comparing smiles before & after

I'm still working on a better before & after compare. Here is a quick version for the curious...

1) In braces for 5 months, May 2008

2) In braces for 11 months, 6 weeks post op, Dec 2008

I think you can see how the braces straightened my teeth, widening my smile even before surgery. As my teeth straightened, my overbite (and over jet, too) appeared larger. My teeth should lighten up again after my next scheduled cleaning. The surgery shortened my face, especially noticeable (to me, at least!) across my cheekbones. My cheeks are fuller. My jawline is now more square. I knew one eye was larger, now I can see the very subtle difference in cheek fullnesses prior to braces. Also, now that my lower jaw is in place, my laugh lines have softened. That's good! I still expect to see face #1 in the mirror...when I see face #2 instead it seems strange. Bit by bit this sense improves. My smile is slowly relaxing and broadening as the muscles in my face come back. My lower lip and chin improve daily. The constant buzzing & twitching nerves lead me to believe this feeling will return, too. :)

Yes

As I approach the six week mark, my attitude is shifting. Finally!

• Am I feeling better? Yes.


• Can I eat more food? Yes.


• Do I like my new smile? Yes.


• Is my energy returning? Yes.


• Is the mild depression lifting? Yes, mostly.

Isn’t that good news?
Yes!

...here I tried to recreate a shot from last Christmas.

gastronomic bliss

Our family visited my in-laws today. My sweet MIL pick up some smoothie mixers for me. Also, we dined at a local pizza spot where I experienced a moment of culinary bliss...ravioli in pesto sauce. Hmmm hmm good!

4 weeks pics...it's getting better

...I actually put on foundation and my favorite top for this...:)

I poured over other's before & afters for hours. It totally helped calm my nerves. Then again, nothing prepares you for looking into your own face in the mirror. Bizarre, really. I've lost 10 pounds now, but since my cheeks are fuller, I actually feel like I've gained weight. Is there such thing as a post-surgery eating disorder?!

Perhaps it is the permanence of the experience that feels so strange.

The fourth week marked the end of my pain, per se, though I still describe my general state as uncomfortable. Something is always achy, twitchy, sore, etc. I am truly a joyful person - don't let the pessimistic sound of my posts fool ya. :) Also, I can now swallow tiny motrin pills, woohooo, so no more liquid motrin cocktails for me! My energy wanes after lunch big time. Most days I try to sneak in a nap...how do you working folk do it?

The best sign of recovery this week is that I cooked an entire meal for my family. We were all thrilled.

So, for any other orthognathic-obessessed folk out there, here is what I think 4 weeks out. I'm uncertain whether one side is more swollen or if my face is that lop-sided. Everything feels swollen, and my husband say I look better in person that in these photos, but I do continue asking myself,"What if this is my final look?" The tip of my nose has come down a bit; it's likely in it's final spot. I love where my upper lip falls against my upper teeth when I smile, though the uneven muscle tone creates a very crooked smile.

At an ornament swap this morning, I totally covered my smile when laughing because a) it hurt to laugh and b) I was aware of how weird I looked. O confident self, where art thou?

Lastly, and I admit to being apprehensive about writing this, but I wish my lower jaw had been moved further or my chin moved out. My new lip compentance is fabulous - truly - doesn't the profile need some balancing? Right now, I'm trying to trust the surgeons who do this sugery all the time, on lots of different bones, and be thankful for the lack of complications I've experienced.

3 weeks pics

....premiering fresh from the shower, sans maquillage...

It feels so strange to post these. I don't completely like the results yet and feel very self-conscious about my new look. Sometimes, I think there's no difference at all and wonder if it is all worth it...I guess this is where the conviction that one's long-term health is more important than a short-term aesthetic change.

Here is how I felt at 3 weeks post op, written the night I snapped these photos:

Christmas music? Check. Haagan Daas? Check. Feeling better? Hmmm, can I get back to you on that?
When friends ask me how I'm doing I don't know what to say. Yes, I can talk, but it aches. Yes, I'm sleeping better but I wake up swollen like Humpty Dumpty. I am constantly frustrated eating. I miss kissing my husband. Most of all, I miss my optimistic self.

