Day 963 - 75 Hours Post-Op

Hi everyone,

Well, I'm on the other side of the operation! I knew these first few days would be rough, and I'm really hoping today is the peak of the discomfort. Consistent with other people's experiences, I'm not sure "pain" is the right word to describe what this is like. It's just extremely tight right now.

Anyway, while the pain meds are allowing me to sit here for a few minutes without the need to get up and move around, I figured I may as well start from this past Tuesday!

Tuesday, April 24 (day before surgery)
I went into the clinic for a 4:00pm appointment where they essentially told me everything they were going to do with me. In my particular case, it was a 3-piece Lefort 1 osteotomy for the maxilla, and a bilateral sagittal split osteotomy (BSSO) for the mandible. The maxilla was going to be moved UPWARDS a few millimeters, OUTWARDS a few millimeters and EXPANDED a few millimeters. The mandible was basically going to be ROTATED in order to meet the maxilla (my pre-op pics will show that the left side of my jaws did not meet), and brought BACK a couple of millimeters. There was also some talk about having a genioplasty due to the mandible going backwards, but after they did all their projections on my jaw, they determined it was not necessary. The last thing was for a couple of cheek implants. I never thought I needed this, but my cheeks are fairly flat, and the movement of the jaws would accentuate this flatness. The doc said something along the lines of, "You may not need them, but if you do, we may as well just put them in there." Turns out I didn't get them....more on that later.

Anyway, I went into this appointment extremely apprehensive - what am I about to put my body through? - but honestly, the resident surgeon who did this 'info session' did a very good job at explaining everything clearly, laying out the potential complications and expectations honestly. I felt much better leaving that appointment than I did going into it. In fact, I even managed to sleep that night. I was one day away from having a functional jaw for the first time in my life.

Wednesday, April 25 (day of surgery)
My wife and I woke up around 5:00am. There's something weird about your alarm going off on "big days". I was mentally ready to go and pretty much in a, "Lets get this over with," state of mind.

We arrived at the hospital for 6:00am. I was brought immediately into the OR waiting room for my 8:00am surgery. Aside from having to change into the gown and all that, I required a tightly taped towel around my head. The normal old operating room headdress would simply not do for this surgery.

After meeting with a couple of nurses, and the two resident surgeons who prepped me, I met with the  anesthetist . I have a history of coming out nauseous from anesthesia, and being sick after jaw surgery is not an appetizing prospect. However, when I had my SARPE three years ago, I was completely fine coming out of it. The anesthetist had a look at my chart from that SARPE and said that I was pumped so full of anti-nausea's during the procedure that there was no way I'd be sick. Makes sense! He said they'd be doing the same thing again. Made me feel a bit better.

Then came the call. The OR was ready for me. I walked towards the OR with one of the nurses after saying a quick bye and I love you to my wife and baby-on-the-way. First thing I noticed: Same OR as the SARPE - Operating Room #10. This must be the OR used for all jaw surgeries. I walked in, and started shaking right away. It is nerve wracking, but hey, if you aren't even a little scared about being put under for invasive operations, I don't think that's normal!! I lied down on the table, and the team quickly got my IV going. While this was happening, Dr. Holmes came into the room. I was still shaking at this point. One of the nurses told me to just pretend I was lying on a beach in Florida. That actually helped a bit! What helped even more however was when the anti-anxiety meds did their magic and calmed me right down! After this, they put the mask on me. I knew this would be it. I recall falling asleep. It took a good two or three good breaths, with my eyes getting heavier and heavier after each one. I was out.....

.....and then before you know it, I wasn't! It's 4:00pm, and I'm now in the recovery room. I remember thinking, "Ok, it's over. You did it." right away, but not much else after that. My wife came down to recovery because I had to stay for four hours. My jaw has cause some mild sleep apnea issues, and such patients are required to be monitored a little bit longer in the recovery room. In addition however, I lost quite a bit of blood in the OR - 1600 cc's! I did NOT require a blood transfusion, but the loss meant that my blood pressure and heart rate were quite elevated following the surgery. I also recall that my oxygen levels were down, so they put an oxygen mask over my nose and mouth which apparently helped out.

My head and cheeks were completely wrapped in a pressure bandage. That night, I could tell I looked kind of like a mummy through my reflection in the window, but I refused to look at myself in a mirror. I was afraid to see what was on the other side!

Around 9:00pm, I was wheeled up to the room. My only bout with nausea was when I shifted from the stretcher into my bed. They quickly administered Gravol however, and I was fine.

