Friday, March 15, 2013

A Year After Orthognathic Surgery - Updates, Revision, and More!

     I reached my one-year mark in December and then my braces were finally removed at 13 months and 1 day post-surgery, on January 14, 2013. My orthodontist expected my braces to be off within a few months of surgery, but that wasn't the case -- for a number of reasons, but I'll discuss them another time.
The photos above and immediately below are from the first week of my recovery in December 2011 following a 3-piece Le Fort I osteotomy and genioplasty.

The above photos are from January 14, 2013 - 13 months and 1 day after surgery.
It took that long to get my braces ready to come off...
And I got Essix Retainers (below) 

    I noticed, however, after my braces were off, I was still having some issues with things I thought would have subsided by now. So after discussing things with a friend who is also an oral surgeon, and checking to see if I could see one of the surgeons that I worked with before, I made an appointment. 

Aren't these nice?! My friend put them together for me from my scans...
These show the healed surgery sites and the hardware before it was removed.
Maybe it's just me but...
I feel like I'm just as pretty on the inside as I am on the outside, so I enjoy seeing these :-)

You can see how the slightly deviated septum could create the "trap door" effect I kept feeling. 
It was really awful but I rarely talked about it. I thought that if I started to complain about it, everything would get worse... I put most of my energy into trying to just deal with it, hoping it would improve.

    Most patients don't go back, at least not in hospitals like mine, and I believe that's partly because it's a teaching hospital so the follow-up is kept to a minimum (but reasonable) and then long-term follow-ups just aren't really common with things like this because the Residents move on. So when I go back, I feel a little like I'm a sideshow act or something haha -- It's nice, though, to see people again after such a long time, and it's ALWAYS nice to be remembered :-)

Pictures from my hospital visits.

    I explained my symptoms and I half-expected them to tell me it was something I had to live with. It's not fair that I take that instant defeatist attitude but it's something I've come to expect with a lot of healthcare. That's another story for another time, though!

    So... my symptoms... the most problematic were the tightness and pulling in my chin, and the sort of "trap door" effect I was experiencing when breathing out through my nose. It wasn't consistent, but if I attempted to blow my nose or if I exhaled through my nose with even slight force, it would just STOP and it would be quite painful, especially in the back of my throat from the force of the stop. I also had constant dull aching behind my nose and through the middle of my face, pretty much along the previous surgery areas, giving me a sort of chronic face-headache. Most days I could tolerate it, and if it got too noticeable where ignoring it was too difficult, I'd just take some Naproxen and cross my fingers.

    As far as the appointment went, after checking some things and setting up an appointment for a CT scan to check my nose, it was determined that the best course of action would be to remove the hardware from my previous surgery and repair my nose, which would include spreader grafts. I was surprised at how quickly the decisions were made because my only other experience was with jaw surgery and that was a completely different situation - I mean, seriously... I was sent away 3 times before I was finally ready for that and my surgeon had been changed at least 3 times too. So yeah, I was surprised. But I felt good about it. This surgeon had a better opportunity to make fast decisions, because of the different nature of what was being done, so everything seemed super efficient. 

   I gathered that since removing the hardware was associated with the previous surgery, this is sort of a "revision" surgery so that's the story I'm sticking with. The nose procedures included septorhinoplasty and turbinectomy which sounds worse than I'd like to think it is. I mean, I know what they entail but I don't have all the details on MY procedures yet so I'm not 100% certain of what exactly was done, but I know that's what my discharge paperwork said. The nose procedures can take a good 6-12 months before it's 100% so I'm prepared for that.

    The hardware removal is particularly interesting to me though. My surgeon this time, who was involved in my first surgery but different from my previous surgeon, said that the hardware was loose when he went to remove it. I'm very glad that I went back when I did or I may have lost the opportunity to be treated by someone I already knew and trusted. I was exceptionally nervous before my previous surgery, but there were a lot of factors that fueled that nervousness. This time I felt like I had a better appreciation for what I could expect, even though I knew it would be different.