I admit, it has been really difficult to stay positive. I'll be minding my own business, and BOOM, a gigantic zap of pain attacks my chin. Each zap means another nerve is waking up. Thankfully, this stage, too, shall pass. Isn't there some improvement around the 6 week mark? Feeling under my eyes, around the corners of my mouth and around my upper lip has returned. Every couple of days another part of my mouth regains feeling. Swallowing remains strange.

Of course, having any surgery during the holidays is challenging. I miss the aromas of good & good-for-you-food filling the house. I'm at home again tonight instead of celebrating with friends. I miss arriving places with lipstick applied correctly....my lips are still kinda wonky. As the swelling under my nose improves, my upper lips are slowly unfolding. My moods are settling down. The mild depression seems to be lifting more each day.

My father kindly asked me today if I was pleased with my new look. I think so...

Honestly, I’m still growing into this softer face. I liked how Million Dollar Smile phrased it, "getting used to new angles". My fuller cheeks make me look younger – that’s a plus, I guess. They also hide what little cheek bone I do have! I don’t yet like my nose angles. It’s funny how looking at other’s photos I can see the little difference is just that, little, but when I examine my own face in the mirror the difference seems E-normous.

Running holiday errands this week, I ran into several neighbors, each of whom asked me if I had had my surgery yet. This was weird. It‘s good still look like myself, right? Is it good that they don’t see the improvement. Or maybe they see a difference, it registers as "not an improvement" and so they ask? I’m not sure.

OS follow up 23 days post op

My Monday check up with the surgeons went well. The entire visit was over in 10 minutes. In short, they were both very pleased with my results, smiled at me a lot, and told me to come back when my braces were off, for a final x-ray and photo. OS even said with a warm grin, "Lady, you're healed." ( he said lady in a pleasant tone, not that middle school slang tone)

I was rather surprised.

When I mentioned that my OD thought there was condoyle sag, my attending OS laughed slightly, and asked the chief resident who assisted the surgery to come check out my bite. Right on. Midline? Right on. Next, they reviewed all my x-rays. Again, right on. I was delighted! I reminded myself how far my jaws & teeth have moved thus far, and even if every tooth wasn't perfect, my current smile is a huge improvement.

There's still some tweaking to do for sure.

A funny moment occurred while looking at the x-rays. The attending reminded me how much tooth I used to show when my lips were at rest. He said the normal range is between 2-3 mm or something. I interrupted him to show off I knew my own measurements, that I had shown 7 mm. Well, he laughed and said more like 157 mm! Humor seem much more appropriate now that the surgery is behind me.

At the end of my extraordinarily brief appointment, I wanted to hug both men (and find the other 2 lady surgeons who cared for me in the hospital). Alas, the clinic was busy. I settled for a handshake. All the appointments, and the fretting, and the blood work, and the drug effects, and late night calls to the dr...all of it seemed over too soon.

This is a huge generalization, okay, but since both of my performing surgeons are men, and both are well, surgeons, they weren't too big on the whole touchy feely aspect of me processing the experience. :) Oh, I wanted to tell them all about it, but I could tell they didn't really want to hear. They've likely heard it before.

The attending did tell me I was too critical of myself (I already know that sir!) and reiterated how pleased he was with the surgery. The resident didn't say much - he leaned in close to measure my new upper lip angle, checked out my jawline scarring, told me that would go away in a bout 3 months, and smiled at me really big! With their combined positive energy, I left the hospital on cloud nine.

Of course, once I was in my car driving the 100 miles home, I thought of all the questions I had intended to ask. The only advice given was to be sure not to chew until I was 6 weeks out. I am to call if I have any concerns, but otherwise, the attending surgeon didn't think seeing me biweekly would do much good. Who knew I could feel so relaxed in the hospital again? Just walking down the hallways at previous appointments had shaken my confidence.

I've been pondering how best to say thank you. How does sending a large box of citrus to the office sound?

First OD visit, post-op

I went to the OD twice this week. I initiated the appointment, and am so glad I did. I wanted to remove the surgical lugs. Yippee!

Bad news? My OD is concerned my condoyles have sagged. Uh huh. NOT what you want hear after surviving two weeks of what I’m coining as “the darkness”. His concerns worried me for several days. Really, though, what can I do except wear my elastics and wait for the swelling to go down? I think this is pretty common. I’ll speak to my surgeons about it on Monday. My assessment is that the OS was very pleased with my bite while the OD preferred my teeth to be set end-to-end to compensate for the settling in process.

