Thursday, 17 June 2010

Change we don't believe in

Guess who's back and still in braces? Yeah. Never thought I'd still be here, 8 months after BSSO.

On the one hand, the worst of the BSSO aftermath is over and done with - after a five month marathon of meetings with the acupuncturist, the dentist, the surgeon, the tooth cleaning fairy, two sets of physiotherapists who took turns massaging my aching jaw muscles from the inside, and last and least, my orthodontist.

The swelling in my face has gradually subsided from red balloon to drooling hamster to lumpy goblin to the point where I hardly notice it anymore. (Which was helpful, since noone takes your anger seriously if you look like a pouting blowup doll)

On the other hand, I'm still waiting for a debanding date - with increasing frustration, since I'm still planning to find a new job and move to another city when I'm done. I need a date to have an idea how much longer I should expect to be here and press cherry kernels to the roof of my mouth with my tongue (the speech witches' newest addition to my ever increasing list of wacky tooth strengthening exercises).

Yesterday was a writeoff: my supervisor told me in passing that I won't get a chance to do a project in India after all, and then, to my complete lack of surprise, the ortho took a long look at my teeth and said 'Why are these molars still not touching?'

Beats me! If the three months they spent in punitively tight rubber bands couldn't convince them, maybe they're just not that into each other?

The ortho's not giving up, though. Not him. He cemented some extra braces on my molars, took the upper wire out altogether and put a new tight rubber band around the new construction. I'm supposed to wear it 24 / 7 for the next 4 weeks. At first I thought it had no effect whatsoever, but I was wrong: A couple minutes later, the molars hurt like buggery.

I asked him whether he had any idea why the molars won't move. And who's he gonna blame? The surgeon: 'We should have taken that transpalatal arch out months ago.' Maybe so.... AND maybe he should have discussed it with the surgeon if he thought putting it in was the wrong decision.

As always, I turned to the gym and this blog for solace.

We shall overcome! Stay tuned for an impossibly lengthy recount of my surgery. I wrote it down for a local forum for the toof-challenged, but would like to put it on the
blog as well, along with some more bracefaced pictures.

Thursday, 15 October 2009

The way of the ninja

I found a speech therapist! And she's a gem.

It took me three days of playing phone tag to get an appointment with her, and by then I was fearing the worst. She has a second job as a yoga instructor. I can feel my neck muscles spasm and my breathing get shallow when people talk to me about energy bodywork and breathing exercises. I can just about get through my Sunday yoga class without developing irrational resentment against my serenely smiling teacher' as I contort myself into uncomfortable positions and focus on my breath(yuck!).
Her message on my voice mail also told me that she speaks in slow motion, overpronouncing every single word just slightly.

So I was happy to see that she's different in person - friendly, but resolute. She listened to the tale of my adventures in orthodontia and did a series of quick tests on my tongue and mouth. It took her all of three minutes to find out that the muscles in my lips and tongue are too weak, which is causing the mouth breathing, tongue thrusting, and frequent throat infections. She asked me to call my mother to do some research on when I developed the habit of breathing through my mouth. She also said (and this was new) that a lot of patients with the same problems have a history of mild dispraxia and weak connective tissue. I still have no idea how these two things can be related, but she was right.

I went home with a brand new tongue depressor and a series of pictures of a boy doing lip and tongue strengthening exercises that I'm to practice. (My favourite one has to be speaking with my lipf ofer my teef. I can use that one while practising my Russian vocabulary)

And I'm supposed to keep the tongue depressor between my lips in the evenings to remind me to keep my lips closed whenever possible. Such is the way of the tongue ninja.

Sunday, 11 October 2009

Lopsided

Last week I was back at the hospital for my first pre-op appointment with the surgeon. It was a fairly exciting morning.

The receptionist sent me straight to the radiologist to have more x-rays taken. The lady at the radiology department was not having a good day. 'Not another extraoral x-ray - we're getting a technician to fix the machine later this morning. Good luck.'

She was right - I spent a fun 15 minutes standing very still with my forehead pressed against a piece of plastic, my tongue pressed to the roof of my mouth and my teeth as closely together as they get while the resigned looking black radiologist and his new intern tried to get the machine to work. It kept making promising noises and then dozing back off with a weary sigh. It finally sprang to life on the fifth attempt, when they were about to
send me home without a new inside view of my skull.