    Anyway, I went in Tuesday morning to have all that done and honestly, I'm more stressed out about moving than I was about going in for surgery. Since I was able to work with a surgeon that I already knew, I felt much more relaxed about the whole thing, which is nice because it made the decision easier for me. When you're stressed about surgery it's not something you can just "ignore for now" when heading into an operating room. I can "ignore for now" the other stuff (e.g. moving stress) because it's not immediately relevant.

Waiting for my turn... in situations like this, when there are a LOT of people moving around and talking to me, it's easy to get overwhelmed and then more nervous. 
I felt a lot better once I saw my surgeon was there. 

   Some of the other people that were involved in my surgery this time were also there last time and that made me very comfortable too. I'm a little disappointed that my thank you letter was never properly handled because, although written while in a fuzzy mental state thanks to post-surgery anemia (last time), I tried to make sure I included everyone that was involved in my care but I know I missed people - so maybe it's good that I have a second opportunity. The nurse, at my request, took time to keep track of everyone for me so I don't have to go track down the names later, like last time. It was also the same nurse I had last time so that was nice. It's funny how something simple, like having the same nurse or getting the names for my thank you letters, can mean so much... to me at least.

   I thought this time would be easier, and I believe I had a realistic expectation of pain because the nerves aren't messed with as much as with the other surgery. What I hadn't accounted for was the difference in care provided after surgery when you're expected to just go home compared to when you're expected to stay overnight. Since I was supposed to leave the same day I was sent to a sort of "discharging section" and it made things a little difficult. The noise was really frustrating while I was still gathering my bearings and it took a long time to get me the nausea medicine (through my IV) because one person put it down on my table and assumed someone else would hook it up for me. They also were a little frustrated with me because they kept trying to give me Percocet and I refused it. Then they offered me morphine and I said "no thanks".... I didn't think it was worth putting that much through my body if I could manage with something like ibuprofen, and then I got irritated with them for not offering me the ibuprofen first. (No one asked me what I wanted when I stayed overnight after jaw surgery, they just gave me what I was supposed to have.) I'm not usually that bad and in my own defense, I did just have surgery and wasn't feeling quite "myself" yet so, hopefully no feelings were too hurt. 

     I ended up feeling very sick and it took me until well after 10pm to "tinkle" so it was good that my surgeon arranged for me to just stay. I was surprised though - not that I didn't expect excellent care, I think I'm just always surprised when the care seems so attentive. -- Ha! I guess that shows I've had some pretty crappy healthcare in the past, huh? Maybe what they do at Walter Reed is the norm and I'm only surprised because it far exceeds my expectations based on past experiences in other healthcare systems. In either case, my surgeon made sure I was okay -- it may not seem like much but things like that, being "checked on," make a big difference to me... that's the stuff I never forget. In fact, it's one of the things I include in my Offensive Coordinators Playbook!

Pictures from surgery day... (12 March 2013)
The bottom-right picture (same as below) is from the trip home.

Look at that! It was a student that put in my IV, Andrew if I recall correctly, and he got it the first try without leaving my hand all bruised and messy. Knowing he's a student, I tried to be more relaxed so he wouldn't tense up, and I tried my best to help so he could get it the first try - success!
I was very proud of him! 

   So I stayed overnight, and it sucked a bit. It could have been worse, but I was glad to go home the next day so I could just care for myself. My compassion and patience have limits, even if it seems the contrary to most who deal with me. I was a little dehydrated when I got home, and still not tinkling enough so I put on my best "hard-charger" attitude (at least as good as I could muster under the circumstances) and started hydrating. I felt a ton better by the time I was ready for bed that night.

  Now it's Friday, so technically the third day. My swelling was worse yesterday so I think it'll start getting better now. I have a lovely matching set of periorbital hematomas (or hematomata, if you know your Greek) -- black eyes, basically. I didn't have them last time because the work was kept lower in my face, but having my nose fixed was certain to be a new experience so at least I wasn't disappointed.

