Day 123: Four Month Update

Today's pic:

 

 

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It has been 4 months since my surgery and so much has changed in such a short period of time! 

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I only have numbness in my lower lip and chin now.  I can tell the feeling is starting to come back though since it is a little itchy and tickly (yes, this is a word, I looked it up.).  The only area that still has a lack of movement is the right side of my nose (left side in the picture below).  I don't seem to be making any progress here.  I can feel the hardware under the skin, so I wonder if this is the reason for the lack of movement and if it will be a permanent result.

 

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I can get 11 popsicle sticks comfortably in between my teeth now, and 12 at a stretch.  I am trying to make it to 14 by the end of the year.  My goal is to be able to finally eat a sandwich again!  Even though I am not able to open my mouth wide enough to eat a sandwich yet, I can pretty much eat anything now as long as I can squeeze it in my mouth.

Thanksgiving dinner #1:

  

Thanksgiving dinner #2:

 

HAPPY THANKSGIVING!!! 

Day 78: Three Month Check-up

Today's pic:

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I traveled to UNC hospital two days ago (on Tuesday) for my three month check-up.  Dr. Turvey and Dr. Brookes were very excited about my progress.  I still have a ways to go with movement and numbness, but they don't see any reason why I won't have a full recovery as long as I continue with my exercises and physical therapy.  At this point, I am able to get 10 sticks in my mouth between my molars.  I am to continue until I can comfortably get 14 sticks in.  I also need to continue massaging my cheeks and around my mouth, nose, chin, and incisions.  Retraining my facial muscles is a big deal now if I want to gain back symmetrical movements on both sides of my face (as of now my smile is a bit lop-sided and I can only scrunch one side of my nose).  To do this I need to sit in front of a mirror while making exaggerated expressions and forcing my facial muscles to react the same on boths sides of my face.

As far as food goes, I have worked my way up to pretty much anything I can cut into pieces and fit into my mouth, as long as it's not too hard or chewy.  Steak and sandwiches are still off the table, but pastas, tender meats, and even pizza are options for me now.  It's nice to not have such limited options.  My jaw still gets fatigued at times, but that means I am getting stronger!

Next appointment with my surgeons is scheduled for the 12 month mark!  That will also be the day Mom and I eat BLTs at Merritt's Store and Grill.  We made a promise during my last appointment pre-surgery to eat BLTs for my one year post-surgery celebration!  P.S. If you haven't eaten a BLTs at this place before... It's worth the drive, so make it happen!

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Today was my second appointment post-surgery with my orthodontist.  Dr. Vanderwall is also extremely pleased with my recovery thus far.  I asked him today when he thinks I will be able to get my braces off, I prefaced by saying that I am by no means trying to rush perfection.  He is hopeful that I will be braces free in March 2014!

On last thing to mention... I no longer have to wear rubberbands all day every day (including at night).  I now only need to wear rubberbands at night.  And my rubberbands were changed from a square on my farthest back molars to a triangle around my eye teeth.

Before:

After:

Day 63: Daily Physical Therapy

Today's pic:

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I know it has been quite a while since I last posted an update.  The first week or two after surgery, there are obvious changes from day-to-day; however, as the weeks go on the changes have become less and less obvious.  I think my recovery is now going at a snail's pace.  I've been told that it could take up to 9 months post-surgery before I gain back all my feeling and movement.  Until then, I have to put myself through daily physical therapy.  Some of it feels soothing and relaxing (the warm towel around the face), while most of it feels uncomfortable and painful (cranking large Popsicle sticks up and down between my molars).

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I dampen a hand towel and then put it in the microwave for a minute to make it nice and toasty...

Wrap it around my head...

Then wait for about 5 - 6 minutes until it cools...

Now it's time for some Popsicle stick exercises.  Getting 8 sticks in between my molars...

(I started with being able to get 6 Popsicle sticks in comfortably and 7 at a stretch.  I need to be up to 10 - 12 sticks by the next time I see Dr. Turvey on October 15th.)

There, got them in...

Crank up...

Crank down...

Other side...

Squeezing a 9th stick in...

Get in there!

Nailed it!

Going for 10...

One final shove...

Help!

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Since the right side of my face is lagging a bit behind the left side of my face in terms of numbness and movement, I do some extra stretching on the right side.  The stretching should loosen the scar tissue and allow for additional movement.  Nothing can be done about the numbness, that will just come back with time (fingers crossed!).

Stretching up...

Stretching out...

Stretching down...

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Also, please enjoy the incision update photos below!

Neck incision:

Head incision (with flash):

Head incision (without flash):

Ear incision (with flash):

Ear incision (without flash):

There's that beautiful sideburn growing back!

Day 41: Six Week Check-up

Today's pic:

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I got my splint and my surgical hooks taken out today!!!