The next suprise came during my appointment with the Chainsaw. The man in the white labcoat looked nearly like the doctor I had expected to see, but not quite. It was as if someone had glued a moustache onto his face by way of a primitive disguise. He also looked 15 years older.

The chainsaw's evil twin tried to head off lengthy explanations at first, but this time I was ready.

ET: 'So, I suppose Dr. Z has explained the procedure to you during your last..'
me: 'No, he did not.'
ET: 'but he sent a letter to your orthodontist...'
me: Yes, to my orthodontist. My orthodontist told me you were supposed to explain the surgery to me.'
ET: 'We have a patient info day coming up in November..'
me: 'my surgery date is on the 29th'
ET: '...I admit your surgery is scheduled pretty soon after that....'
me: '...the twenty-ninth of OCTOBER...'


At that point he gave up deflecting and started to explain:

Apparently I won't have my upper or lower jaw shifted forwards or backwards after all. NO! It's just that both the lower and upper jaw are a bit asymmetrical. Which is fancy doctor speak for wonky and lopsided. (He gave me a mirror and put a tongue depressor between my teeth to demonstrate HOW lopsided. My tongue was not quite as depressed at the result as the rest of me.)

Since my palate is still too narrow and I'm showing too much teeth, they'll cut a slice out of my upper jaw to move it upwards. Then they'll buzzsaw it into three pieces to broaden my palate and slightly rotate both sides to make my teeth fit together.
The lower jaw will just be rotated slightly. Then they'll staple the pieces back together with plates and screws and wire a splint onto my teeth for 5 weeks. Wheeeee!

More Q&A: It is hospital policy to take the plates out after one year. He admitted some hospitals don't do that, but Evil Twin tells me that is mainly done to keep costs down for patients. Leaving the plates in can cause infections and temperature sensitivity among other things, and after a year the plates are still easier to remove than later on.

I am not supposed to donate blood prior to the surgery for a potential autologous blood transfusion. 'Only six percent of patients need a transfusion. And if they really do need one, just the two units that you would donate would not be enough' he said cheerfully.

Will I get by on my own without anyone at home to cool my fevered brow when they kick me out? Evil twin had no doubt that I would (and that my stay would be closer to 6 days than 2 weeks), but I intend to turn back to my fellow jaw surgery bloggers for more advice. I doubt that he has ever tried that at home.

Will my face change a lot, I asked? Not a lot, but it will - the middle bit will be a bit broader, and and the lower part around my chin a little less elongated and more symmetrical. 'And your nose may become a bit broader and maybe slightly turned up at the tip. But that's an improvement
because you have a hump on your nose.' Nice and honest, ET.

The doctor also measured my face and bite, took pictures and asked me a long list of questions.
ET: How about your jaw joints. Any clicking or popping?
me: No.
ET: Are you sure? (puts his fingers on my joints). Open - close - open...

Deafening CLICK.

me: Oh...
The worst moment of the day came when the surgeon asked me WHY I haven't had an appointment with a speech therapist so far into the process.
Apparently my swallowing technique leaves much to be desired. What a serve! I was about to reply 'I haven't had any complaints yet'. Then I spent a happy moment fantasizing about creative ways to kill my orthodontist instead. Both the orthodontist and the surgeon know, and have known since the beginning, my open bite will come back if I don't retrain my tongue into not pushing against my teeth. Preferrably before the surgery will turn my facial bones into jelly. If Boris had sent me to the speech therapist back in April, when I had my expander removed, I might already know how to avoid that.

The surgeon told me people with open bites should not even undergo surgery if the speech therapist advises against it. In some cases it's not possible to retrain the tongue, or the patient is unable to breathe through his nose.

Then I was ushered me out with more info material on my surgery and its potential side effects, to study thoroughly before I get to ask him anymore questions. He made me promise to go and make a first appointment with a speech therapist before surgery day. Which I did! My ortho is SO DEAD.

Wednesday, 23 September 2009

I learned an important lesson today....

If your toothpaste tube is all gummed up and you feel like squeezing it harder, point it somewhere else than your right eye.

I am very ready to get to the point where I DONT have to take a toothbrush with me no matter where I go. 5 and a half weeks to go until surgery day!

