first consult was with Dr. C on March 3rd.  He said he would do it with the invisalign and that he had done it once before and that it came out very well.  I told him about all the youtube videos I had been watching and he thought it was funny.  He said one of his patients had made one, he thought.  I actually came across a blog of a girl who had gone to someone else in his practice.  Anyways, he said 1 week of liquid and then soft foods.  Sounded good and I was off to the next consult the next day.  This Dr wasn't so pleased with the invisalign idea and said I'd have to get braces on before the surgery.  He also said I'd be wired shut and on a liquid diet for 4-6 weeks.  I didn't go with him.  Dr. C all the way!  After Dr. C okayed the invisalign, it was all systems go and they sent in the molds on a rush order and they got them to me fairly quickly I think... Anyways I'm on my 7th tray and that's the one that I'll stay on for a while because that was the position of my teeth when they took the mold for the splint at my work up.
          For those of you who don't know how invisalign works, you wear each set of trays for 2 weeks and then move onto the other.  You are supposed to wear them for at least 20-22 hrs (? I can't even remember...oops) each day and only remove them to eat and drink.  You can only drink water with them in bc they can get dyed and you get a lot of cavities bc normally the saliva in your mouth cleans your teeth, but the invisalign basically sticks the food to your teeth causing decay.  So the constant brushing and flossing is ridiculously annoying and even though I always try to do it, I can already see cavities wahoo!! But at least I don't have braces.  That's what I always remind myself.  Honestly, I don't know how I was so lucky to find Drs who were willing to work with the invisalign, but I don't know if I'd be going through with this if I had to get braces.  Those of you in orthognathic land are much braver than me in that respect.

          So I guess that's where I am now.  Now I'm just anticipating the horrors of recovery and looking forward to 3 months from now when I can chew normally... hopefully.   One of the hard parts about this surgery is that I know exactly what to expect, but most of my friends and family really have no clue how bad it's gonna be for a while.  I'm gonna be mad ugly and mad swollen for quite a while.  I've been trying to prepare my friends and family for it, but I don't think they grasp it. Maybe I should show them some pictures of other people during their recoveries.  I showed one of my friends a few months ago and it freaked her out hahaha. 

Well whatever that's my back story, if you scrolled through it (I couldn't blame you if you did), here's the gist:

Using invisalign and TADs during the surgery instead of braces and surgical hooks.
Underbite/ Class III Malocclusion correction due to maxillary deficiency/ mandibular hyperplasia
surgery July 29th 2011, one piece Le Fort I osteotomy(as far as I know it isn't segmental, but I think they'd have told me if it was)
not sure of movement yet, but probably about 5-6 mm forward.  
very nervous, very excited

Tuesday, July 19, 2011

It's Coming Up...

So my surgery is getting closer and closer and I'm getting more and more worried.  But I can talk about my stresses later.  First the work up:

