Day 10

Swelling has dramatically reduced, first on the left side yesterday and on the right side today.  I have defined cheek bones again!  It's hard to tell from the pictures, but a significant amount of swelling remains.  Puffiness around the mouth, cheeks and nose with hard pockets along the jaw.  Bruising has all but disappeared.  Had a few bouts with pain on my left side again.  It tends to flare up at night, sometimes during the day.  Nothing an Ibuprofen dose can't handle.  

 

I was looking around a little closer since the swelling and discomfort are down I can see better.  Major shock - my left canine is short!   I hoped I was imagining it and pulled up photos from pre-surgery and it was exactly as I remembered.  Before it was pointed, now it is blunt extending just below the bracket, shorter than the adjacent incisor.  No sharp edges, it was smoothed off and at least looks normal.  I will certainly address that with the surgeon as neither he or the residents made mention of it at any point.  I won't know how bad it is until visiting with my orthodontist and seeing without all the bands, but to my eye it needs to be fixed.  A cap was not in my treatment plan - very upsetting.  Other than that, the teeth appear to line up right, within the range expected for final braces adjustments.  

Continuing on the liquid diet, more protein shakes, smoothies and purees.  While the routine has gotten pretty manageable I am looking forward to my next post-op appointment and recovery stage.  

  

One Week - First Post-Op

One Week Post-Op milestone!  Feels like a split second and an eternity.  I got a little emotional while sitting in the waiting room remembering my first visit just shy of a year ago and how stressful the last appointment was.  All that in the past now, my newly minted jaw already a huge improvement from how it used to be and recovery on the downhill stretch.

While I was waiting for Dr Best the other surgeon passed by, saw me and stopped in.  I was so excited and told (mumbled and texted) him all about my progress.  He kept asking about and testing the numbness, but otherwise agreed that I was doing really well.  Dr Best arrived and I gave him the rave reviews of his team and how smooth recovery had been as a result.  He was eager to have a look at his work and before I knew it was clipping away the bands.  I had four sets of triple bands on each side and three wires holding a splint (U-shaped plastic plate with impressions to hold the teeth in place after re-positioning the jaw, ie. "tooth cast") to the uppers.  The splint was discarded forever and I was so glad to see it go.

With my jaw free he had me practice opening very slowly and carefully.  Although I couldn't feel exactly what I was doing because of the numbness it seemed smooth and painless, just stiff.  I was able to speak my first words in a week, that was startling and exciting.  He left me with a resident to continue moving and (finally!) brush my teeth.  Never thought my mouth would feel empty with only braces, but yeah... so easy without all the bands, wires and splint.  I worked up to one finger's width opening, but not quite enough to get the tooth brush inside my mouth.  A goal for next week.  With that new bands were placed; this time doubles, three on each side.   My instructions were to not lose weight and continue good hygiene.

Leaving the office I was in tremendous pain on the left side by my ear (at the jaw joint) and felt light headed.  Occasionally at night or in the morning I get a tinge of pain, but nothing like this.  As soon as I got home I took a dose of Ibuprofen and crashed, sleeping for five hours straight.  It amazes me how so little activity can have such an extreme effect.  By evening I felt better and started exploring the new set up.  Without the splint I can feel the inside of my teeth, all neatly lined up with so much space compared to before.  Most importantly, as expected it's a little easier to drink.  With a few breaks to rinse, I was finally able to get the peach smoothie down.  Now starting on more substantial soups, like lentil and polenta.

Before and after pics (sorry the close ups are a little scary).

Pre-appointment.  Still swollen, bruised and puffy.

Hooks, bands, wires and splint.  One full mouth!

Post-appt.  Less puffy, getting closer to normal.

Down to hooks and bands.

