Day 9: Worst to Best Days

Today's pic:

You can tell from this pic that the swelling on my left (your right) has gone down more than the swelling on my right (your left).  The uneven swelling made me concerned, but the docs said this was normal and all would be fine when the swelling is 100% gone.  Whew, what a relief!

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I have ordered the days from the day of surgery through the first week in order of worst to best.  After Day: 7 it seems that each day gets slightly better or is at least the same as the day before.

Day: 0 (Surgery Day)

The day of surgery is the worst.  Not the part of the day before the surgery, but the part of the day that comes after you wake up from surgery.  The nurses in the post-op recovery room had a hard time waking me up after surgery, so they had to bring my mom into the room in hopes that she could wake me up.  I am sure the reason why I didn't want to wake up is because of the pain and discomfort and I thought that if i just kept sleeping it would go away.  Eventually, I was forced to wake up because I was told that if I didn't then they wouldn't give me any pain medicine.  Once awake, it all hits you... that you are in pain, you are uncomfortable, you are cold, you are thirsty, you are hungry, you need to use the restroom; however, you can't speak to convey these needs so then you just feel helpless.  Later in my hospital room, every time I sat or stood up from a laying down position, blood gushed from my nose and mouth.  I was soaked in blood.  My 'jaw bra' was soaked in blood, my ice pack was soaked in blood, and my hospital gown was soaked in blood.  All of these items had to be changed multiple times.  A resident came in my room around 11pm to check on me and then was sticking large popsicle stick things into my sore and swollen mouth to check my incisions.  He showed my mom how to clean me up (my external incisions and my bloody nose) and then had me work on taking out and putting in rubber bands.  This is NOT what I wanted to be working on at 11 at night when I am just out of surgery.  It was a rough day and I was definitely questioning myself as to why I would put myself through this.

Day: 4

This day was the second worst day because it was the day I was at the peak of my swelling.  Having the rubber bands in my mouth and the 'jaw bra' on helped somewhat because then my jaw felt supported; however, I did not look forward to meal times as I would have to remove the supports.  My jaw felt weak, heavy, swollen, uncomfortable, and awkward. I preferred to just not eat.  And don't even think about trying to talk to me on this day because I was not going to even try to move my mouth to respond.  

Day: 1

This day was the third worst day because it was the first day I was to try to eat something after the surgery.  When I was first learning to eat in my condition, it was time consuming, messy, and frustrating.  You would think I was an infant again.  Another reason this day was the third worst is because the IVs in both my hands started to become painful.  Today, on Day 9, I still have bruises from the IVs.  The nurse had to take the one out of my left hand early in the day because it was starting to swell and form a knot at the point where the medicines enters my blood stream, which worried her.  I knew I needed to be discharged on Day 1 because I could not and would not be able to have these IVs in for longer than that.

Day: 2

I was back at home and feeling more comfortable, which made it an improvement from Day 1.  Plus, my mom's cooking is waaaay better than the hospital's food.  

Day: 3, 5, 6, & 7 (and on...)

There aren't any huge changes or improvements from day to day, but each day just seems to get slightly better, whether it's due to actually healing or just getting more familiar and comfortable with what I am working with.  Staying positive is my goal every day of this journey.  That's the only way I'll get through it.

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Last puzzle and punch lines. :(  Enjoy!

Day 8: Clinical Study 1

Today's pic:

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I was asked to participate in a clinical study that UNC Dental School was conducting together with surgeries such as mine.  I agreed.

Title of Study: Influences on Stability Following Orthognathic Surgery - Skeletal Adaption/Recovery

What is the purpose of this study?

The purpose of this research study is to learn about:

- What happens to your facial bones and jaw joints after jaw surgery.

- How you feel and what you experience during recovery.

- How surgery affects the way you feel about yourself and the way you look.

- How the shape of your jaw and where fixation is placed during your surgery affects whether you experience a change in facial sensation after surgery.

 

Our goal is to document what happens during the clinical treatment that you are going to have so that doctors will be better prepare3d for treating patients like you in the future.  You are being asked to be in the study because you are a healthy patient having orthognathic surgery for the first time.

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

You should not be in this study if:

- You have a congenital syndrome.

- You are having treatment because of a recent injury or previous surgery complications.

- You have had previous facial surgery.

- You have had or will have surgery on your chin only.

