Thursday, March 30, 2006

One week post-op

30 hours post-op ______________ 7 days post-op

Well here it has been one week since surgery. As you can see the swelling has gone considerably but still a bit to go. Small bit of bruising on my cheeks still but that is also fading. I talked to a couple of people on the phone today and they said I sounded a lot better too, and I think I'd agree. I still need to be careful not to overdo it but it does feel improved even from yesterday actually. My range of motion in my upper lip is also very slowly improving. Still a way to go as far as eating is concerned however. I tried apples and cinnamon oatmeal this morning and those little dehydrated apples were too rubbery to chew even after cooking. Shoulder and neck are still bothering me. Gotta try to find some liquid ibuprofen. Doubtful that children's Motrin will cut it.

Today was expansion day #5. The first turn was easy but the second one hurt too much so he stopped. The thing now is that I have to wait until Monday for the next turn. I'm worried about my jaw healing up too much before then meaning that the next expansion might really hurt or be impossible. Anyway, my OD had no worries over it. The good news is that he said the crossbite on my right side is almost gone, woohoo! This is after only about 10.5 turns and I can clearly see the improvement in the mirror too. I just wish I hold my mouth open wide enough to take a photo of it!

Monday, March 27, 2006

Post-op day 4 / expansion day #2

I was expecting today's expansion to be my biggest complaint but turns out it isn't! The trouble now is with my right shoulder and upper back it seems. It may be from how I've been sitting or sleeping the last couple of days. I can't comfortably lift my arm very high and I feel some tugging in my upper back, which is also making me feel a little dizzy. Sitting at the computer is also difficult for very long. I'm going to try sleeping with just one pillow tonight and see if that helps any. I was having back and dizziness problems long before the surgery but this is a new sensation.

I managed to hobble to the OD today for expansion day #2. Much to by surprise it went WAY easier today, I barely felt it. He turned it two times. Go figure. I would sure be happy if the rest of them are this easy, in which case I may decide to try it myself if I can keep my hands steady and my back returns to normal. Anyway you can see the gap forming in the photo above.

Swelling seems to be down some. I swished with some warm salt water and I've been using a hot compress too, so I guess that appears to be helping. The bruise on my right cheek is a little darker today. I can't wait for the woozy feeling of gently pressing on my face to be gone. Oh, and I managed not to take any codeine today either, yay for that. Not to say I don't have any pain, just not enough to warrant being conked out by narcotics.

Eating is a huge chore, and I often get it all over my shirt. I'm still on blender food and liquids. I haven't felt super hungry yet so I guess I'm doing ok but I should probably weigh myself soon to make sure. For dinner tonight I put a can of brown beans in the blender with one can of water and a 1/4 cup of sugar. Tasted better than the first time I did that without the water and sugar.

Saturday, March 25, 2006

Expansion day #1

Went to the OD today, my first visit post-op. (I wore a dust mask on my walk there and will continue to do so until the swelling is down.) He had a look around with the mirror and said it looked fine. I wondered if maybe I wouldn't be able to open my mouth wide enough for him to do an expansion but it was no problem that way. The first turn was the worst because the screw was a little bit stuck and he had to give it a good few pushes to make it turn. The pressure was a LOT more than I was expecting and it really startled me, and I whimpered a bit. He stopped mid-turn and asked if it was hurting me, and once he stopped I realized that it was pressure and not really pain per say. So he continued turn #1. It sounded like when you rub your finger on a wet piece of plastic or something. Then he did turn #2, which went easier but still lots of pressure and more whimpering from me. And finally turn #3 came and went as well. The immediate pressure pretty much stopped as soon as each turn was done and I didn't notice any residual pressure except for the whole of my top jaw felt tighter, as it were. He then gave me some cranial sacral treatments and said he got a good 'release', which is good news, meaning that he was able to reset the bones. …I should mention that I took a hit ofcodeinee before I went, so that probably had something to do with how I felt, without too much real pain, just pressure. I could feel the new space between my incisors right after the turns and it is clearly visible in the mirror now too. Still too hard to get shot of it with my webcam right now though because of the swelling. I took more codeine at lunch and that was enough to put me to sleep most of the afternoon. For dinner I just had a can of brown beans which Iliquefiedd in the blender. Need to add more water next time because the thickness made me feel like gagging once I got down towards the bottom of the second glass of it. Nice.