   

Day 5 & 6

Day 5

For reasons entirely unrelated to surgery I slept horribly last night (loud neighbors).  With only a few broken hours of actual sleep I was not happy in the morning and stayed low, drinking and taking the requisite meds.  By afternoon I was ready to shower and get out for a bit and took a jaunt around the neighborhood.  Being in public, albeit trying to avoid interaction, was incredibly refreshing.   With that I felt up to more and spent the rest of the day cooking soups and blending smoothies, experimenting with recipes and foods.  I will post more on that including meal plans and recipes separately.  Today introduced acai smoothies, again a treat I have really been looking forward to.

Incremental changes are exciting to see each day.  Today swelling continues to go down, however bruising is more noticeable.  It's not a huge area, around and below my chin near the incisions.  As the bruises heal the area grows and has turned bright yellow.  Very strange looking.  No change in numbness, I have resigned myself to that for awhile and will update when it progresses noticeably.  I get lots of tingles after I lie down to sleep, a good sign that my body is working on it even if it's not visible yet.  For the first time I can feel and see the end of my jaw bone and my cheek bones are starting to show better.

Even with daily changes and my extensive planning to get through recovery as quickly as possible, today was a reminder that no matter how well I am doing there is no fast track through recovery.  I can do the right things and make it easier, but it has to run the full course which is a long road.  Day by day - pay attention, adapt and wait it out.





Day 6

Today started off with my Mom departing.  She came in the night before surgery and has been immensely helpful by my side through operation day and the challenges of the first days in recovery.  Although I am set up and comfortable taking care of myself at this point, could not have managed the first few without her and the moral support has made the rest of it easier and more fun.

Swelling continues to drop.  Still more swollen on the right side.  Today I can almost see my profile and my cheeks and lip appear more natural.  I'm hoping to look close to 100% for my one week post-op tomorrow, but even how it is today I think Dr Best will be pleased.  Bruising has expanded more in the chin area, plus a slight shade on my throat where the tube was.  A dab of tinted moisturizer covers it up for the most part.

Eating was a little traumatic today.  One of the smoothies I had prepared yesterday included wheat bran for extra bulk.  Unfortunately the flakes didn't liquefy in the blending process and it wouldn't go through the tiny space in my teeth where I am able to drink.  I am hopeful after tomorrow's appointment I will be able to manage.  In the meantime, an acai smoothie with added almond butter tasted amazing.  I continue to drink every two hours, trying to keep well hydrated with small portions of substantial nutrients.

Activity is mostly back to normal, no naps or fatigue anymore.  I attribute this to my surgical team for doing a good job setting up recovery so that I didn't have prolonged pain, medication, or complications.  More or less since the afternoon of discharge my head has been clear.   Now only continuing the week of antibiotics, which don't seem to have any side effects.  At times I almost feel like nothing happened, but looking in the mirror is a reminder that how I think of myself, what I feel like and how I look are nothing alike.  Plus, I don't actually know what my new face will look like.

  

Day 3 & 4

Day 3

I woke up very tired and knew I needed some serious nutrition.  I had planned to start the regular liquid diet on Day 4, but it needed to happen sooner.  I went through my morning meds (ibuprofen for the swelling, amoxicillin for anti-bacterial, and qucertin supplement for anti-inflammatory) and had a juice, then had my first protein shake.  Cannot describe how good it tasted!  First to have normal food, second all the much needed nutrients.  Then I showered for the first time since the hospital.  It felt good to clean off all the surgical tape residue and the steam was great for my sinuses.  After all that excitement I needed a nap.

The afternoon included a brief visit to my rooftop for some fresh air and a change of view, a nice diversion.  More napping in the afternoon and more feeding.  I made my first attempt at drinking from a cup, which was very challenging at first with a numb lower lip.  I still keep towels under me to catch the occasional drip.  After a few tries I got it down, much faster than syringing and moving my lips a little helps the healing process.

The swelling has started to go down, my right side is still very large.  I have light bruising around my chin that is starting to change color.  The numbness has gotten slightly better.  My lower lip and chin area are still mostly numb except for slight sensation (can feel touch, but not a drip of liquid).  I continue icing as much as possible using bands that wrap my head and jaw and light massaging to stimulate the nerves and increase circulation.

