Monday, February 25, 2013

My "oral history" and Jaw surgery March 2011

It’s hard to believe 1 year and 1 month ago I faced one of the scariest days of my life. I had Orthognathic surgery Maxillary LeFort 1 Osteotomy with genioplasty- it’s a mouthful, I know!  Why did I undergo this surgery you ask?  I had several problems, an open bite, a cross bite, a tongue thrust, and the biggest of all sleep apnea.
Before I dive into the surgery, let’s take it back to the beginning. Ever since I was born I had issues with my mouth and bite. I was told I had my mom’s small mouth, and my dad’s big teeth. I spent from age 6 to 18 getting baby teeth pulled out to make more room, wearing every orthodontic device you could name, sporting braces for 4 years, and finally heading off to college with my trusty set of retainers to wear for life.
When I was 23 my dentist told me he was not happy with the work the orthodontist had done and he wanted me to go back. After several meetings and x-rays they told me the problem with my bite was my jaw. They gave me three options to fix this: 1- Jaw surgery, 2- braces and a new retainer, 3- a retainer with a hawley to keep my tongue in check.  Well because in my mind I didn’t think my bite was so bad, I said no way to surgery, and definitely did not want to be seen in braces at my age, so I went for the least invasive retainer option.
Fast forward 2 years, I went to a new doctor (mine was away at the time) for a sinus infection and she was beyond shocked to see sleep apnea on my file and hear that I was not doing anything about it. She told me it’s something that puts stress on your heart and your body and only gets worse as you get older, and I should seriously do something about it.  So I was sent to an ear nose throat specialist with the thought that my sleep apnea was caused by my large tonsils.  After an extensive visit with him, he told me the root of the sleep apnea was my jaw and not my tonsils.  This being the third opinion that my jaw was causing problems, I finally decided to schedule an appointment with the ear nose throat Dr.’s recommendation Dr. Leonard Kaban.
My journey with Dr. Kaban began in June of 2010 with an appointment that ended up lasting two hours where he looked at my files and x-rays, sat and talked to me, and came to the conclusion that Orthognathic surgery was the answer.  He felt the surgery would change my life for the better and that I needed it sooner rather than later. The process would include 1- 2 years in braces, T.A.D.S temporary anchorage devices to pull up some of my teeth, a possible pre-surgery to widen my pallet, and a final surgery involving breaking and advancing my upper and lower jaw as well as a genioplasty (chin implant). I knew in the end the decision was up to me, and I didn’t want to go through all of this just so a surgeon could do a surgery, I feel like that’s their answer for everything.  As if he read my mind before my parents and I headed home, he left us with this final thought that had it just been my bite issues, he would have sent me on my way and told me to have a nice life, but because I had sleep apnea he wasn’t comfortable with the idea of me not having this surgery.
Before the mention of this surgery, I had never had surgery in my life, or spent more than a half hour in a hospital. I was petrified, upset, embarrassed at the thought of braces at the age of 26, and overall not wanting to go through any of the procedures that would consume the next two years of my life. Even though Dr. Kaban said it would seem like a huge amount of time during the process and would seem like a small blip when it was over, I still felt it was a lot of time out of my life that I was not ready to commit to.
I went home with a lot of thinking to do, I thought about how my life would be in a few years if I went through with surgery, not being exhausted every day, being able to bite into food without having to move it to the back side of my mouth or rip it off and end up making a mess, and being able bite down and have all of my teeth touch. I thought about how the need for this surgery had come up three times in the last few years, and it would most likely keep coming up, and now I was young and healthy but who knows where I would be several year from now. After about a week of weighing the pros and cons, researching, and talking to whomever I could find that had gone through the surgery, I decided to go forward with it.
Once I verbalized my decision, I began my many appointments. I met with MGH dental associates for my consultation; I got a pre-surgery workup done at Dr. Kaban’s where they took models, measurements, and x-rays. Not too long after I got the dreaded braces, the day I got them; I walked out of the appointment, got in the car, took one look at myself and burst into tears- I thought I looked like a 12 year old. My friends and family all assured me they weren’t bad at all, and they wouldn’t even notice them had I not pointed them out.  Despite their reassuring words, I still hated them but at the same time realized there was nothing I could do.  After a few months I got used to them, I always felt self-conscious meeting new people but for the most part I forgot they were there. 
Just about the time I was beginning to forget about the braces I was faced with the first procedure of placing the T.A.D.S.  I opted to go under local anesthesia instead of general, so I was awake for the whole thing. The procedure went relatively well, it was not as scary as I thought- only one of the T.A.D.S was a problem going in.  I think the worst part was the Novocain needle!  A few weeks later once the T.A.D.S. had settled in place they were connected to my braces to begin pulling the side molars up to match the level of my front teeth.  Over the next few weeks I experienced some complications with the T.A.D.S not staying in properly, my gums trying to grow over one, two falling out, and eventually had them taken out.  For some people they work great, but for others they don’t.  I have to say over the next few months I was beyond happy to just have my regular braces with no extras. 