I am very excited, but also a little scared. Reading up on other people's jaw surgery experiences may not have been the smartest move. I'm a little uneasy about the fact that they won't just move both jaws, but also split and broaden the upper one. (or so my ortho said) The other BSSO people seem to get in and out of hospital in about 4 days. My letter from the hospital said they'd keep me there for two weeks. Also, there's no one else here to pick me up from the hospital and feed me soup or anything, so I need to be able to get by on my own by then.

But I faced my fears like any good hypochondriac would. I made all necessary pre-op appointments with the ortho and the hospital and marked them on my wall calendar. I made a plan to reduce my coffein and sugar intake gradually during the weeks leading up to the surgery. I'm taking food supplements, which may not be the worst idea since I'm a vegetarian. I'm going to the gym 3-4 times a week. I even started taking cold showers.

I may be trembling in my boots, but I will be prepared as a boy scout come October.

Sunday, 6 September 2009

It's the final countdown!

Hi! I'm back among the living. With. A. Surgery. Date.

The chainsaw and I are going to meet for the second time on October 29th.

7 and half weeks to go! I'm psyched. This is how psyched:











While I've not always been thrilled with my ortho, Dr. S, during the last months of minor jaw pain and teeth grinding, I'm really happy he got me surgery ready on schedule. He said it'd be a year after I had SARPE, and it is - I had SARPE surgery on October the 30th last year. Guess I won't need a costume this Halloween, either.

Now reading Kate's, Susan's and Chris' stories to be prepared for the second round of face sawing and the aftermath. I'm slightly dismayed that I will need another round of surgery next year to get the plates from this round removed (one and a half year of orthodontia seems plenty... ), but I will make it my mission to use the remaining weeks to get in shape and cut down on caffeine and sugar. Madness? This is not madness.

This! IS! SPARTAAAAAAAAA!

(Cut to training montage )

Braces: A mental health hazard

I'm posting this separately because it concerns the last months rather than how I feel right now.
Stephanie, Kate, Jeff and Michelle: thank you for your kind words.

The aftermath of SARPE was a bit of a mess to sort out in my case, this is partly why I temporarily dropped off the radar. It was not so much that my bite was getting worse. Rather, I was not sure if things were moving in the right direction, if I was still more or less on schedule, and whether my bite could even be sorted out by another surgery with just the amount of palate expansion I achieved with the expander.

Take this period of orthodontic frustration, and add a less-than-satisfactory-job situation,a new town, little contact to old friends and a boyfriend in a war zone, and you've got a recipe for a very depressed braceface.

------------------------------------------
This is a short time line of the orthodontic developments. Feel free to skip this bit if you're only interested in the current status:

January: Dr. S confirms Junior's decision not to put a second expander in, but to expand my bite a little further with braces and fix the rest during my second surgery. Front teeth start moving back together, but since the magic plastic of teeth broadening is still in place, I still look like a pouting gerbil.

February: Ortho & witch in his employment assure me we're doing great, jaw-wise. Then, the witch takes a chisel to my front teeth to get part of the plastic off. It feels more like she's solving my gerbil problem the other obvious way. Also February: First post-op teef cleaning and checkup with my dentist. My dentist, Dr. L, is loud and optimistic and has more folksy charm than Sarah Palin. When I first met him, he offered this comment on my brace dilemma: 'Opinions are like assholes - everyone has them, but you don't need to see them all'. The dental hygienist was not happy with me because I was bleeding all over the shop. I left the scene of the carnage with three extra toothbrushes, a checkup date and many good intentions for my future cleaning habits. Flossing is much easier sans braces.


November '08-April '09: Working full time on hopelessly underfunded and overstaffed software project from hell.This requires me to attempt speaking English with the Japanese, sometimes over the phone, with the expander still in place. With mixed results. By the end of these months, I have learned to work around the expander and can speak quite clearly, but at the end of the workday, I sound like something off the muppet show. I spend a lot of time doodling on whiteboards ("A house! a motorcycle! A plane! Oh, it's just a list widget.") and use chat clients as my primary mode of communication whenever I can.