I took my temperature and it is normal. I also took some children's Tylenol since it is the only other liquid painrelieverr around. I don't feel like having the codeine knock me out again right now.

Next expansion is Monday at 9am. I'm going to have to have my OD do them all for me for now. I really can't see me being able to do it. I flinch way too easily.

Gonna try some heat now.

Friday, March 24, 2006

Let The Healing Begin!

day before The day before.
30 hours post-op 30 Hours post-op.

I've always thought I was quite a swell guy, hardy har har. Here is me the day before and 30 hours post-op. I look more like Mr Potatohead more than ever! The swelling is pretty bad right now in my opinion though others have told me they think it just looks like my top lip is swollen, but really it's my whole nose area and some of my cheeks. Also a bit of brusing beginning on the right side. I can't feel very much from my eyes down in the center of my face and my top lip is almost totally numb to the touch. I can't smile enough to show you my teeth but there is a small space between my incisors, maybe 0.5-1.0mm.

There isn't a whole lot of pain in the traditional sense but the discomfort from the swelling is quite bad. I have liquid codeine to help with it. I took some earlier and it didn't seem to do very much, but I think I only took 5ml instead of 10ml. The part that bothers me most is that every time I swallow or bite down I feel the bones shifting around, which is very unsettling. And if I talk to vigorously it hurts then too and I have to immediately stop. I've taken to almost whispering now so I don't over do it, and really I'm just not talking much at all unless I have to. I also can't open my mouth very wide to due to the swelling, which will make tomorrow's visit to the OD a fun trip. My sinuses are partially blocked too, so I'm doing a lot of mouth breathing and almost drooling due to excess saliva. Oh, and I just noticed that I can't hear quite as normally as I usually can right now, again likely due to the swelling.

Eating is going to be a challenge, at least until the swelling is down. I think I'll be blenderizing a lot and having to use a feeding syringe. While I was in hospital the only thing I ate, or rather drank, was some pineapple juice from the syringe. I was hooked up to an IV the whole time so I didn't even feel hungry.

My dear friend Michelle agreed to get up at the ungodly hour of 5am to drive me to the hospital for 6:30am. We were there with time to spare and chatted about U2 stuff before I got called in. The nurse took my blood pressure, weight, and heart rate and then instructed me to change into the hospital coutour. No ass hanging out, oh well. Then not 10 seconds after meeting Michelle in the waiting room my name was called. Michelle would wait for me and call my mom and my friend Chris when it was over. I was brought to a gurney in the hallway and laid there for quite a while with a nice warm blanket that had just come from the dryer waiting for my medical team to arrive. I talked with a nurse, then the anaesthesiologist, and then my OS before being walked in the OR. Really cool looking there I must say, felt like a space ship or something; and they had the radio playing too, as if surgery was like doing desk work! I laid down on the table and they put the IV in my left hand. They didn't tell me when they were going to put the drug in but I remember looking at the ceiling and thinking "oh, there it is" as I realized I couldn't focus my eyes. Next thing I knew I was in the recovery room with two nurses beside me, asking me if I wanted more morphine. I kept saying yes but it didn't seem to be doing much until they had almost given me the maximum dose. I had a tube going from my nose to my stomach though and once that was removed I felt somewhat better, though that was the beginning of a pretty sore throat for the rest of the day. I guess I was feeling good enough to chat with another couple of nurses that traded with the other ones. We talked about American Idol and my friend Jessica's travels to Afghanistan as a nurse practitioner helping the earthquake victims.

There was a delay in getting my bed ready upstairs, so I was actually in the recovery room something like an hour longer than usual but I didn't mind the attention. Once I did finally get wheeled up I remember not liking the sensation of moving while lying down. Kinda dizzying like they were going too fast. Turns out I got a private room right beside the nursing station. I hadn't asked for a private room so I hope I don't have to pay extra, but I guess if I do then it was kinda nicer that way. I kept trying to move my feet around like I was supposed to but it wasn't until later in the night when I decided to raise my knees that I really understood why they wanted me to do those exercises. The anaesthesia really does do a number on you. I also found when I sat up that I was really weak and had to cough up some crap in my lungs, also from the anaesthesia. Wasn't expecting that at all. I even became dizzy and buzzed the nurse and told her I felt like I was going to pass out. She said that was typical when you first sit up, so she put some oxygen on me and that seemed to help. I also asked for a shot of codeine, but probably should have waited until after coughing because I think the two of them made me feel ill. Anyway, the rest of my time there consisted of nurses coming in to take my vitals every so often. I think my favourite was Pat, a Jamaican woman who was both pushy and extremely helpful. I think that made a good combination for me. I dozed on and off all day and night and then finally at about 6:20am my OS appeared to tell me everything looked good and I could be sent home later in the morning.