The first night, as expected, was rough. My famous bloody nose from last time couldn't stay away, and was draining pretty much all night. Moustache dressings - which would catch the blood drip from my nose - were applied pretty much on the hour. I was also bleeding/drooling heavily from the mouth. Not to mention that I had to wear that oxygen mask the entire time!! It was annoying to say the least. However, my wife was there the whole time.....something I am so grateful for. Also, we had a great overnight nurse who came quickly with every ring. But overall, that first night was bad. There's not much you can do aside from count the minutes until the sun comes up. Night seemed to last forever. At one point, I think I was slept for 25-30 minutes continuously, but it didn't get better than that.

Luckily, the sun always comes up.....eventually!!!


Thursday, April 26 (1 day post-op)
The junior resident stopped by at 7:00am to tell us that everything went great and as expected. This was a huge relief. The pressure bandage was then removed a couple hours later when the senior resident stopped by to pretty much tell me the same thing.

I managed to get onto my feet and walk around a little bit, which is big since the movement has the dual benefit of helping with the after-effects of the anesthesia, and also with minimizing the swelling (although right now, I can't imagine myself much MORE swollened!).

I went down to the clinic in the afternoon for my panoramic x-ray. I caught a glimpse of it on my way out.....lots of metal in there! Hahaha. When I have the exact hardware they put in there, I'll let you know, but for sure there are four plates in the maxilla and two in the mandible. Again, the residents said that everything looked great!

Due to the blood loss during the procedure, they had to monitor my hemoglobin throughout the day via blood tests. The bad news about the amount of blood loss is more swelling. However, one day post-op, I was still doing ok in this regard - the steroids they give you help with that! He mentioned that my scarring from the SARPE contributed to the bleeding. I guess things were just that much tougher to move around.

And that brings me to the cheek implants. The surgeon decided that due to the blood loss, and the fact that it was decided I didn't absolutely NEED them, he just wanted to end the surgery and leave it at that. I can't really argue with that - whatever he thought is good with me!

I didn't get much sleep on this night again (and not only because the Ottawa Senators had just lost game #7! Grrrrr.....ah well, they played an exciting game), but I would walk back and forth to the ice machine, get back into bed, try watching a little TV, maybe drowse off for a bit, then do it again. Again, you end up just waiting for the sun to come up. My wife went home on this night to get some real uninterrupted sleep in our own bed. She came back early though - right at 6:00am.

At this point, I still had not looked at myself in the mirror. My parents were scheduled to come down on Friday, and I wasn't sure what their reaction would be. The swelling has definitely been in a constant state of growth since coming out of the procedure. I'm told that it generally peaks at around 72 hours post-op, and I came out at 4:00pm on Wednesday, so I'm counting the hours from there. As I sit here, I'm at 75 hours.....and I really hope it has peaked!!


Friday, April 27 (2 days post-op)
My parents and sister arrived at around 10:00am. We needed my parents on this day because my wife had an appointment with her OBGYN RE: baby. So her plan was to pick up my prescriptions (since I would probably be going home on this day), go home and have a nap, go to her appointment, and then come back to bring me home. Apparently, getting the prescriptions was a little adventurous, but she got all four of them (antibiotics, painkiller, mouth rinse, another painkiller). Her adventures cost her some precious nap time though.

My painkillers were running good while my parents were there. And again, my swelling was not yet peaked, so they generally understood what I was saying! Overall, they were expecting me to be much much worse than I was (probably because I made this clear with them beforehand.....I wasn't going to be a pretty site!).

I was discharged at around 5:00pm, before my wife's appointment was done, so my parents brought me home in the joy of a Toronto Friday-afternoon rush hour. They stayed another hour or two after my wife got home, and then took off.

My nosebleeds had finally begun to clot on this night. It's still annoying though. I can't breathe anything through my nostrils because of how plugged they are. Hopefully this clears out soon! We also bought a cold-air humidifier which is supposed to help with this. It does, although I'm not sure it helped any more than marginally.

It was also my best night of sleeping. I probably got a total of five hours in, off and on. I think half of this is just due to exhaustion.

My diet is limited to strictly clear liquids until my next appointment on Tuesday afternoon, at which point I can hopefully graduate to some more 'full' liquids like Ensure or Boost. There's only some many combinations of beef broth, chicken broth, tea (no milk though!), fruit punch, apple juice, and water that you can have! However, it's not like I'm FEELING hungry, you know? When your body physically can't eat, it will hold off on that feeling of starvation for as long as possible. Because I've been good on the liquid intake so far, my weight loss has not been dramatic. I'm anticipating that to change over the next couple of days as the swelling goes down but diet stays the same.

Oy, I can feel that I'm getting kind of tired writing this, so I think I may stop for the night. Again, I am past that 72-hour post-op mark, which supposedly is the peak of the swelling. I'm really hoping so!

If I'm up to it, I will post the pre-op pics tonight.

Take care everyone,

Paul