- You have a systemic medical condition that has degenerative, immune system, musculoskeletal, or neuropathy sequelae.

- You are unable to follow verbal or written instructions in English.

- You do not want to return for the required visits after surgery.

This study lasts three years and requires 4 visits.

 

You will have a cone-beam computed tomography scan (a CBCT scan) taken.  This scan is specifically designed for imaging only the head, rather than the whole body.  This new imaging technique is not currently standard of care for patients receiving surgery involving the head and neck but it provides more detail than the traditional dental radiographs that have been used to see the jaw and jaw joints.  The radiation exposure from a scan of the head (the face and jaw) is approximately 3 times the amount of a single dental panoramic radiograph.  A CBCT scan will be taken a total of 4 times:

 

- Before surgery

- Four to six weeks after surgery

- At the end of orthodontic treatment, usually one year after surgery

- Two years after the end of orthodontic treatment, usually 3 years after surgery

 

It take about 5 minutes to obtain the scan at each appointment.  The cost of each scan will be paid by the research project.

 

You will be asked to complete questionnaires at each visit that ask about the way you feel about yourself, your treatment and the results of your treatment.  It will take about 15 minutes to complete these questionnaires.

 

You will also be asked to fill out a diary questionnaire about how you feel physically and emotionally each day for a period of 3 months after surgery.  It will take 1 to 3 minutes for you to complete the diary each day.  You will be given addressed, pre-stamped envelopes so you can mail the diaries to us.  A research associate may call you on 4 different evenings during the 3 month period to ask how you felt that day.  Each telephone call will take about 3 minutes.

What are the possible benefits from being in this study?

Research is designed to benefit society by gaining new knowledge.  You will not benefit personally from being in this research study.

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

You may feel uncomfortable about answering some of the questions on the questionnaires.  You are free not to answer any of those questions.

 

During approximately 40 months, a maximum of 4 CT scans will be taken of your head.  The radiation that you will be exposed to from all of these 4 CT scans is 27 mrem which is about the same as the amount of radiation that you receive from natural sources in 27 days.  This radiation is in addition to the radiation that you receive from panoramic radiographs and cephalograms that may be taken for diagnosis and clinical assessment purposes during that same period.

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The smoothie recipe below is one of my new favorites.  Obviously, I have a sweet tooth.  The first time we made it with blueberries as called for in the recipe, but today we made it with strawberries.  Just as good!  Tip: if you use frozen fruit you don't need the ice.

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Back with the puzzles!  Stay tuned tomorrow for the punch lines!

Day 7: A Closer Look

Today's pic:

Can you believe how much the swelling has gone down in just one day?!?  I am starting to look like my old self again.

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Left side.  Bruising on the cheek is green/yellow and the incision at my ear is almost unnoticeable.

Right side.  The bruising behind my ear has gotten darker, but the bruising on my cheek is green/yellow.  The incision on my neck below my jaw bone is looking much better as well.

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I have washed the hair around my skull incision 4 times and it still looks like this!  At this rate it's going to take 20 more washes before all the greasy ointment comes out!

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Now that my swelling is down to a manageable level, I have been able to take some pics inside my mouth.  I think I may have more foreign materials in my mouth than I have teeth, tongue, and gums!

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In the photo below you can see some of my sutures that are inside my mouth.

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Even though swelling has gone down some, I still have a lot of numbness.  I circled 4 areas in the photo below to show where I am still 100% numb.  All other areas I have at least 75% of the feeling back.  Also, the roof of my mouth is still completely numb. Together with the numb lips and numb roof of my mouth, eating is still quite difficult.  I use a mirror at every meal to make sure I am getting the food into my mouth; however, still about 25% of the food ends up outside of my mouth, either on my face, my clothes, or the table.

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I eat 4 times per day to coincide with the medicines that I have to take every 6 hours.  You don't want to take narcotics on an empty stomach.  I take the following medications 4 times per day:

Ibuprofen 600mg (pain reliever)

Hydrocodon-Acetaminophen 5-325 (pain reliever)

Cephalexin 500mg (antibiotic)

Pseudoephedrine HCl 30mg (nasal decongestant)

I take the following medication 2 times per day:

Afrin

And I take the following medication 1 time per day:

Feosol 30mg (iron supplement)

To keep up with all the medications and the time that I need to take each, I bought a pill organizer with morn, noon, eve, and bed boxes. This has really come in handy!