My left side looks great. My right side is slightly class II, so that side has stronger elastics. The plan is to correct my bite while the mouth is still settling. Then, around the six week mark, we’ll start tweaking rotations, mid lines and such.So, new flexible wires are in as well as a lower power chain. My little persistent gap finally seems to be closing. Prescription is to wear the Fox elastics on the left & Ram elastics on the right 24-7 for the next three weeks. I feel more pressure than pain from these, though my cheeks are still puffy and catch on the elastics whenever I speak.

Since I cannot chew any food, the additional pain hasn’t slowed me down. Well, perhaps it’s made me grumpier than usual. I am definitely more focused on comforts than I used to be: warm socks, smooth puddings, hot showers, fresh sheets. As long as I don’t have to chat much, excursions help me distract myself from the discomforts.

Last night, my husband and I taught an NFP class. Oooh, I paid for all that talking today. Every muscle in my jaw aches, even under my chin. My face also swelled back up. Grrr.

Oh, I cannot for these babies to come off!

Brrr...

I've been surprised by just how sensitive my face is, to well, just about everything. So many friends have loved on my family with frozen meals that most nights, I'm pulling supper right out of the oven. It's a real treat, for sure! Strangely, that initial gust of hot air really stings my face. It's the same when I step outside into colder air. It's like someone turned on a giant internal vibration device on...any shift beyond about 10 degrees F feels really uncomfortable.


Sunday, I tried joining my little ones at the park. Weather was a cool, 50 degrees F. I lasted 3, maybe 4 minutes before jumping back into the car, turning up the heat, and placing the warm rice pack I'd brought along, on my cheeks. Husband-of-the-year took over thankfully.


Been reading about similar experiences on Archwired and Yahoo....


The best explanation I've found is this: the metal expands/contracts at a different rate than bone & tissue, therefore, the sudden shock of temperature change "feels" noticeably different. At this point, that difference registers as pain. Hopefully, once the nerves are back in place, the sensation will just be "different".


I guess it's good I'm here in Carolina. :)

how my young children are reacting...

Hi Katherine, you asked about my children. Overall, they are taking it in stride. It took my youngest (18 mos) about 4 days to come around. She is a sensitive, quiet child. We bonded one afternoon when we spent about 5 hours together, just us two, and said very little. For my old chatty self, this was different and beautiful. I need to remember this when she grows older! My older daughter (3yrs) spells love with time and activity. She doesn't mind my new look but is impatient with my lack of energy, apathy and sometime tears. Since my return from the hospital, she's grown concerned I'll disappear again anytime I have a doctor's appointment. She's not yet aware that this is just a stage. My take is, like potty training, she'll figure it out eventually....my challenge is to remain calm & steady for her.

My physical pain ebbs and flows unpredictably as have my emotions. Sweetpea is the first to say, "Mama, don't cry, it's okay...just go take your medicine." While I am touched by her sympathy, I am concerned she's acting like a parent. I reassure her that I am "not feeling well" and soon I'll be back to my old self. This comforts her. Also, I try to warn her when I am in pain. When I feel good, I make an extra effort to engage her. My other tactic has been to follow our general routines. Mentally, I know they're too young to remember this experience well. I guess my fear was that we'd all find ourselves in a new pattern and then let that become normal. Thankfully, my husband is pretty grounded. He (plus the many dear friends who have "remembered me") are keeping me from straying too far.

Thanks for asking about my little ones. :)

quick pics - a side view at 14 days out

I don't quite have the energy to post proper before & after pictures. Here is a quick comparison of my profile about 1 month prior to surgery and about 2 weeks after surgery.

In my after shot, you can tell my nose still turns up from the residual swelling. Also, my surgical lugs are on, as well as, lots of dental wax. I am not completely used to my new look, but I do like the placement of my chin foreward.

Upper jaw: impacted 3.5 mm

Lower jaw: moved forward 5mm

coming out of the dark

Each day continues to feel a bit better!

I'm still experiencing some pain and mild depression - though there are moments where I feel the old me has returned. Since my OS encouraged me to talk at Monday's appointment, I've been trying to talk more, to stretch out my waxy-feeling facial muscles, but of course, it increases swelling and sucks all my energy.