So I got there a little late... oops.  My phone took me a ridiculous way...sometimes I hate google.  Anyways, it went fine.  It was pretty funny actually.  I was called back and sat down in a chair like the ones they have at the dentist.  It had the overhead light and everything.  Then my surgeon, who I had met with before, came in and asked how I was doing; normal small talk stuff.   Another man, in a white lab coat, walked in after him and then a man in blue scrubs walked in.  Then they all gathered around me, leaned in, and stared.  hahahah it was the strangest sight!  They were all looking at me from different angles and nodding and tilting their heads every so often.  I guess it was kind of uncomfortable, having my abnormality analyzed, but I know that's what they do all the time and they have definitely seen MUCH worse. Plus, I didn't feel that they were judging me in any way, just analyzing what they could do. 
It's hard to remember the order everything happened in...I probably shouldn't have waited 5 days to revisit it, but oh well.  Okay so the main surgeon basically told the other two to take pics, get molds, and get xrays.  Then he left :(.  I'm kind of upset that I haven't gotten to know him better or spend more time with him.  It was funny though, when they were analyzing my jaw, I noticed he has pretty crooked teeth.  I thought that was cool of him, I hope I can keep my teeth a little bit crooked after all of this, I think it gives them character.  So first, the 6th (and last) year student (maybe resident? idn) wearing the white lab coat sat down and asked me questions about the functional problems I had experienced due to my jaw discrepancies.  It was hard to answer because I have a bite now due to my invisalign "fitting" together so that's what I'm used to.  Then he asked me about things I didn't want to change post surgery and things I wouldn't mind changing.  My list of things not to change was pretty big, but I definitely told them that they could tilt my nose up as much as they pleased haha. 
Then I went and got xrays and had to bite on those stupid plastic things that keep your head still for the panoramic shots.  ouch!  Then I came back and they had me take pictures of my biggest forced smile, my normal bite, and my profile.  Then I sat down and they took a shot from a bird's eye view and worm's eye view.  I probably shouldn't have worn a v-neck...  Then they took molds.  The student in the white jacket did these and was so excited at how easy they were because I didn't have braces.  By this point, I was getting nervous about getting all of my 2 pages worth of questions answered and pulled out my notebook... I hope he didn't hate me.  He answered all my questions and was nice about it, but I felt bad.  He then did my physical by asking me questions about my health and then gave me a prescription to get blood work done. 
They didn't have imaging software there because it's inaccurate and they didn't like using it.  The main doctor, Dr. C, I guess I'll call him, said they are going to try to fix my bite by only moving the top jaw, but they got consent for both just in case.  They said it looks like they'll just move it out 5mm, but when I told them my ortho had originally said 7-8 mm, Dr. C said he'd need to do the "surgery" on the models and then he'd know for sure.  Dr. C had said at my consult that they'd be moving it out and down, but idn.  The white coat guy, TJ, said they'd look at my nose while they're in there and see if they can fix anything.  I fell face first onto brick ground a few months ago.  I now have a collapsed area in my nose, can't smell a thing!!, it hurts randomly, my sneeze has changed, and I feel pressure in it often.  TJ also said this would be the last time I'd meet with them before the surgery and that he would be there during the operation.  They said the surgery for the one jaw should take 2 hrs, but if the lower jaw is involved, it'd take longer: 4-5 hrs.  I'd stay in the hospital for 1 night and he made the recovery seem like nothing, as I've seen to be common with most surgeons.  But I know better!  And ugh for the life of me, I can't remember what he said about the splint and being wired/banded shut and everything.  It's vital information!! But what I have in my head is splint and rubber banded together for a week and then after...I draw a blank.  At my consult, I know Dr. C said I'd be on a liquid diet for a week and then soft foods for a while after.

Didn't mean for this to run so long!! but one last thing: I keep worrying that I'll wake up after surgery and have braces!! haha that'd be a shock, but I don't think it'll happen.  I get my TADs (temporary anchorage devices) put in... um I'm updating my phone right now so I can't look, but maybe tuesday of next week, July 26th?  Idn how many or where or anything, but I don't care as long as everything turns out right.

NINE more days!! AAAAAAHHHH!!!

Thursday, July 14, 2011

Work Up tomorrow!!

Hi to anyone who may see this! I'm having my work up for my jaw surgery tomorrow. FINALLY!!! I am so excited, but nervous that I won't remember to ask all of the questions I have or sleep late and miss the appt or worst of all- find out something's wrong and have to postpone my surgery!!  That would be awful.  I've never had a blog before and definitely never thought I would, but I've thoroughly enjoyed reading SO SO SO many other patients' experiences so I guess I have decided to make one.  I was originally just going to make videos and post them on youtube, but I guess I'll do a combo of the two. 
I have to go to sleep sometime soon or else I'll be miserable tomorrow, but I just wanted to get this started and get my feelings about tomorrow in here. 
My surgery is July 29th to correct my underbite.  As of right now, I'm only having a le fort 1, but that was the word at my consultation so I'll see what my doctor says tomorrow after my 700 measurements. 
So excited!!! I can't wait to see what I'll look like and get more details on the hospital stay, splint, liquid diet... the whole deal!! I also have an organic chemistry test tomorrow that I guess I won't be prepared we'll see how that one goes....
I'll update tomorrow hopefully!