Still not even a hint of pain.  I feel so lucky to not have had any of the nausea, congestion, bleeding or other effects any people talk about.  I sleep propped up on a few pillows, which is a little uncomfortable since I am normally a side sleeper.  Having had severe flue several times the past couple years I am used to that as well and know the difference it makes.  Especially the first few days, any tilting of my head caused pressure increase.  Very important to keep elevated.

Cleaning is essential, especially now that I have started more rich foods.  I do a saline rinse a couple times a day and brush the outside teeth carefully, avoiding sutures.  Although I can't open my mouth, my lips are still stretchy and the brush can go where it needs to.   Aquaphor has been my best friend, regular application has helped my lips heal quickly from the operation.




Day 4

Stage Two of recovery, the worst is in behind!  This morning I started with a protein shake and apple juice, which felt great.  Today's snack menu introduced pressed juice and smoothies, both of which I have been looking forward to.  Feeding sessions still take ages, small portions sip by sip.  I continue to syringe my meds to get them toward the back of my mouth instead of coating all my teeth.  My tongue is protesting the splint and feels sore around the front whether eating, swallowing or talking.  More stretching to keep my mouth active.  The numb area decreased again slightly, now covering about a finger's width inside my chin area.  The swelling went down dramatically today.  Encouraged, I stopped icing and taking ibuprofen.  The bruising has turned yellow, a good sign it will be gone within a few days.

Second big step today - I showered and got presentable to go outside for a walk.  Great to see life outside the apartment and move around more.  I'm starting to feel like myself again, only mute and swollen.

Surgery Day and Recovery Day 1 & 2

June 22, 2016

After thorough research I had compiled all the supplies needed and roughed out a menu plan for a 3 day clear liquid diet, 4 day - 2 week liquid diet, and progression to soft foods.  All preparations were in place.  My pre-op instructions cut off food, water and anything in the mouth from midnight.  I ate a monstrous dinner that evening, then had a snack and ginger tea right before midnight, then settled in for a good night's sleep.

The next morning was go time!  10:30am we departed for the hospital where I checked in at 11:30.  Shortly after I was taken up to the staging area and changed into a gown, then met with the anesthesia team.  The lead was also named Allison and she was one week older than I am!  She offered an anti-nausea patch and got me all preped.  The surgical team trickled in and by 1:30 all were assembled except Dr. Best.  A full hour passed and finally he showed up at 2:30 and I was wheeled away.  Before we got in the elevator I was out and don't remember a thing until waking up in the recovery room.  We stayed there for several hours, nurses cycled through, each being preped on my case and status.  Eventually I was all alone in the back of the recovery wing while waiting for a bed upstairs.  Around 11:30 a team came in for a CT scan, then back to sleep until vitals check.  Around 1am I was taken up to the room.  More ice, more IV fluids.  I felt no pain or discomfort, no nausea, and no congestion in my nose that many people complain about.  Allison took good car of me setting up an easy recovery.  One of the surgical residents visited before he left for the night.  All seemed to be going remarkably well.  I was all smiles, so excited to have the giant hurdle complete.




Recovery Day 1 - June 23

I woke up at 6am to the whole crew paying a visit.  It was good to see their familiar faces, but I was tired and didn't have much to say.  They gave some medications and instructions to the nurse and cleared me for discharge after meeting with the nutritionist.  That took all morning, although she was supposedly on the floor somewhere she never made an appearance, instead sending a trainee to give me a pamphlet describing a blended diet, protein intake and sample menus with recipes.  The nurse came back with my prescriptions, took off my IVs, I changed and packed up, leaving the hospital around 2pm.  A brief stop at Walgreens to fill prescriptions and finally we returned to my apartment.  I took a brief nap, and started syringing drinks and medications.  It takes about an hour to complete dosage of medication and juices.  Lots of towels for dripping, and concentration to make it smooth.  So far I have been using a 10ml syringe, inserting between my front bands and shooting to the side.  Swelling increased through the day.  I can run my hands around the jawline and have feeling everywhere, which is a good sign.  Some numbness still that makes it hard to drink regularly from a cup.  Regular icing and gentle massages see to be taking effect on the swelling.