Thank you to my friends for emailing, calling and loving on me. It makes a difference. :)

The Darker Side Effects of Dilaudid

Today, I finally investigated the side effects of the pain reliever I was taking. Since I couldn't swallow very well, and vomited several other pain meds in the hospital, Dilaudid's 2-4 mL doses worked well for me. I am grateful for the pain relief the drug provided, but goodness, it seems I was sensitive to the drug in almost every category! I'm so glad that I am not still taking this powerful drug every 3 hours.

For anyone researching jaw surgery and such, here is a copy/paste of the side effects. I've italicized the ones that effected me. Also, I checked out withdrawal symptoms, and BAM - there were other symptoms I'm experiencing.

I am glad I am not really going crazy!

"The major hazards of DILAUDID-HP include respiratory depression and apnea. To a lesser degree, circulatory depression, respiratory arrest, shock and cardiac arrest have occurred.

Dilaudid is an analgesic narcotic with an addiction liability similar to that of morphine. It is apparent within 15 minutes and remains in effect for more than 5 hours. Dilaudid is approximately 8 times more potent on a milligram basis than morphine. Often called "drug store heroin" on the streets. Dilaudid inhibits ascending pain pathways in Central Nervous System. It also increases the pain threshold and alters pain perception....of course, the pain alteration is why this was so helpful during those early days. :)

The most frequently observed adverse effects are lightheadedness, dizziness, sedation, nausea, vomiting, sweating, flushing, dysphoria, euphoria, dry mouth, and pruritus. These effects seem to be more prominent in ambulatory patients and in those not experiencing severe pain.

Less Frequently Observed Adverse Reactions:
General and CNS:, Weakness, headache, agitation, tremor, uncoordinated muscle movements, alterations of mood (nervousness, apprehension, depression, floating feelings, dreams), muscle rigidity, paresthesia, muscle tremor, blurred vision, nystagmus, diplopia and miosis, transient hallucinations and disorientation, visual disturbances, insomnia, increased intracranial pressure

Cardiovascular: Flushing of the face, chills, tachycardia, bradycardia, palpitation, faintness, syncope, hypotension, hypertension

Respiratory: Bronchospasm and laryngospasm

Gastrointestinal: Constipation, biliary tract spasm, ileus, anorexia, diarrhea, cramps taste alterations

Genitourinary: Urinary retention or hesitancy, antidiuretic effects

Dermatologic: Urticaria, other skin rashes, wheal and flare over the vein with intravenous injection, diaphoresis"
--from web.md

Here are the possible withdrawal symptoms:

Withdrawal symptoms from Dilaudid can occur four to five hours after the last dose. dilaudid withdrawal symptoms usually last 7 to 10 days. Ah ha! Users may respond to the pain of dilaudid withdrawal by taking another dose without realizing they have become addicted. Dilaudid Withdrawal symptoms include but are not limited to:
severe anxiety , insomnia, profuse sweating, muscle spasms, chills, shivering, tremors, restlessness, yawning, gooseflesh, restless sleep, irritability, anxiety, weakness, twitching and spasms of muscles, kicking movements
severe backache, abdominal and leg pains, abdominal and muscle cramps, hot and cold flashes, nausea
anorexia , vomiting, intestinal spasm, diarrhea, repetitive sneezing, increase in body temperature, blood pressure, respiratory rate, and heart rate

some Tidings of comfort

This morning I am resting at home, wrapped in blankets, cradling a warm cup of coffee, and listening to the morning service at First Pres. Oh, how I appreciate internet access to our warm church family during my recovery. Hearing Dr. Ferguson humorous deliver the children's message comforts me. Hearing the choir sing the wonderful Gabriel's Message, comforts me, too. (this is a great link if you enjoy fine choral music).

I have felt very lonely this week. If anyone is still reading my all-over-the-place blog, you'll know I've had some rough days. I have new compassion for the home bound, the elderly, the truly alone. I'm grateful for that.

After sleeping in a recliner for three nights I am breathing a bit better. I've also practiced breathing through my Airlife spirometer. Last week,I could inhale about 2250, then it dropped to below 500 this week. That's how little oxygen I received! Thankfully, I improved to 750 yesterday.

My children have been very patient with me. My older daughter, full of compassion, rubs my arm, instructs me with big eyes, "Mama, it's okay, you'll feel better soon." Then a few hours later, "Mama, I know you can't really read yet, but can I sit in your lap with my book?"...and then she climbs into my lap with about 8 books, 2 baby dolls, and a snack.

