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

Day 957 - Clock is Ticking.......

I'm not so sure I've ever been more afraid than I am right now.

I have spent the last couple of days searching around the net, and wow, I am realizing this surgery is quite invasive and serious. My latest concern now is BREATHING. I hear that breathing is a challenge, which makes me feel claustrophobic. I'm a pretty heavy-breather already.

The common string amongst everything I have read is to expect a week of hell.

I'm really trying to keep the end-goal in mind here, but today am questioning if it's worth it.

Day 952 - The Day Has Arrived

Ladies and Gentlemen, this is the MAIN EVENT of the evening. Introducing first, the challenger. Hailing from Toronto, Ontario, Canada, this man went in for an orthodontic consult in June 2008, and now, after six tooth extractions, a SARPE that required a half-inch of expansion, a retainer, and three years of braces, he is finally ready for the final fight. PAULLLLLLL KENNEDYYYYYYY!

Ok, so apparently the stress is getting to me a little bit! Hahaha!

But seriously, I am going in for my orthognathic surgery next Wednesday, April 25; just over 3 years since my SARPE. I didn't know how I would react when I was told I was booked. To be honest, I thought I'd be scared like I was with SARPE, but as serious as this one is (more on that in a minute!) compared to SARPE, I was more EXCITED that anything to get the news. I am still apprehensive of course, but am excited to finally have this over with.

The timing could not have been any better, literally. Had the surgery not been able to happen this month, I made it clear I wouldn't go through with it. Not because I'm sick of the wait, I mean, teeth are teeth and it takes time to move them. It is because my wife is pregnant with our first child! She is due in early September, and so I wanted to make sure she would not be dealing with a jaw surgery patient so late in the pregnancy. Wouldn't be fair on her. I let my intentions be knows to my new orthodontic student at the clinic (Joanie had graduated last spring), Heather Ford, and I think she really went to bat for me and got me in there. The program held up its end by getting me in for April, and now I will be holding up mine!

The baby news has really just capped what has been a CRAZY three year period since the SARPE. In between the SARPE and the orthognathic surgery next week, we have bought our first home, I have switched jobs (twice), gotten married (once! Hahaha!), received my Fellowship in the Society of Actuaries (a seven year process which is the topic of my other blog FYI!), and have a baby on the way! Wow. But I digress.....

The surgery itself sounds....intense to say the least. Although I have not officially been briefed yet (they leave this until the night before surgery!), I know this will involve a 3-piece Le Fort maxillary expansion - because obviously the 16.75mm SARPE wasn't enough!!!! - a lift of the maxilla a little bit to show a little less gum when smiling, and some slicing and dicing of the mandible to fix the crossbite and get the jaws lined up properly. Oy. All in all, the procedure is supposed to last 6-8 hours. I report to the hospital at 6:00am the day of, and will be put out at around 8:00am. I kind of like the idea actually - no one wants to wait around all day for their surgery to start.

So I've been spending the last few days pigging out. Based on the fact that I lost 30lbs with SARPE, I'm expecting to lose at least 40lbs with this one. The good news is that I am overweight by about 20lbs (I am 6'7", 240lbs currently), but the additional 20 would put me at a weight I haven't been since being a scrawny basketball player in high school!

I am thinking I am more comfortable (at least so far) with the idea of this surgery because I have done SARPE already. I realize this surgery is SO much more serious than SARPE, but do I realize I will be a bloody, swollen wreck? Yes. Do I realize I will be eating with a syringe? Yes. Do I realize the weight loss will be significant? Yes. Barring any complications, I do have some idea how this will go down.

Anyway, as I did before, I will post some photos of my "before" surgery, and will keep a close eye on my progress post-op. And since I will be off of work, with not much else to do, I'm sure I'll be updating the blog regularly over the next little while. My plan right now is to partially return to work after two weeks by working from home a few hours a day, and then return to the office after the third week. I think it's a realistic goal, but I understand that everyone's situation is different. We'll see!

If anyone out there has undergone the 3-piece Le Fort, drop me a line. I'd love to read about your experience with it!

I'm definitely a wreck right now, but again, it's exciting to being so close to having this over with!

Wish me luck!

Take care everyone!!

Day 828 - Surgery Time

Sobering news today - it is surgery time.

I have seriously been contemplating not going through with the surgery. I am extremely satisfied with my results thus far. My bite is definitely not ideal (I have a crossbite, my midline is off, my maxilla - believe this or not - is not quite wide enough, etc.), but my teeth have come so far, so dramatically, that I was thinking, "Hey, why put myself through this surgery?"