Chris and Rosie came to pick me up. Chris was just trying his hardest not to make me laugh. I know it's his natural instinct and I value it highly but I had to law down the law today. Sorry bud! :o) We got back here and then they did a trip to the pharmacy for me to get my codeine and antibiotics and a couple of other miscellaneous items, which was nice seeing as I wasn't too keen on going out in public like this. Tomorrow will be another story though when I go to the OD.

Anyway, I made it. Now I just pray this swelling and discomfort will disappear quickly.

Wednesday, March 22, 2006

Pre-op festivities

Well I just wrote a huge post only to have it somehow swallowed by Blogger, urgh!!! So now I will have to rehash in less detail while pressing 'save' often.

First was a visit to Dr T. I was shocked that the waiting room only had two other people in it. They took a panorex x-ray and then Dr T explained to the DH assistants what he was going to do in the surgery, it was as if they had never heard of SARPE before, which I found surprising. Dr T told me I'd need to be on a liquid diet for 4-5 days and that it would be 6-8 weeks for the gap to close. I think it will be less than that based on others experiences that I've read but I guess it's not a bad idea to be ready for it to take longer. He also thinks I'll be able to walk on my own to Dr W's office on Saturday morning.

Then it was off to the hospital pre-op clinic. A nurse named Liz used a machine to take my blood pressure and heart rate. Both of those were fine. Then she asked me a few standard questions, and the only alarming one was about my diet. I told her I'm a vegan, but I thought I saw her write vegetarian on the sheet. I'll have to be sure to remind the nurse in the ward because there's no way I can drink anything with milk in it without getting a very sore stomach. Soy milk is fine, though I don't like the taste of it. She also gave me some leg exercises to do right after surgery while I'm lying in bed to prevent blood clots due to the anesthesia. Very easy. She also said I'd have tubes in my nostrils during the surgery but I'm not sure that will actually happen. I know they do this for the upper/lower surgery but I'm not sure about SARPE. I'll have to ask Dr T tomorrow before we start. I wasn't expecting this but I guess if that's the way it has to be then so be it. Hopefully they'll take them out before I'm really too awake if I do have them. I was then sent for a blood test, which I assume turned out fine or workable. I can't remember the name of it - OCS? Anyway, some acronym like that.

Then as I was waiting to see the anesthesiologist I met a couple of younger guys who were there with their parents from far out of town who were also patients of Dr T. One was having upper and lower, and the other just lower. I am lucky to not have to fly in and stay in a hotel like they and their families have to. I wished them luck and then my name as called. The anesthesiologist asked me some questions and listened to my chest. Given my past history of tachicardia he ordered an ECG (electrocardiogram). Another nurse did that for me and it was normal.

So that was all she wrote for pre-op. Then I went to Canadian Tire to get a blender. Just a $50 Oster, should be fine. And later after dinner I went and stocked up on some groceries. I spent $70 mostly because I bought high calorie, fatty stuff like brownies, soy ice cream, and pumpkin cheesecake...oooh!

So I guess that's all there is to report. My surgery is at 7:45am tomorrow. I'll post when I get home on Friday and feel up to it, hopefully with photos.

Monday, March 06, 2006

Cranial Therapy Installment #2

Went to see Alix today, my cranial therapist. I hadn't been since July when I was still investigating everything and I could feel that it was definitely time to go back. My neck and back were really tight and I've been having more episodes of vertigo lately. It is a very relaxing type of therapy. I really felt like I sunk into the table I was lying on, ahhh, very soothing. She said my temperal bones and occipital bone were likely to blame for the vertigo. They send different messages to the brain when they're not moving synchronously, so she spent extra time on them. She said my head responded very well. I still feel a little tense in my neck though but we'll see how I am over the next day or two.