March: During a routine checkup with the ortho, I complain about the expander and ask when I can get it out.
Dr. S: "Does it bother you, then?"
me: "I think I've had more fun."
After some haggling (I got quite nervous he'd take a spanner to my teeth right away, my yuppie ortho is not much of a one for nuance), we agree on a removal date in April

April: Expander is taken out and replaced, where necessary, by additional braces. Ow, ow, OWWW. Since SARPE surgery, my eating habits have slowly reverted back to regular soft foods, and getting enough food down was never a serious problem. But chewing puts nowhere near as much pressure on individual teeth and upper jaw as having the expander taken out. I spend an hour lying in the orthodontist's chair with my head way below my feet - ideal waterboarding conditions - while a team of assistants tortures my upper jaw. [It was pretty embarrassing, but my front teeth were still so sensitive after the surgery I literally had tears streaming down my face and had to stop myself whimpering when they put the new wires and ligatures on.]

Back on my feet, I am so pale even my none-too-observant ortho notices I'm not feeling so hot. Still, the result is worth it - no more RPE!

I also overhear an interesting conversation between my ortho and the new lady doctor who is working with him (the witch seems to have taken her tarot wagon to another town).
Junior Witch: "and you think you can fix this until November?"
Dr. S: "Ahh, we had better buckle down and get on with it then."

May: The braces go to Egypt to meet the boyfriend (flying in from Sudan). I get to brush my teeth in some more interesting places.

June: After some prodding, Dr S remembers he still needs to take the remaining plastic off my front teeth so the gap can close fully.I leave his surgery with newly powerchain'd front teeth and his permission to get another appointment with the surgeon. This visit pretty much sums up everything that is wrong with my orthodontist. He is a wizard with a diamond drill, but you basically have to weld him to the floor to get any information about the status of your treatment out of him. I trust his judgement, but I have to remind him of every little thing and basically handle the whole information flow between him and the hospital because he has too many patients to remember anything about individual ones between visits.

July: I'm back at the hospital for an appointment with the surgeon, hoping for some info on how long it will take to get me surgery ready. It's quite a memorable appointment. The hospital is very busy that day and the phone in the treatment room is ringing off the hook. Something seems to be wrong with the call forwarding system. The chainsaw is his usual friendly self, but flat out refuses to give me an estimate of the remaining treatment time at first. [I'm ashamed to say I got a bit upset at this point. I told the chainsaw in one long whine I was really worried my treatment would drag on for some more months without anybody telling me how things were going, that I felt hospital and orthodontist should be exchanging information on my treatment plan directly instead of asking me, and that I feared the expansion that was achieved>with the RPE was so insufficient it could not be fixed during the second surgery. It would actually have been funny if I hadn't been so upset, since everybody in the room was looking very flustered and the phone never stopped ringing. The chainsaw finally interrupted his reply to tell the nurse 'I don't care what you do, but make the damn thing stop ringing.' She ended up taking out the batteries, with shaking hands.] Then, Dr Z sends me off to have molds and x-rays taken again. Back in the treatment room with the x-rays, the chainsaw wins my heart by apologizing for the confusing updates I got. He says I should be ready for surgery sometime within the next 6 months, and that he will send my ortho a letter detailing what remains to be done as soon as he has had time to look at the new model of my biteand work out a plan for the next surgery.

August: The braces go to Chile for a week! Also, the boyfriend is back for a month between missions. He will leave for Jordan in September.

September: A much reassured Foxface has another appointment with Dr. S. The chainsaw has phoned him with his recommendations, as promised. Blue thingies that look like buckles are placed on my teeth to close the remaining gaps between two pairs of teeths in my lower and upper jaw. After another cleaning appointment at the dentist's (Dr L-quote of the month: 'morning hour hath gold in its mouth and lead in its arse'), I finally get permission to call the hospital for a surgery date.

----------------------

So, why did I bother to write this all down in excruciating detail? Even before I started the big teef makeover project, I found it very helpful that other people on the net put up realistic accounts of what their own time in braces and before and after surgery was like. I think it's important to point out that the big challenge during such a project may not be the physical discomfort, but also the psychological difficulties you face when you feel like your treatment progress is not what you hoped it would be, or when you're uncertain whether you can trust your doctor to handle a problem correctly.