My black eyes... they matched my lunch from yesterday (Thurs. 14 March)

  Like last time, I also have these large triangular bruises extending from the corners of my mouth downward but angled toward my neck and subtle bruising on my cheeks but not too bad. My neck and chest aren't all bruised this time, so that's nice.... Although not in every case, some bruises can slow healing so I'd rather deal with swelling if I have a choice. Not that swelling can't be problematic too, but when I'm caring for myself I'm able to keep it down most of the day and I get up frequently at night the first few days, at least, to keep an eye on things and apply ice if needed. The swelling is really similar to last time, and really not that bad. It's uncomfortable, but my skin is relatively undamaged and I'm having no issues so far, so that's a "plus" in my book. The difference is that this time the swelling extends a lot higher, so much so that the first couple of days I had a lot of issues with my eyes and I couldn't quite tell what it was until it was under control.

Atom giving me kisses to "make it all better" (Wednesday night)
He's very good about being careful with me, otherwise I wouldn't allow him so close to my face...

Thursday morning, the top-left is when I first woke up; the other three are after I started hydrating, which I do from the moment I get up, and after I showered, had something to eat, took my meds, and applied ice for a bit.

These are from today... several of my male friends have insisted I start telling people "You should see the other guy!" when anyone asks what happened. 

It's not very pretty, but it's temporary - bruises disappear, skin recovers, tissues heal, and swelling dissipates... 
but the benefits will last. 
That, to me, is a very small sacrifice of time and patience.

I really had no appetite for most of the day today which is obviously not good. I did manage a good amount of nutrients despite the lack of appetite, but it took forever to consume them so I made use of the time with a little multi-tasking. 

Icing my face... 
(As I said that aloud, I almost cried from pain as my stitches pulled a bit - I had to fight the laugh prompted by the mental image of putting cake-icing on my face haha! Yeah... that wouldn't help much... the ice packs are great though, I have a whole collection... This blue one WAS wrapped when it first came out of the freezer, it's not smart to apply them frozen right to your skin. This one had been out for a while when I took the picture.)

   A major difference between surgery last time and this surgery would have to be the way my nose feels. Last time I had no real congestion except a little trouble on the second night home but I managed. This time I have splints and "stuff" in my nose, in each nostril, plus stitches which are definitely not on my list of "favorite things"... and I have a sort of splint on the outside of my nose to keep everything safe. If I had to describe it, even though I don't feel congested, between the stuff in and on my nose, the swelling, and the bruises, I feel like a cross between having a really bad cold and losing a really dirty fight. It's kind of crappy but, it's not the worst I've ever felt and my mind is clear so that's good.

   I cannot believe the difference I feel so far without the hardware, though! It hurts, don't get me wrong, but I can tell even now that it'll feel a lot more comfortable once things heal. No wonder I was so cranky all the time.... like I said, it felt like a constant headache but in my face, and most people can relate to how a dull nagging headache that persists can make us cranky. I had my doubts about removing everything. I understand it's all healed but I've never had broken bones before so I never had to trust a healed bone and I had trouble fully grasping that concept. I can understand the underlying processes and I can understand what I see in my scans, but the very idea that everything is fine (and nothing will just "fall off") was a tough one to swallow. 

  Unlike last time, I did not keep track of notes for the surgeons for my first follow-up appointment. I just don't think that these guys will receive them with the same enthusiasm as my initial surgeon so I won't bother. That's not really a big deal, everyone is different and I can appreciate the differences in the surgeons I've been able to work with. I have notes for myself and that'll do. Besides, this recovery is relatively easier... or at least, shorter. There's less anxiety that I'll screw something up haha! My surgeon keeps checking on me anyway, which is really thoughtful and he answers my questions fast. So I may not bring a beautifully-typed and printed packet of questions like last time, but I'm getting the answers and support I need to feel good about everything and, in this situation, that's more than enough.