A pill splitter has also come in handy for me. The size of a few of the pills I have to take are too large for me to swallow with my mouth in this condition. 

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My mom has been really good about being creative and adding variety to my liquid/mush diet.  This morning she made French toast with peaches topped with maple syrup!  She just blended with milk and.... Ta-Da!!

Some other delicious meals that she has made for me are:

Burrito Bake (blended with salsa and beef broth)

Chicken and Dumplings (blended with chicken broth) - seen on day 5

Pot Roast (blended with mashed potatoes and beef broth)

Quinoa (blended with vegetable broth)

Tonight she is making baked ziti (blended with beef broth).  I'll let you know how it goes; however, based on the other meals she has made for me, I see this one being just as yummy.

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And this is the cute little Toy Story baby tooth brush that I use to brush my teeth after each meal.

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Check out these gorgeous multi-colored mini roses from my friend, Alley.  She knows they are my fave! 

Day 6: One Week Check-up

Today's pic:

I am on my way to see my surgeon for my one week check-up!  Cross your fingers for awesome news!

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Great news from the docs!  All incisions look great and are healing perfectly.  I can stopping putting antibiotic ointment on my incisions, I can stop wearing the 'jaw bra', and I can finally wash my hair!  I did, however, get a small lecture on my weight decrease, so I'm stopping for a milkshake on the way home.  Also, time to start exercising my facial expressions.  Prepare for pics!  Next follow-up appointment is in two weeks, on August 20th.

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Meet my surgical team: Dr. Timothy Turvey and his Chief Resident, Dr. Carolyn Dicus Brookes.  I couldn't be more grateful to these two for the work they put into my jaw.

 

 

Dr. Turvey's Bio:

Dr. Turvey is Professor and chairman of the Department of Oral and Maxillofacial Surgery at the UNC School of Dentistry and at UNC Hospitals. He earned his BS degree at Villanova University and his DDS at Columbia College of Dental and Oral Surgery. He did an internship and residency in Oral and Maxillofacial Surgery at the University of Texas Southwestern Health Science Center (Parkland Memorial Hospital) in Dallas. He is a diplomat of the American Board of Oral and Maxillofacial Surgery, a fellow of the American Association of Oral and Maxillofacial Surgeons, and the American Academy of Cosmetic Surgery. 

Dr. Turvey is the co-founder and co-director of the UNC Dentofacial Program and a member of the Craniofacial Center. He lectures in cleft palate, surgical-orthodontics, and craniofacial surgery. His major teaching involves supervising Oral and Maxillofacial Surgery residents at the University of North Carolina Hospitals.  

Dr. Turvey's current research interests include: long-term stability and adaptation to the correction of facial deformities. His work has been published in over seventy books, journal articles, and book chapters. He is the co-author of Facial Clefts and Craniosynostosis.  

Dr. Turvey is Editorial Consultant for four journals, serves on the Advisory Committee of the American Board of Oral Maxillofacial Surgery, and is chairman of the Long Range Planning Committee of the American Cleft Palate-Craniofacial Association. He is also on the Oral and Maxillofacial Surgery Advisory Committee to the Commissioner on Dental Accreditation.

http://www.dentistry.unc.edu/ce/ahec/biosketch.cfm?EmployeeID=1961
 

Dr. Brookes' Bio:

Dr. Brookes attended Boston University's School of Dental Medicine where she received many awards for her outstanding abilities and potential.  She also spent time abroad in Colombia repairing cleft lips and palates.

Congratulations to Carolyn Dicus DMD 08, who received a scholarship award from the Foundation of the Pierre Fauchard Academy upon the recommendation of Dr. Jeffrey Hutter, senior associate dean, and the BUSDM Dean’s Office.

"This scholarship award has a proud tradition of many years for its presentation to dental students who have demonstrated the greatest potential for development into outstanding leaders in the dental profession," said Foundation Executive Director Frederick Halik in a letter to Dicus.

http://www.bu.edu/dental/2007/05/30/carolyn-dicus-dmd-08-awarded-for-leadership-potential/

Carolyn Dicus DMD 08 received the Outstanding Student Leader Award from the New England Section of the American College of Dentists. This award recognizes senior dental students for demonstrated leadership and outstanding scholastic performance.