My younger daughter still tugs on my shirt indicating she wants to nurse. I tell her we can't, she sighs, gives me a tiny hug, and scampers along. Later, she brings me a book to "read" with her, her latest crayon creation rumpled in the fingers.

Scenes of everyday family life comfort me. The sage old saying: "Do ye the next thynge" is still apt. When there is nothing to do, do the next thing.

For me, that meant finishing the hem on some dresses I had sewn for my daughters. Here is the dress on my new bed. It's the first time I sewed piping & a ruffle. Sweet sister dresses in French blue corduroy with a pretty contrasting lining.

My second improvement has been managing my pain. I decreased my Dilaudid over the few days, kinda saving it for when it got really bad, and thankfully many of the narcotic side effects have disappeared.

• not as edgy, can concentrate
• appetite is returning slowly
• GI track is normalizing
• all over itchiness is gone
• no more nightmares...these were really wreaking havoc w/sleep

Still do experience the following side effects of surgery:

• constant low grade fever chills
• throbbing pain & spiked stabs of pain in my chin
• swelling under my nose is worse due to the Lefort I
• stitches in upper jaw itch constantly
• numbness - nose, cheekbones, half of chin, roof of mouth, all upper teeth

Pain meds now consist of Motrin/Ibuprofen 800mg every 8 hours, plus 400mg Tylenol as needed. I have about 3 doses of Dilaudid left before my OS appt tomorrow. These are for tonight.

My splendid spouse turned our gas fireplace on last night. Ah, I waited 2 years for that moment! It was SO nice to sit somewhere other than my bedroom. He picked up some Pho soup at my request. I blended the meat for extra protien. What a pleasant change from chocolate Muscle Milk sh kes. He put the children to bed, and we chatted just like old times in front of the fireplace before he departed to put in a few hours of work at his office.

In ways both big and small I am encouraged.

my iron lung

I remain in the "wincing and weeping" stage for another few days I am afraid. My current hurdle is trying to breathe deeply. After listening to my growing list of physical ailments, my husband ordered some blood work to be drawn. The results from last evening's trip to the hospital came back positive, that is, there were no obvious signs of infection. They did not, however, reveal what is causing me such pain.

I suspect it is muscular, from how difficult it is to find a sleeping position. If anyone reading this would share how they handled their post-op sleep, I would be much obliged. If I move my head much out of center, my ear aches terribly, but it feels like my neck is begin pulled somehow.

Goodness, I am a mess!

As best as I can describe it, I am wearing an iron lung that prevents my from breathing anything other than the smallest of breaths. Pleghm drips onto my esosophelgus-whatever, and then I can't cough. Any breathing causes my chest to constrict into muscle spasms.

Should I see a chiropractor? Do I need a muscle relaxer? I know I need help. My next visit wit the OS ins't until Monday at 1 pm.

Thanks y'all.

lounging in bed, again

Today marks 1 week since surgery. Amazing. On Day 5, I felt awesome. noticed lots of swelling was down, chatted up a storm, smiled with my children, saw visitors. but once again did not sleep. Day 6, I sadly paid for all that talking. still no sleep at night. Today, the situation is somewhat improved, but uncomfortable. I can't quite shake the frequent "white, hot pain" spasms.

So, I have modified my med schedule. This should help with sleep. Without any rest, every response is exaggerated. Y'all, I was taking a different med at every hour for six days. No wonder I feel loony!

I'm called the OS to ask him my questions. He was pleasant, reassured me that all my issues were temporary.

Kinda vacillating between wincing and weeping. Where did my old normal self go? Sorry to sound down. It's just gonna be one of those harder days. Maybe today is my low point?

happy anniversary!

Eight years ago on a cold, rainy day B and I said our vows in front of many dear family and friends. Thank you to anyone reading this blog in 2008 who supported us back then. We young things needed lots of advice along the way! With each year that passes I am more pleased with my groom. As I see my respectable sins, too, I am reminded how little I deserve such a fine man. All good things really are a gift of grace...

Some highlights of those 8 years:

• 2001- B is a student, I am laid off in the tech crash...we are in love, in debt, scared and decide to try small town living....who knew we'd find such a grand hometown in Columbia?