While the physical difficulties I've had so far were not negligible - it was quite difficult to speak clearly, eat and get restful sleep for months after SARPE, and my teeth always hurt for a couple days each time my ortho changes my wires - I found the emotional ups and downs that came with the treatment far more annoying. There's no ibuprofen for overthinking things and worrying.

As with everything, your mileage may vary. My boyfriend and my family are very supportive, but they live much too far away to talk me through every little problem. Having people around you to take care of you during the less pleasant stages of the treatment is probably a big plus.

Friday, 16 January 2009

Foxface is lazy

Howdy!

I hope you haven't given up on me. Last time I updated I was pretty frustrated since the Chainsaw's henchmen sent me home and declared the expansion process incomplete.

A week later, I wandered back to my ortho, still fuming and pretty upset about the extra week I spent cranking my expander (which, I knew, was completely useless- the ortho had told me that the screw would refuse to budge at some point, but turning the damn thing still worked just fine, it just didn't help me width-wise). It must have been obvious to them that I was close to explosion, so everyone was extra nice with me. The witch told me that, although 3, or 5(?) millimetres were still missing to complete the expansion, they would not replace my expander by a new one and continue expansion that way, but seal the current expander, start the healing process, maybe gain another 2 millimetres through the braces and do the rest during the second surgery. She said that integrating a second expander while the upper jaw was still instable was not advisable.

I was still sceptical, but it didn't sound too ludicrous - my molars in the left upper jaw are tipped slightly inwards in comparison to the rest of my teeth on that side, so moving them with braces could really make another 2 millimetres of difference.
To confirm this new theory, I made a second follow up appointment at the hospital during the week before Christmas. Another one of the Chainsaw's assistants was on call that day - he must have been one of the youngest doctors there, and he was looking slightly panicked that the other surgeons had left him alone with all the mirrors and drills and the plaster teeth models wearing santa hats.

Junior won a prize - he listened attentively to my orthognatic tale of woe and measured and re-measured my long-suffering palate. When he saw that I was very close to the maximum of what could be achieved during a second surgery (5 mm - not a lot of margin for error there), he decided, with trembling fingers, to (GASP!) phone my ortho to discuss whether they shouldn't go for a second round of RPE expansion instead. Of course, he just needed a phone joker because he didn't want to make a decision on his own, but I was chuffed - up to now, direct communication between my orthodontist and the surgeons at the hospital was close to nil, so it was always me who had to paraphrase, inexpertly, whatever the other doctor had said during my previous appointment.
In the end, Junior signed off on my ortho's plan as it stood after remeasuring and declaring that I was in fact still missing just 2 millimetres, but before I left, I was as thoroughly x-rayed, photographed (both my profile and my teeth) as never before. He may just be worried about his end-of-term grades, but nice work, Junior.
I came across the assistant that examined me last time around in the hallway. He spotted me at once and nervously scanned my face for signs of an imminent nervous breakdown. I flashed a gappy smile at him.

Since then, it has been business as usual - the Gap of Legend is slowly being closed with a powerchain (I strangely got one on my lower teeth as well), and my pronounshsshiation has improved slightly. It's nothing like it used to be right after surgery, but a slight gargoyle factor will definitely stick with me until I get rid of the blasted RPE. Junior implored my ortho to keep the RPE on as long as possible during the healing phase, at least the full 6 months, to stop my palate from losing another crucial millimeter in width. Damn. I'm keeping my fingers crossed for a removal in April, but I'm not holding my breath. Last time around my ortho had to remove a bit of the added plastic to close the gap further - hooray! It feels good to know that Madonna is on the way out.

Eating chewy things is still a pain, although I hardly think about those things during work days. Last Saturday I finally cracked and decided that I would die of SCURVY that very second if I didn't get some nice apples in non-mushified form, no matter in how many pieces I would have to cut it to get it down. Since then, solid fruit is back on the menu.

I will post pictures of the teef soon(have been lazy about taking new ones), you people are the only factor that still motivates me to keep them clean and shiny. I got ridiculously lazy about flossing and brushing (usually no more than twice a day with two kinds of brushes) on ordinary work days. I never use the blender, and very rarely my waterpik. If last week's new powerchain hadn't come with a ridiculously poky edge, I'd still be able to say that I never once used wax so far either - way too much work.
I hope catching up on my fellow orthobloggers' blogs will shame me into doing better on that front.