I met with the surgeon, Dr. Holmes (the same guy who performed my SARPE), yesterday, and he answered that question very simply: If I do NOT do the surgery, there is a high chance of relapse. After investing over three years of my life now (hard to believe my expander first went in over three years ago!), the last thing I would want is to take steps backwards and undo what has taken so long to accomplish. I trust Dr. Holmes' word very much. He is a very experienced surgeon who has this gift - at least with me - of relieving any anxiety related to these procedures.

Therefore, I'm sitting here today almost positive that there will be maxillofacial surgery in my near future. As to the exact timing, I am obviously not quite sure, but likely late March/early April.

Dr. Holmes brought me through some of the details of this surgery. Does not sound fun.

As I pointed out before, my maxilla has to be expanded even a little further than it is now. For those who have read my blog, you will know already how far my maxilla has been expanded. As a quick recap, there were 67 activations of the expander, for a total of 16.75mm of expansion - well over half an inch. In fact, the maxilla had to be expanded so much that they had to switch expanders half way through because the screw in the first expander was not long enough! Unreal to think on those days again.

I think the rest of the plan for the maxilla is to bring it a little forward and push it a little upwards. Everything then gets screwed into place, which is different than SARPE where my upper jaw was left to 'naturally' heal, and therefore was loose and "wobbly" whenever I would do something as trivial as lightly brushing my teeth.

The surgery also involves work on the mandible. *Sigh* I think basically they will be looking to rotate it a little to fix the crossbite and bring my bite together. This damn bone sounds like the trickier part.

He also said that my jaw will not be wired shut. There will be some elastics to ensure I do not move the jaw too much, but no wires. I guess that's good. I'm taking any good news I can get right now!

We then spoke a little about how long a surgery like this will typically last. He said, "At least 5 hours, likely closer to 6 or 7." …… that floored me. I have never been under the knife for so long.

How long is the recovery? The first 2-3 days are in the hospital. Then home. Liquid diet for a MONTH (to compare - the liquid diet with SARPE lasted just under a couple of weeks), likely 2-3 weeks at least on short-term disability from work, all the joys of that swelling and bleeding that I missed so much from SARPE. Hahaha. Oh, did I mention that I would then still be in braces for probably another year? Hahaha. Man. What am I doing? Someone talk me into this or talk me out of it! Please!

Anyway, now that the ball is rolling again, I will be back on this blog, pictures and all.

If I am not back on again, Merry Christmas and all the best for a healthy and happy 2012!

Day 448 - Update

Wow, 448 days with braces. This is crazy.

Just thought I'd post a quick update. Basically, my teeth are now aligned. The spaces are more-or-less closed up. The one time-consuming item is that they had to push my upper molars UP, as they were kind of sticking out a bit. My orthodontist said that because my molars had never lined up with my bottom teeth, they grew out a little sideways. If they left them as they were, there would be a risk I'd be chomping down on my cheek once the maxilla is advanced in the surgery. My molars have now been pushed upwards, and look in-line with the other teeth, so basically I'm ready to go!

The only thing I have to wait for is the actual surgery date. The surgeons are going to see me next week and will hopefully confirm that I am indeed ready to go. I just want to get this over with. 448 days of braces + 60-something SARPE activations + SARPE surgery + living with an expander in my mouth for over a full year has been daunting. In Ontario, because I think this is considered more of an elective procedure, the wait time for surgery can be long. The last time, for SARPE, I had waited 2 months and then got a call saying, "We have you booked for this Thursday." Hahaha. I have a feeling someone cancelled or something and so they called me. Hopefully it won't be a long wait. February or March would be PERFECT for me, just incase I flunked the exam I wrote on November 4. If I failed that exam, I'll be writing again next November, which means I'd have to start studying in June/July. So if the surgery is in Feb/March, then by June/July, I should be close to 100% back to normal I would think.

I'm a little nervous to find out what the game plan is for the surgery. It would be AWESOME if they only have to work with the maxilla and leave the mandible completely out of it. If I want the 'perfect' bite, the mandible will probably definitely have to come into play I think due to the crossbite I have, but if hacking apart my mandible ends up only serving the purpose of fixing the crossbite, then it may not be worth it.

Anyway, I will keep you posted once I see the surgeons next week. Now that the surgery is upcoming, I plan on posting here much more frequently!