This morning before 9am, with splint and surgical hooks:

After my 9:00am appointment with Dr. Turvey (Surgeon), sans splint:

After my 11:50am appointment with Dr. Vanderwall (Orthodontist), sans surgical hooks:

Feels nice to not have a mumbled lisp anymore... Haha.

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Time to go hardcore on the mouth exercises.  I was sent home today with these popsicle stick party favors.  Currently, I can fit 7 sticks in between my top and bottom molars.  Once in, I have to crank them up and down to stretch my mouth opening.  Dr. Turvey wants me to be able to fit 10 to 12 by the time I see him again in 6 weeks.

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My rubberbands have been changed, also.  You can see how they were previously in the picture above.  Now I have to create a box between my farthest back two top and bottom molars, on both sides.  This is to bring my molars together when I bite because when the splint was taken out my molars no longer touched.  This needs to be corrected.

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As of today I am allowed to start jogging again!  I ran 2 miles today in 20:23.  I am really happy with that because it's the most activity I have been able to do besides walking.  Maybe it's time to start training for that half marathon I have been thinking about doing.

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Tomorrow is my first day back at the office!  No more lounging in my pjs on the couch... shucks!

Day 32: Clinical Study 2

Today's pic:

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The second study that I participated in is titled: A Prospective Intercentional Study to Reduce Postoperative and Postdischarge Nausea and Vomiting in a High Risk Orthognathic Surgery Population (PONV for short).

What is the purpose of this study?

The purpose of this study is to study the experience orthognathic surgery patients like you have with nausea and vomiting after surgery, not only while still in the hospital but also during the first week at home after leaving the hospital.  Our primary goal is to evaluate a protocol we have developed that will guide your care while in the operating room and while in the hospital.  We believe this protocol will decrease the number of patients who experience nausea and vomiting after surgery and after leaving the hospital.

We know that patients who have orthognathic surgery, especially when the top jaw (maxilla) is operated on, have nausea and vomiting more often after surgery than do patients getting other types of surgery.  In fact, at UNC, about 60% of patients undergoing this type of surgery experienced nausea and/or vomiting afterwards.

We have developed a protocol using medications and principles often used during anesthesia and post-operative care to try to decrease the chances that you will get nauseated or vomit after your surgery.  None of these medications is experimental.  Our protocol is based on studies that have worked very well for patients undergoing other types of surgery, and we believe it has the potential to help you, too.

Are there any reasons you should not be in this study?

You should not be in this study if:
- You have uncontrolled GERD or hiatal hernia
- You have chronic kidney disease stage III or greater
- You have prolonged QT interval (QTc > 460)
- You have a history of severe constipation, pre-existing chronic nausea or vomiting
- You are allergic to or have contraindications to protocol medications, which include scopolamine, midazolam, propofol, remifentanil, erythromycin, solumedrol, depomedrol, decadron, droperidol, ondansetron, ketorolac, Tylenol, Phenergan, and fentanyl
- You cannot read English
- You do not want to complete a daily diary for seven days after surgery
- You have glaucoma
- You have a seizure disorder
- You have a COPD (chronic obstructive pulmonary disease)
- You have a baseline high blood pressure (hypertension)

How long will your part in this study last?

This study will take place in the hospital and at the Oral and Maxillofacial Surgery Clinic at UNC.  Total time will be roughly 10 day after surgery (the exact number of days will vary depending on how long you stay in the hospital after surgery, typically 1 to 3 days).

While in the hospital, you will be asked about nausea and vomiting by the surgery, nursing, and anesthesia teams.  This will take a total of 5-10 minutes daily each day you remain in the hospital.

After you go home from the hospital, you will be asked to complete a daily diary for one week.  Each day's diary entry will take about 5 minutes.  You will bring this diary to your next postoperative visit after completion of the diary or you may mail the diary to us in a pre-paid envelope.

What will happen is you take part in the study?

When you undergo anesthesia, a special protocol will be followed.  An IV will be started before surgery, which is what usually happens even if not in the study.  The protocol will guide the medications you will receive and the amount of fluid that you receive in your IV.  The protocol is based on prior research studies that show similar protocols reduce nausea and vomiting after surgery.

After surgery, you will receive several pain medications both by mouth and through your IV.  Some of these medications are intended to decrease your need for opioid pain medications like codeine and hydrocodone as these have been shown to increase nausea and vomiting.

After you leave the hospital, you will be asked to complete a diary every evening for one week.  You may feel uncomfortable about answering some of the questions on the questionnaires.  You are free not to answer any of those questions.

In addition, there may be uncommon or previously unknown risks that might occur.  You should report any problems to the researchers.

What are the possible benefits from being in this study?

Research is designed to benefit society by gaining new knowledge.  The benefits to you from being in this study may be a decrease in the chance that you get nauseated or throw up after the surgery.

What are the possible risks or discomforts involved from being in this study?