Right around the fall of 2011 things began falling into place for the surgery to be scheduled, and truly I just wanted it to be all over with.  When you schedule the surgery after the orthodontist and surgeon feel your bite is where they want it, it is scheduled for three months from the day you make the call.  Right around Christmas, my bite was finally ready . . . a good gift! They scheduled surgery for March 27th, 2012. 
Between December and March, I went to the orthodontist every few weeks to make sure everything was kept in place. One month before surgery I went in for Pre-op tests, it was an entire day of meeting with different doctors, getting blood drawn, models made, measurements taken, and making sure I was in good health for the procedure.  About a week before surgery I had surgical hooks placed on my braces (these are clamped on the wire so there is a place to attach the bands after surgery to keep your mouth closed).
The evening before surgery March 26th, my parents came to town . . .my mom with suitcases in tow ready to move in for the next three weeks, and my dad with a weekend bag to visit in-between work. I went to my dance class for what would be the last time for 3 months, and had a delicious dinner. My mom painted my toes since I could not have any polish on my fingers, so I would have something fun to look at in the hospital, and I think to distract me from thinking about the surgery.  I woke up the next morning after not much sleep at 5am, dressed in something comfortable and walked out the door to head to the hospital- I had to be there at 6am. I tried to pretend it was just a normal morning, and a procedure that was no big deal, although I was extremely nervous.
Once we arrived at the hospital I was immediately checked in and sent to a room where I was given a hospital gown, a lovely hair net J and a bag to place my clothing and personal belongings in.  I was then wheeled off to get IV’s put in and prepped with some purple markings on my face for surgery. My favorite part was these wonderful heated blankets they brought and wrapped around me.
Before I knew it Dr. Kaban and his surgical team greeted me, and it was time to say good-bye to my parents as I was wheeled off to the operating room. Usually at this time before you are wheeled in you are a little foggy based on a medicine they put in your IV to kind of take the edge off, unfortunately they could not get IV’s started in me so they had to do that in the operating room.
It seemed like I had just closed my eyes and the next thing I knew it was all over. The surgery began at 8am and lasted 8.5 hours; my parents were updated every half hour.  I had a hard time waking up, and didn’t end up really opening my eyes until about 8pm that evening.  My face was wrapped in ice, I couldn’t really talk, there were boots compressing on and off on my feet and legs to keep up circulation, machines beeping left and right, and a blood pressure cuff automatically checking my pressure every 20 minutes.  I felt like I was on another planet, but was not in any pain.  One of the affects this surgery has on your nerves is that it stretches them, and when nerves are stretched they become numb. I was numb from the base of my eyes down to my chin. I did not really sleep the entire night, it was hard with nurses coming in and out every half hour, and all of the machines, and I think because I slept all day essentially I wasn’t really tired.
The next morning began early since I wasn’t sleeping anyways.  I had fluids being delivered to my body from the IV’s, but the nurses wanted me to start trying to drink some water from a syringe (at this point you can’t really drink from a cup).  It was not working very well, I couldn’t get the hang of it and water was spilling everywhere, I was extremely frustrated.  They told me I needed to relearn to swallow and that it would be difficult but I needed to work on it so I could 1- get some pain medicine in me because they could no longer give me morphine (they don’t want patients on that for long), and 2- could leave the hospital quicker.  The more progress you make the quicker you can go home. I kept trying but was getting really exasperated, I was getting soaked with water, and I felt like they didn’t get it how hard it was.  After attempting to help me for about 15 minutes they eventually left me to my own devices with the syringe and a cup of ice water sitting in a chair, I was pretty miserable.  About ten minutes later Dr. Kaban came in with a gang of curious fellow doctors and interns asking me how I felt?  Truth be told I felt horrible, I wanted some pain medication, I was tired, I didn’t want to be propped in the chair I was in . . .I was not the happiest person.  They poked and prodded around my mouth for a few minutes, said I looked great, and then headed off on their rounds. 
Around 8am my parents showed up, I was quite a site to see- although they were glad to see me sitting up.  The rest of the first day was spent sampling every anti nausea drug they had, trying to sleep, and working on swallowing. Dr. Kaban came by a few more times to check on me, and at 5pm I graduated and was wheeled up to my new room in the main part of the hospital- the first night was spent in the PACU (Post Anesthesia Care Unit). I was a little scared to leave the comfort of my own “personal nurse” and her checking on me every half hour or so, now I was up with all different patients, and new people that I somehow had to communicate that I couldn’t communicate very well. I attempted writing down things I was trying to say, but more times than not, no one including myself could understand the scribble of words that were landing across the paper- how I wish I had kept those to laugh at now!
Your length of stay in the hospital after surgery all depends on the extent of your surgery, if you have sleep apnea, and how well you progress in the initial recovery. For me day three was the day I got to go home.  I started that morning with a visit to Dr. Kaban to get x-rays, my teeth and mouth cleaned, as well as instructions on how to change the bands that were keeping my mouth closed. In the end based on my bite he decided to eliminate the bands all together. My IV’s were removed, I met with the nutritionist through pain medicine induced sleepy eyes, and was on my way out into the real world and life I already felt so far away from.