Take care,
Paul

Day 370 - First Year with Braces DONE

One whole freaking year! And what a year it has been!......got married, changed careers, passed one of my final two actuarial exams, went to Europe......wow!

But bring my jaw blog, I'll stick to the teeth.

Seriously, when I look back at the Day 1 blog pictures, my teeth have come light years in one single Earth year! My teeth are now straight, believe that or not! I no longer wear the upper palate retainer, and there has been a little relapse up there (I can tell because that retainer does not fit very snug at all when I try to get it in there), but for the most part everything is looking great! I am currently in the process of closing the gaps caused by the extraction of the lower 4's back in the spring of 2009.

Once that is done, the real fun starts, and my return to this blog will be assured. Impressions of my teeth are going to be taken, and the surgical team is going to figure out the appropriate course of treatment for the impending surgery. It makes me nervous just to think about it. I guess I can take solace in the fact that once THAT'S over, then this whole process is going to be over as well.

I am going in to see Joanie once every 3-4 weeks now since the wire used to close the gaps is only good for that amount of time. I also still have a problem with the upper molars, which have not quite aligned with the rest of the teeth yet. They protrude slightly to the outside, which could be a problem if they move my maxilla forward during the surgery....I may be chomping down on my cheeks. So they are trying to push these molars UP as far as I'm aware. It has made for a couple of uncomfortable days since my last adjustment, and the bracket wire is once again slicing into my cheek.....which has not happened in months!

I will keep everyone up to date.

So given that it has been a year now, I think these are my top observations of life with braces:

1. Carrying a toothbrush with you is a must. Something from every meal is going to get stuck in the brackets, and can be quite disgusting. Lettuce or any kind of leafy vegetable gets stuck in there every time I eat it.

2. Flossing is annoying, but is pretty important. I would recommend at the very least using a waterpik if flossing is as annoying for you as it is for me.

3. Electric toothbrush is a must. The OralB Triumph has special heads for people with braces. I use the pick-like head to clean the brackets, and then the regular head to clean the teeth.

4. Go to your dentist as often as possible for cleanings. The bottom line is that your teeth are not going to be kept as clean with braces as they would be without, so going for cleanings as often as possible is strongly urged! I currently go every four months. Once this is all over, I may pull back to every 6 months.

5. Keep your eyes on the prize. After it's all over, your teeth are going to look great. Besides, adults with braces is becoming more and more common.


I will update this again once I start hearing about the surgery.

Take care!

Paul

Day 274 - Apologies

Holy crap - I've been terrible about updating this blog. Forget about the pictures, which I have also been bad at, I can't seem to update this BLOG!

That's maybe because there's not much to report. I really want to post some of the pictures that I've taken. The teeth look great. The ortho has stated that they are pretty much aligned now. Pretty soon, they're just going to be closing the gaps in the bottom jaw caused by the teeth they removed last year.

Speaking of 'year' - on June 30 it will be one year since the SARPE expansions stopped. So this means that one year ago, I was sporting a HUGE gap in between my teeth. It's crazy to think about how far everything has come since then!

My surgery was tentatively scheduled for late this summer/early fall, but I think my orthodontist, who is a student still, maybe got a little ahead of herself because now they are saying no surgery until next year! This is what I was assuming initially when this whole thing started over a year ago, but given how well my teeth have been coming along, I was really hoping for this year. Oh well.

The other significant event that occurred was the removal of the expander! This happened at some point in March - about 13 months after it was initially placed up there. The expander was replaced with a removable retainer to ensure the relapse of my jaw is held to a minimum. The retainer was something else I had to get used to, but now it's fine. Holy crap though - when they removed the expander, my palate was very sensitive, it felt weird even when AIR would touch it! My mouth's palate was like a cathedral!! Of course, I'm used to it now. Oh, when I got home, I took a picture of my expander when the process started versus the expander when it was all over. I think you'll be as shocked as I was at the difference (yet another picture I have to put up here!).

My orthodontist is about to go on her summer break. I have an appt next week, and one in July right after my WEDDING actually. It's going to be a busy summer.

Finally, the orthodontic works is nearly paid-in-full!! Next month will be the final payment. Again, I have been very lucky to get this work done through the university. I have a great job and pretty good benefits, but even with all that, I just don't know how I could justify the price tag of this work done through a private clinic.

Anyway, I'm going to try to update this blog a little more regularly. I'll put some pictures up here really soon.

Take care,

Paul