Alix recommended a homeopathic product called Arnica to use following surgery. It supposedly helps bruises and other trauma. I'm still reseaching it but I'll probably try it. Might wait until after my expasion is done though, I don't want it to interfere with the "distraction osteogenesis". For my second surgery it sounds like something good to have.

Friday, March 03, 2006

Day 4 with the RPE

Seems a little easier today. Eating is still a chore but it took me about 20 minutes less to eat something resembling dinner tonight, beans and a bun. I think allowing the food to fall through the holes on the sides is the new strategy I'm working on. I'm noticing some mild discomfort in my left temple area when chewing. I also have to be very careful not to chew 'the wrong way' because I felt like I almost bit my right canine off when it hit my bottom teeth once yesterday, yeaow!!

Didn't use any wax yesterday. I decided to tough it out and was ok. We'll see how that goes.

I still can't speak very clearly and it gets tiring. I'm going to allow two weeks for that to improve and then see where I am.

Funny thing...I've been watching American Idol (come on, it's fun!) and noticed that Elliott seems to need some serious ortho. I feel for ya bro! It's odd how I notice these things now, but really, he does seem to have a similar case as me - narrow upper arch, long mandible, and lots of crowding. The dude can sure sing though!

Wednesday, March 01, 2006

A Sigh of Relief!

Ok, so yesterday I got the RPE in. Dr W also gave me the prediction photos, he emailed them to me and I didn't actually see them until I got home. As I was in the chair he described to me that after doing the photos he thought we might get away with doing just upper advancement. Cool, only breaking one jaw is a-okay with me! But, he said Dr T would have to make that call once I'm actually ready for it, which isn't for another year and half.

I forget what was said exactly but I ended up asking him, "so is that the difference between a LeFort I and II?" ..."No, a I and III", he replied. So off home I went to research a LeFort III. What I found was utterly terrifying. A LeFort III involves moving the entire mid-face forward in three sections completely away from the rest of the skull. They have to peel your scalp forward in order to access the sutures around the eye sockets. You know how some people have very bulging eyes? A LeFort III will correct that for them, but it is VERY invasive. I was horrified that I might be doing this and was rather dumbfounded at why this possibility wasn't presented way back in July when I had my initial consultation. I searched and searched and couldn't find ANYTHING or ANYONE who had this done as part of getting their teeth straightened, you know, like normal ortho. All I saw were pictures of children with major facial deformities (Granted the surgery worked wonders for them).

So I lost a lot of sleep last night and was wondering what the hell I was gonna do. So today I decided to call Cathy Tocchio. She works in the reception at Dr T's office and is very knowledgeable about all the surgeries and is also Dr T's wife. I described my concerns to her and it turns out that my research on a LeFort III greatly mislead me....

A "segmental LeFort I" can have up to 3 segments, usually. Depending on the situation the maxilla may be segmented in up to 3 pieces and placed accordingly. Everything they touch is below the zygote and the procedure is completely intraoral. ...This is WAY different than a LeFort III!! Got that kids? Get your terminology straight. Thank god I got this explained to me or I was totally going to throw up the red flag.

By the way, the reason why the LeFort III scared me in the first place was because Dr W's simulation of it looks awful (my nose jets out a lot) and I sure as hell wasn't going to let them morph me into that. I am now convinced that Dr W just isn't a very good artist (or rather maybe it's hard to do photo manipulation). He doesn't have the software which actually calculates the differences based on digital x-rays and "real" simulation. I've seen this done elsewhere and the photos I have are nowhere near as good. No reason to be discouraged though as I've looked at tons of real before and after photos of other people and they all look like improvements, and in many cases stunning improvements. So I'll hold off on posting my photos for now. I'm hoping that after the big surgery I'll be able to make a before-prediction-actual photo and laugh at the prediction because the actual will be so much better.

Also, as I was talking with Cathy we also found that Dr T had made some notes regarding my chin as well. So I might end up with some genioplasty in the mix as well, which is fine. The bottom line is that it is impossible to tell precisely what will be needed until after I've had braces. With a 3-segment LeFort I the nose may be moved forward slightly, which causes some concern as to whether rhinoplasty would be needed. Cathy said she didn't know of anyone who actually needed it but it is something to discuss beforehand. She also offered to have me come in and look at some before and after photos when the time comes.