The next few days were not easy. I was most excited when I got home for a bath (didn’t have the strength to stand in the shower) and the quiet.  The hospital is extremely noisy between all of the patients and beeping machines, and it was amazing to just have silence.  I learned to successfully drink from a syringe before I left the hospital, so I continued getting as much fluid in me as I could. Gatorade and watered down flat Ginger ale where my two favorites. The first few days were clear liquids mainly broths, and the fore mentioned beverages. Once I was able work with those I graduated to some more interesting things like Orgain - a MUCH healthier and organic version of something like Ensure, you can actually pronounce all of the ingredients that go in it (I purchased discounted cases on AMAZON).  As you will learn in my Jaw Surgery cookbook I am extremely dedicated to a healthy and organic lifestyle, focusing on the most natural things to fuel my body, and that was something I wanted to maintain that throughout my recovery.
I kept the ice packs on 24/7 and made sure to take my pain meds and nasal decongestants on time, and also keep my mouth as clean as possible, maintaining several saltwater rinses a day.  My goal was to recover as quickly and painlessly as possible. I slept on my back with my head elevated and my body surrounded by pillows so I wouldn’t roll over in the night, definitely not my favorite sleeping position but helped with the swelling!  I continued to try new blended mixtures, take walks as far as I could make it, sleep, read and just let me body heal; after two weeks I went back to work.
My first week back to work was rough, I only made it 9am-2pm the first day, then I came home and fell asleep for 3 hrs. It’s amazing how the simplest things in your routine can wipe you out after surgery.  I continued the rest of the week making it about an hour longer each day, and finally making it the whole 8hrs on Friday.  Looking back I would recommend taking 3 weeks off of work, I think one more week would have really helped. Not only would it have helped as far as resting more, but also there are a lot of things you have to bring with you and do since you can’t eat or drink normally. Although I had gotten myself off of the syringes for eating and had been drinking out of a cup and using a spoon, you still need saltwater to rinse your mouth with, a toothbrush and toothpaste.  One super embarrassing accompaniment to the recovery is you drool like crazy and you’re numb so you don’t always know. Luckily I work with some great people who didn’t mind and kept me on top of it J.
The next 5 weeks were spent coming up with creative liquid concoctions to keep me full, making new friends at restaurants by requesting soups and broths or inquiring if things on the menu could be pureed. I continued to drool, salt rinse, syringe clean and brush my teeth. On week 6 my splint got removed, and I was ecstatic. I could not WAIT to get it off! I could finally brush ALL around my teeth and talk normally again.  Although the funny thing was, I almost had to relearn how to speak correctly.  I had gotten so used to having the splint in my mouth that I had stopped trying to pronounce the letters I hadn’t been able to, like B and P. 
The day I got my splint removed, I also headed to the orthodontist for a braces adjustment and impressions for a palatal bar that would replace the splint for the next few months.  I was now able to eat soft food! I have to be honest, as excited as I was I was also nervous. But I started slow and was just fine.  The first few things I ate were scrambled eggs, pancakes with lots of syrup, soup with noodles and cooked vegetables, and pasta. I got my palatal bar in a week after the impressions were taken, and also got new wires on my braces.  The next few appointments I got rubber bands to wear, each appointment a different configuration was created and I made sure to wear them 24/7 except for eating; I wanted the braces off as soon as possible!
A few months later the day I had been waiting two years for arrived. I walked into the orthodontist for what would be the LAST time in braces! I laid back in the chair and snap, crackle, pop in a matter of seconds they were off.  Dr. Klein scrapped off all of the extra glue, and then it was my turn to look in the mirror. Since I’m being honest here, I have to say I wasn’t prepared for who I saw staring back at me. I thought my teeth looked like horse teeth, they were huge and they felt so strange.  I suddenly wanted things back to the normal they had been for the last two years. NOT the reaction I envisioned! Dr. Klein assured me my teeth and I looked absolutely beautiful.  I had impressions taken for my retainers, and pictures for my records. I couldn’t stop looking at my teeth and my smile; it was all so strange. I was mad at myself for not being off the charts happy; I had wanted the braces off since before I even got them on.
It’s a big change, and not something you should feel bad about not being ok with right away.  It took a couple of months, but I finally adjusted to my new look and was in love with it. I couldn’t stop smiling and catching my reflection, it was all finally worth it. It was a long, crazy, sometimes painful journey, but I would do it again in a heartbeat.  I can now bite into celery all the way through- sounds insignificant, but that is BIG for me. I was always trying to rip a bite off of that and many other things, and getting embarrassed at parties. I now sleep the whole night through for real, and I don’t sound like I’m cutting trees down with my snoring, or have my mouth gaped open trying to catch flies.  I am a runner and since surgery have dropped 5 minutes off my 5k! I can take a deep breath through my nose- I never could before.  Life is pretty great post surgery, it wasn’t easy . . .but it was worth it!