   I have a one-week appointment scheduled for next week. I know the stitches last time didn't fall out, they continued giving me trouble and were eventually removed by one of the Residents at my week-three appointment (or week-four but I'm pretty sure it was week-three). I just hope they don't kick me to the curb after my one-week appointment so I don't have to argue with them. With the previous surgery, once I got to the week-six appointment they were done, and I wasn't aware that would be it so I wasn't prepared. My other surgeon was accommodating though, and saw me in week-10 to help me get the rest of the info and answers I needed.

   Considering what was done, I don't think it's too much to ask to be seen at least a couple of times to make sure things are all fine... and stay fine -- teaching hospital or not -- I'm a relatively good patient, if I do say so myself, so I'd like to think they can at least tolerate me a bit longer and aren't eager to just be rid of me haha... 

   On a separate note -- I am almost done!! I now have 6 individual Playbooks as part of my Jaw Recovery Playbook System, which didn't start out as a system at all. I hadn't planned on taking it to it's own website, but then I did. Then the response was so great, with patient after patient after patient contacting me for support... I couldn't just leave it the way it was. So I revamped the website and wrote the 6 Playbooks which are mostly being edited now and I will publish soon. I wanted them done by surgery but it didn't happen -- they will definitely be done before I move so I can bring them to my surgeons, along with other tools for the new site. After all, if it wasn't for the exceptional care, support, and attention I received throughout the past 2 1/2 to 3 years, the project probably would not have progressed as it did -- so my Jaw Recovery Playbook System is just as much a tribute to my surgeons and others involved in my treatment/care, as it is a comprehensive tool for patients, their support team and families, and also for other surgeons and providers. I even have requests for translations by other surgeons before the books are even published!

The Offense Playbook guides patients through the preparations leading up to surgery, including tips for improving their health inside and out for better potential to have an easier recovery.

The Game Day & Recovery Playbook prepares patients for surgery (their "Game Day") and the hospital stay, whether one night like mine or several nights like other patients I've worked with. Then the Playbook helps guide the recovery process, divided in two parts: weeks 1-6 and weeks 7-12.

The Defense Playbook is meant for the patient's family, spouse/partner, parents, kids, friends, and anyone involved in supporting the patient throughout this process. It resembles the Offense Playbook but offers a unique perspective for the non-patient caregiver/observer.

The first Recipe Playbook had about 90 pages. The NEW Recipe Playbook has more than double that, with a complete section of soft-food recipes for the second half of recovery as patients work their way back to tolerating regular foods. I've added more on nutrition and supplements, including which supplements I use/used and why.

While different from the other Playbooks because it's written for professionals who don't need all the "details" that I give patients... the Offensive Coordinators Playbook is geared toward oral & maxillofacial surgeons, as well as others in dentistry and related fields, but the information is easily applied to any professional field. 
I've included information that's proven to be important, based on my own surgery and recovery experience(s) AND information I've gathered from the 100+ patients I've helped over the past 14 months. In simplest terms - the Offensive Coordinators Playbook is meant to improve communication efforts for greater patient compliance, increase patients' confidence in their providers, and ultimately improve overall patient satisfaction with greater consistency. 
Ultimately, my JRP System helps bridge the gap between patients and their providers, helping surgeons instill confidence in their patients while empowering them with the RIGHT information and the RIGHT guidance for surgery, recovery, and beyond!

The Braces Playbook is shorter than the others and meant to provide tips and guidance for both typical orthodontic patients and those heading toward jaw surgery, in an effort to help them better manage their own care and treatment, 
while keeping them on track to reduce inadvertent obstacles along the way.

     The website is "under construction" at the moment so visitors will see frequent changes as I finish tweaking everything but the site will be up and running with the release of the 6 Playbooks and I have a variety of new content I will add over time to keep things "fresh" and entertaining, while maintaining the efficacy of my Jaw Recovery Playbook System :-) I'm a little proud of it, can you tell? 


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