Dean ad interim Hutter presented the award to Dicus at the American College of Dentists Luncheon held on Saturday, February 2 during Yankee Dental Congress.

"It is an honor and a privilege for me to present this award to Carolyn," said Dr. Hutter. "She truly deserves this honor. She displays the qualities inherent in this honor society which fosters development of higher professional achievements, strong leadership, high ethical standards, and social responsibility."

http://www.bu.edu/dental/2008/02/08/congratulations-carolyn/

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Punch lines!  Haha, thanks Erin!  Who knew that I would actually look forward to putting together puzzles?!?

Day 5: Not So Fresh and Clean

Today's pic:

My hair is getting so dirty!  I can't wait to be able to wash it!  Hopefully I can wash it tomorrow afternoon after I go back to see the surgeon for my one week check-up.

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Below are some pics of my cheek bruises. They are already green and yellow.

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I've found a favorite smoothie that I've had my mom make for me twice already in the past 4 days.  It's so creamy and delicious!

Chocolate yogurt

Chocolate syrup

Frozen cherries

Milk

Give it a try!

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Another daily puzzle compliments of Erin (stay tuned tomorrow for the punch lines!):

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What's for dinner?  Chicken and dumplings.

Before:

After:

Yuuummmmmm!

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Emily came to visit and brought ingredients for her favorite smoothie:

Basil

Spinach

Frozen strawberries

Almond milk

I can't wait to try it!

Day 4: Holy Swollen

Today's pic:

Without the 'jaw bra'.  So swollen!  Does this even look like me anymore??  My mom thinks I look like a fourteen year old girl.  I think I agree with her.

I have some bruising behind my right ear.  I am surprised by how little bruising I have as of now.

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This is my eating/rubberband/cleaning station.  Notice the vanity mirror, tissues, q-tips, nasal spray, antibiotic ointment, pill bottles, pill splitter, towel, rubberbands, hydrogen peroxide, etc.  And of course the two lovely carnations to help brighten the atmosphere.

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Haha!  Great punch line, Erin!

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Flowers from my amazing roomie, Amber!  Thanks so much!!

Day 3: Challenges

Today's pic:

Not much has changed since yesterday.  There is a bit more swelling today, but Dr. Turvey says that's to be expected.  

Also, I am rocking this cowlick like it's my job!

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Challenge #1

Sleeping has been a little bit of a challenge because I have to sleep on my back with multiple pillows under me to keep my head elevated.  I am usually a side sleeper, so I find myself waking up every few hours.  Good thing I have all day to sleep.

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Challenge #2

Another challenge that I have been experiencing is frequent nose bleeds. Whenever I sit or stand up, I usually get a nose bleed.  This is also considered normal because during the surgery my sinuses filled with blood, so now it is just trying to empty it all out.

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Challenge #3

Eating has been extremely difficult, but not for the obvious reason of not having a large opening for using a spoon.  The bigger challenge is that my jaw starts to get tired and feel heavy.  Even drinking water can be a challenge.

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Challenge #4

Erin left me with this puzzle challenge yesterday.  Now I am intrigued to do the next puzzle!  I wonder what the punch line could be?!?

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The beautiful plant below arrived today from my aunts and uncles in South Dakota.  I feel so loved.  Thanks aunt Debby, Pam, Sonny, uncle Geno and all your families.  This means a lot to me!

Day 2: Procedures

Today's pic:

I am thinking about keeping these Angelina Jolie lips!

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I had a total of 6 procedures on July 31st.  Below is the list:

1) Le Fort I osteotomy

2) Left sagittal split ramus osteotomy

3) Right extraoral vertical ramus osteotomy

4) Left condylectomy

5) Genioplasty

6) Right cranial bone graft harvest to the bilateral maxilla, right mandible, and genioplasty

Such a mouthful!

I have 3 external cuts and the rest are all inside my mouth.  The first external cut is in my hairline and along the front of my left ear where they did the condylectomy (removal of growth plate).  

The second external cut is on my right side just below my chin on my neck where they added a bone graft.  

And the last external cut is camouflaged in my hair where they did the bone graft harvest from my skull.

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Thanks for the gorgeous flowers all the way from London, Dom!  They really cheered me up!

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Erin came over baring gifts (beverages galore!), to eat dinner with me, and then take me on my daily walk.  Thanks, girl!