• 2003- B is still a student, found a job I adore, but I'm traveling too much with work.






• Next, B is still a student, and he encourages me to follow my dream of studying abroad for an MBA. Now we're both students again, have no money, but are very happy. Remember climbing Mt. Schafberg?



• 2005 - We celebrated 5 years together, realizing for how much of it we had lived apart.


• Blessed with a baby girl, now a SAHM. Still think sometimes about the roads not taken but, mighty happy.
• 2007 - Blessed with a second baby girl.Look at 'em cooo-ute baby feet.

• After hearing me talk about it enough, you encouraged my wish of getting braces. And here I am on our 8th anniversary. Gooby lipped, and despite the temporary grumpiness, still very much in love.

Happy Anniversary B!

the prettier side of recovery

I am feeling the effects of my last dose of narcotics, so this post is a quick one. Here are my humorous attempts at keeping it real. :)

I am feeling a bit like Ms. Jolie. Other adults are watching my children while I hang out with a good looking husband. Strangers tell me how lovely my children are. Oh, and the more water weight I lose, the better my giant lips look! Definitely puffville at my house this week.

Discovered a cool trick: when the rushing sounds of my pulse race through my ears, I push on all sides of my face and it's instantly quieter.

Check out these sexy lips...they got worse but sadly, or maybe not, these are the pics I snapped of the uber grossness.

macho for morphine

I felt so confident at 8:45 am that I skipped my 9:00 dose of dilaudid. Silly girl. By 10:00 I was very aware of my error. Ooew, I have never been so delighted to hear my clock strike 12 noon! To help pass the time, I picked off the ooey whatever was growing on my fat lips. Yuck.

Now my face will stop shaking. I'm making myself repeat, "I will not go macho again. I will not go macho again."

Alright, back to staring aimlessly at my wall. Isn't beige the best color of all?

Home

What a pleasant word to write. It’s now Sunday evening. All reported was that my surgery Thursday morning went smoothly – and my recovery is progressing. Surgery took just over 5.5 hours. The last 36 hours on floor 7W have been very difficult. Hours of intense pain ticked along, the first twelve hours measured in 6 minute increments on my morphine dispenser. As each click brought relief, my eyes grew heavy and an oxygen alarm notified the nursing staff my pulse had fallen. Ooh, and the drug cocktail makes me itch all over.

Those were long hours indeed. Like falling love, reading about it this surgery and experiencing it are entirely different.

I needed to spend an extra night in the hospital to manage my pain. Here is where the good news begins. I am not wired shut, nor am I wearing any rubber bands. This enables me to mumble somewhat coherently. Also, my pain has been higher in part because so much feeling has returned to my face! My chin flutters 4/x hour. My face tingles all over. One of the surgeons thought this was super.

The daytime nurse, Lynne, and evening nurse, Brenda, made it all bearable. Their kindness blessed me immensely! Guess what? Brenda underwent the same surgery about 15 years ago. Her encouragement throughout Saturday night helped me reach “the other side”. At last, I experienced enough relief to see the end was somewhere…

We left the hospital at 12 noon today, raced 120 miles home, in order to pick up prescription pain meds in Columbia in the right liquid/dose/volume. Only one pharmacy carried liquid dilauded in 4mL. These two hours were awful. I felt as if my whole person was being shaken…every new metal screw in my jaws rattled with the road wear.

So far, I have been too concerned with pain management to worry about my new look. My precious three year old wouldn’t look at me at first, then warmed up, piling toy after toy on the bed, saying, “Here Mama, for when you feel better.” I did tear up when my precious 18 month old would not meet my eyes. I tired covering up the swollen parts, and saying her name softly, but she still looks away.

In a few days time, we’ll feel better. For now, I am glad to be home.

the lugs are on

I wish I had kissed my husband more last night. I didn't realize just how strange these surgical lugs would feel.

Today's appointment with my OD was good. The entire staff was fabulous. Inquisitive, thoughtful, gentle, patient, encouraging. Lots of well wishes were exchanged. Though I was very apprehensive on Monday and Tuesday, I feel more excited today. It must be that fight-flight adrenaline rush I'm feeling....that and being covered in prayer by my dear friends & family.