Recovery Day 2 - June 24

Today I had more energy, started walking around a bit.  I am trying to talk more and move my lips around, but my tongue hurts when it rubs on the splint.  Other than that I still have no pain or discomfort.  The swelling has started to go down on the left side, the right side and my lower lip are still very large.  I started to feel small tingling sensations on my lip, like little champagne bubbles floating up on the sides or middle.  No bruising, even around the area on my hands where the IV's were placed.  I continue on the clear liquid diet until Day 4 where more dense beverages can be introduced.  So far much easier than expected, aside from eating taking so long.  A short nap mid morning and mid afternoon, settling in for the evening now.  Waiting for my jawline to slim down so I can see my new profile.

Pre-Surgery

At this stage I expected my surgeon to take the lead, informing me of process, guiding through and keeping open communication.  That was not the case at all.  Being a teaching hospital, UCSF operates much differently than private practice.  Essentially lacking in business skills.  The main phone system is a mess that leads to a dead end.  The office manager doesn't pick up her phone or return calls.  Trying to set this up and coordinate between a dentist, orthodontist and surgeon keeping in mind personal plans, travel arrangements, not to mention work projects was quite frustrating.  Surgery is only every other week and regular appointments on the alternating week, a very narrow window of opportunity.  Making matters worse, I was told the date wouldn't be confirmed until insurance approval went through, 6 weeks after my follow up consultation.  Basically they wouldn't speak to me until I had the pre-op appointment.  I did my best to schedule a tentative date while  making it clear that I needed more than a week's advance notice on the operation and was not willing to let my treatment plan slip due to scheduling missteps.  I had heard horror stories of treatments being delayed 3 months and having difficulty scheduling followup appointments and getting insurance approvals.  After much persistence I finally found the right approach and began making headway with key contacts.


Follow Up Surgical Consultation - May 18, 2015  

At this appointment I was seen in promptly at 9am and was out by 9:30am.  Dr Best looked at my teeth and new molds taken by my orthodontist the week prior.  He walked me through details of the the timeline and process and gave the okay.  I followed up immediately to ensure the insurance submittal went through and scheduled my follow up dental cleaning and orthodontial pre-surgical appointment anticipating the surgery date.  I don't know if it was my hounding or if I was overly worried about the process taking too long, but within two weeks it was signed off and the office contacted me to confirm.  I am on the calendar for June 22nd, Week 38 of braces.


Pre-Surgery Appointment - June 15, 2015

One week in advance the surgical team meets to review and practice the operation.  My final orthodontial appointment was the day before.  All movement is paused until after, this was only to place the surgical hooks which will be used to stabilize my jaw while banded shut.  All of my brackets have hooks built in already, the only additional hooks necessary are in between the incisors.  They are big and catch on my lip, but at this point I don't really care as I will soon have bigger problems to deal with.  Another twist - Dr Good is pregnant and will be on maternity leave in July and August.  I am glad she has been able to see me through leading up to surgery.  My follow up appointment and re-starting braces will be with a stand-in, which is a little disappointing.  At least she will get to see better results in September.  Hopefully by then I will be very close to braces off for the finished product.

Back to the surgical appointment, it took ages.  3 hours, most of which were sitting waiting for the staff to do something.  All very stressful on the heels of navigating my two weeks off work, only to continue to have numerous post-op appointments before full recovery.  Once again enforcing the fact that this is a huge time commitment and that some things can't be rushed.  In the end I had a CT scan, current photos, current molds and and any last questions answered.   Aside from the dysfunction of the office, Dr Best is capable and knows his trade.  I have full confidence all will go well.