Any time you undergo general anesthesia, there is a very small risk that you could remember what happened while you are asleep.  This risk is minimally increased with a total intravenous anesthetic, which you will receive in this study.  To reduce this risk, you will be monitored closely by your anesthesia care team throughout your surgery for signs that you need additional anesthesia medicine.  Another thing that reduces your risk of this very rare event after general anesthesia is that you will not need to be paralyzed throughout your surgery; this gives the anesthesia team another sign to monitor to reduce your risk of awareness.  If you experience awareness, tell us immediately so we can help you access resources to process and recover from awareness.

Any time you receive medications there are risks of side effects or allergic reactions.  This is true whether you participate in the study or not.  You will be monitored while receiving medications and will be treated as indicated if side effects/allergic reactions develop.  Please note that erythromycin can sometimes cause nausea or vomiting; however, the investigators feel that it is more likely to reduce than to increase nausea and vomiting in your situation.

We have carefully set up our data storage with advice from the Information Technology services at UNC to maximize data security.  However, there is a small risk that information collected in the study could be lost.  If this occurs, we will inform you of the breach and work with Information Technology to recover data/restore security.

There may be uncommon or previously unknown risks.  You should report any problems to the researcher.

Day 27: One Month Check-up

Today's pic:

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Today was my one month (or 4-week) check-up.  Dr. Turvey said my incisions look great and he doesn't see any issues.  I was hoping to get my splint out today, but no cigar.  I admit that I was being a bit too eager.  I am having it taken out at my next appointment which is scheduled for two weeks from today - Tuesday, September 10th.  At that time, he will release me back to my orthodontist.  Once the splint is taken out I should be able to start chewing soft foods.  I think I am going to start with a big plate of pasta!

 

I took a list of questions with me to the appointment.  See below (with answers).

 

1)  When can I stop sleeping on my back in an elevated position?

A:  I no longer have to sleep on just my back, but I do have to continue sleeping in an elevated position.

 

2)  When can I stop wearing SPF 45?

A:  I need to continue to wear the SPF 45 for now.

 

3)  How long do I need to continue to take the iron supplements?

A:  I no longer need to take the iron supplements.

 

4)  When can I blow my nose?

A:  I can start blowing my nose.

 

5)  When can I start to jog?  When can I resume my normal exercise routine (i.e. sports, vigorous gym classes, etc.)?

A:  I can start jogging in 2 more weeks.  More strenuous activities will have to wait.

 

6)  When massaging my cheeks and around my incisions, how often per day should I massage and what kind of pressure?

A:  I should massage 3 to 4 times per day.  I should start with a warm damp rag wrapped around my head/face to loosen the muscles and scar tissue, then massage and do face exercises.  The massage pressure should be comfortable but firm.  I can take ibuprofen if this leads to pain and soreness.

 

7)  The joint where the condyle was removed aches occasionally, is this ok?  I have tried to work on stretching my mouth opening but the joint is sore and I feel I am not getting anywhere.

A:  The pain is normal.  This is my physical therapy, so I have to do it or I won't get the results that I want.  Same as the answer above, I should start with a warm damp rag wrapped around my head/face to loosen the muscles and scar tissue, then massage and do face exercises.  I can take ibuprofen if this leads to pain and soreness.

 

8)  Now that the swelling has drastically decreased, I have noticed that my chin is off-center.  Is this going to be the final result or do you still expect it to be centered once fully recovered?  If the off-center chin is final, what can we do about it?
A:  Dr. Turvey acknowledged that that my chin does look off-center; however, he doesn't think this is anything to worry about at this time.  He said that it will take 9 months for my face to mature and settle into it's final place.  At that point we can talk about the chin again.
 

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Last puzzle, I promise!

 

 

Day 25: On My Own

Today's pic:

I took my daily walk at the zoo today.

You are never too old to ride a rhino!

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I left my Dad's house on Friday and moved back to my apartment.  I've been fending for myself the last two days.  It hasn't been that bad, since I watched both my parents make many smoothies over the last 3.5 weeks.  (Shout out to my parents for taking such great care of me!!!)

My first smoothie all by myself (it's a pb&j):

I've been getting out a lot lately without any troubles.  I went to a Mudcats baseball game Saturday evening and walked around the zoo today (Sunday).  Pain and discomfort have been minimal.

Fireworks after the baseball game:

Gorgeous day for the zoo:

This past Wednesday was my first day back at work.  However, I am only working 6-hour days for the first 1.5 weeks (starting from this past Wednesday through this coming Friday).  I space the 6 hours out with 2 one-hour breaks, so that I can build my stamina.  The first day back went well; however, it was exhausting and I had to take two naps throughout the day.  Thursday and Friday were a bit easier and only required one nap.  Tomorrow (Monday) begins my first full week back at work.  Hopefully, I will be even stronger this week!

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3-D puzzle! WHAT?!?