This adjustment was THE most painful experience I can remember. Getting the lower wire in brought tears to my ears for several minutes. Why isn't torque a 4-letter word? See, we had to cut the wires out b/c of the crimps. The new wire is straight and this has to be hooked to my teeth before new crimps could be added. My mascara trail was more dramatic than I would have liked but what can you do except cry at a moment like that? The staff handled my pain well. Four people and 800 mg Advil later my mouth felt better.

I muttered that if I ever feel like not wearing my retainer in the future, I will remember this moment. Seriously.

Here are my teeth today before any changes were made. Crimps are visible (and coffee stains, too!)

Here is a picture of my naked teeth right before new steel wires & lugs were added.

Here is me grinning in the sunlight, cold air rushing through the lugs. 31 looks chic doesn't it? I have hundreds of thoughts to journal, but most of them don't belong on my blog. :) If I have time, I'll try to post some of them. Right now, my energy needs to go to laundry and household tasks before we leave town tonight.

Two bright spots to share.

First, my father called last night to wish me well. He's traveling for business through Asia, so when we saw his call from Taiwan we grabbed it quickly. Thanks Daddy for praying for me. You can never hear someone loves you too often! Second, I have dinner reservations tonight at the romantic restaurant where my husband and I had out first date. B, do you remember how I kept dropping my napkin so I could accidentally move my chair closer to yours?

Well, my husband will not likely post while I'm at the hospital. I should be back online in a week or so. Surgery tomorrow should take about 5.5 -6 hours. It is so strange to be in this moment.

Dr. Ferguson has recently framed his sermons in this context: what is God doing with you, right here, at this time, and in this place? For now, I can answer that He is keeping me under His banner.

And in that day there shall be a Root of Jesse,

Who shall stand as a banner to the people,

For the Gentiles shall seek Him,

and His resting place shall be glorious. - Isaiah 11:10

a shout out

I want to give a giant shout out to my friend-of-a-friend Brooke who first sported a -cutest-blog-on-the-block background. You are such the trendsetter. Thank you for sharing this fun blogging tool with us orthognathic bloggers. :) - katherine in Columbia

Game on!

My doctor decided to postpone the Saturday afternoon test until lunchtime Sunday. Phew, this morning was a bit rough but I'm glad I made it. Drum roll....my hemoglobin soared to 12.3 today according to my blood work.

I chewed on ice chips in the evenings. The small pumpkin spice latte Saturday morning was a very pleasant reprieve.

The headaches and wooziness weren't THAT bad. During Sunday school this morning I joked with a friend that "water is totally overrated". Of course, at any point I could have broken down and chugged a liter. It was never a dangerous situation - my physician monitored me about every 3 hours via interview. The nadir was my constant whining to my husband, "Honey, i'm thirsty...do you think I could grab a little glass of...?" I would not recommend this route to someone else, but I would repeat it if necessary.

Tomorrow I chat with the OS.

a reverse diet

This week I can eat whatever but drink nothing. Next week, I'll be able to drink and eat nothing. SO Ironic. To prepare for my next round of bloodwork, my doctor has encouraged me to dehydrate my body. Uh-huh. Can you imagine my expression when I was told to avoid drinking anything or eating anything that is comprised of a lot of liquid, " for two days? It isn't that bad, though, now that day 1 has passed I am really thirsty. We had a lovely day of heavy thunderstorms, so unusual for November. All I wanted to do was sip a cuppa of joe (or maybe 5 cups!) and read. Instead, I added an extra gym class today to dehydrate. :)
My aim of course is to raise my iron levels past that 12.0 mark. The current plan is to test tomorrow evening at my local hospital. Monday I have the second pre-op and blood work appointment with my OS in Charleston.

Hope to have more good news to report.

*Ferritin - this was the additional test ordered with my last round of blood work. It measures the iron stored in tissues, I think. It came back positive.

blood work shows some improvement

I had blood work taken yesterday. My anemia is improving. Yeah!

The new hemoglobin level is 11.7...yep, basically a 0.1 movement/week of treatment. It has room to improve, but my general physician is pleased. He consulted a hematologist colleague to discuss the results. She was very pleased, indeed, she was surprised to learn my surgery had been postponed for a hemoglobin level of 11.5. The normal range is (11.1-15.8).

Per her advice, my doctor ordered an additional test (that i cannot remember). Results should be back later today. My doctor will then call the oral surgerons with the update.