10 month progress photos, hooks and all, two days before surgery... can't believe it's here.

 

Braces Progress

2 Months:
Eager for progress, trying to be patient while Dr Good works her magic.  My second appointment inserted rubber spacers between the back molars, after two weeks the lower rear brackets were placed and I was fully braced.  Then a longer wait til the next appointment.  I asked to go to a heavier wire, to no avail.  You can see in the close up the lower front teeth are so crowded the wire isn't even engaged on two of the brackets.  My top incisor was angled in during pre-teen braces to compensate for the over-jut.  That makes the wire look super crooked, due to the closeness a white rubber cushion was placed on the bracket below to keep it from hitting.

  


4 Months:
Getting in a groove, appointment were generally evenly spaced 5 weeks apart.  I always asked for 4 to accelerate, to no avail.  Worse still on a few occasions she did say 4 weeks, but the office would be closed or no times were available and it would end up 5 weeks after all.  Sometimes visible progress was made by the time I got home from the appointment!  My top teeth had started straightening out, evening of the wire.  The biggest challenge was the lower incisors.  To address the crowding Dr Good added coils, one on either side of my center lower tooth.  They were very painful and in contrast to the ceramic brackets very metallic and obvious.  I had to use wax constantly to reduce sores.  It didn't stick well to the coils, complicated cleaning and adding further bulk to my mouth.  Knowing that my over-jut correction involved undoing some of the work from my pre-teen braces I was prepared for my bite to get worse leading up to surgery.  I was not prepared for the horror the coils created.  Since the flanking two teeth were unattached, they got pretty crazy while the coil did its job pushing the outside teeth away.  By cruel twist of fate this occurred over the holiday season with parties, family gatherings and a prominent project opening with most of my network and VIPs.  Sigh... there is definitely a personal growth aspect to having braces.  Starting out highly self conscious, going through braces and very messed up teeth has built significant self acceptance and thickened my skin to the extent that not much about my appearance and others opinion about it could throw me now.   Appearance can help, but is secondary in any interaction.  That is a valuable lesson to internalize.

  

6 Months:
Miracle occurred and the coil was removed!  The adjacent teeth moved quickly back into place and in the following appointment clicked into the wire.  To further adjust alignment Dr Good added a power chain, which I feared was yet another coil fiasco.  Instead it was more or less a rubber band chain that hooked around each bracket.  Since it was white it actually made the brackets less visible and it was comfortable, so I was happy.  For my upper teeth the treatment plan includes veneers to increase the size of my "peg laterals", so we are creating space on either side.  That involved more coils, only this time she used a smaller size that was hardly noticeable visually or on my lips (not shown in the pics below).   The third photo shows my true jaw alignment with tongue crowded behind the teeth.

  

8 Months:
This is when I started to get anxious since my treatment plan indicated surgery 8-10 months in and I hadn't even had a followup appointment.  It was stressful to juggle work and attempt to minimize impact without having any idea how schedule would work out.  Dr Good finally gave me the go ahead at my 27 week appointment and I immediately called to set up my surgical appointment.  Finally it is happening!  Meanwhile, minor adjustments top and bottom continued.  I was up to the heavy gauge surgical wires, which meant any misalignment was painful.  Both the lower front teeth and back molars took a lot of pushing and prodding before clicking in.  The assistant tried to warn me and be gentle, but I still whimpered as my tooth felt like it was being pulled out at one point.  That was the most painful appointment (nothing a few Advil and a good night's sleep couldn't fix), but I knew it meant final adjustments were in progress.  I noticed that my upper midline has shifted slightly off, that will be corrected after surgery.  I also want to bring the uppers in as they are still slanting out slightly.  You can see the lower power chain in the second photo.  In the last photo I set my jaw forward, anticipating what it will be like.  Teeth are getting very close to final alignment!