What pleased me most was learning how healthy my blood is. Measurements of Iron, Folate, B12, glucose, and TSH were all excellent. I was especially interested in my iron and folate levels after nursing two babies.

In other exciting dental news, I visited my ortho this week. This visit was particularly positive!

• examined latest molds...I think this makes the 8th set taken in 10 months?
• power chain on lowers, working to close gap in front and gap b/w back right molars
• new steel wire on lowers (after the previous one was cut)
• wire crimp to bump up my left canine...turns out the tooth sits a bit low...it's not the jaw plane that's unlevel
• complimented my OD for his well trained eye

Basically, we're making big changes for 1 week, then my mouth has to be stabilized (again!) for the OS to take final molds on 11/10. At one point I yelped at all the movements, the staff asked me if I was okay. I muttered something like, "Well, yes, I've delivered two babies, but, phew!" Poor 13 year old boy in the chair beside me. Sorry.

new surgery date

Well, I am feeling MUCH better. A hearty thank you to those of y'all that left me a note, and to my good buddies that called with well wishes. It does make a difference. ;)
My new date is November 20th. My extended family has been pretty understanding. The iron pills aren't too bad. The funniest aspect of carrying around pills is how often my little one pulls them out of our diaper bag, shakes 'em loudly, and then hurls them on the floor. Nothing like throwing around prescription meds to get everyone's attention!

Other ortho news? I visited my OD this week, too. We're going to make a few minor adjustments on my lower teeth. I am actually eager for a power chain - my lowers feel like they're trying to fall out of my mouth.

So, I am back at the gym, finishing up projects, reading about orthognathic adventures, and enjoying my favorite month here in Carolina. It's finally sweater weather.

On my darkest day of the Katherine-decides-to-have-a-pity-party, I glanced at my Bible on the bedside. I knew it would bring me comfort, yet I resisted opening it. My bookmark opened to a passage I had been reading a few days prior. There was the familiar Proverbs 3:5-6
"Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge Him and he will make straight your paths."

Then I continued to the next few verses...including verse 7:

"It will be healing to your bones and refreshment to your flesh".

how appropriate!

Surgery postponed due to anemia

My surgeon call me just as I was on my way to have my surgical lugs put on. Last week's blood work revealed my iron is at 11.5 g, and it should be at least 12-13 before surgery. I am disappointed more than I can describe. So many details have been planned. I'm sorting out how to rearrange the pieces.

So, the current plan? I'll take iron supplements 3x/ day and have my blood checked monthly. As soon as we see progressive improvements, I can reschedule a surgery date.

Last night, as I lay awake late into the night, I drafted a lovely post about the fabulous evening I spent with dear friends, how they loved on me, prayed with me, prayed for me, how they filled my freezer with meals. My pastoral minister even called me to pray. Oh, I felt the arms of God wrapped around me as real as anyone. I felt safe. I felt ready for Thursday.

There is so much to be thankful for...I hope in a few days time my sadness and anger will depart and I can re-grasp a sense of peace.

Missing my power chains

I never thought I would actually miss those chains. My OD removed them last week at my final pre-surgical adjustment. Since then, my lower teeth have continued shifting, moving outward. It concerns me, though I'm trying to tell myself it's no big deal.

My hubby is on a guys hiking trip this weekend so it's been just us girls at the house. Ah, I wish I was more patient with my children. We had a magical moment this morning reading together, but overall the day has been long. On a good note, they did help me wash the front doorway. We took turns dipping our rags into a bucket of warm soapy water and scrubbing the dirt off our door and lights. Me dressed in gym clothes, the girls dressed in ballet costumes. The girls had already drawn all over themselves with markers after lunch...we were quite a sight. :) Here is my sparkly front door.

Now that the children are in bed, I'm gonna turn on some music, finish my deep cleaning, and hope a little gin & tonic nightcap will help me knock out a sewing project.

Pre-op Recap

My pre-op appointment went really well.

There was a problem with my upper molds warping or something, and so Dr.C called me last evening and asked me if I could go back down to Charleston for another set. Of course, I said yes, he needs those molds to set up the surgical models over the weekend, but golly, it's hard to move that quickly with two small children. I'm sending a shout out to my friend RT in Chas. for keeping my 3 year old during the appointment. I'll take Buttercup with me.

This little twist led to a rush of emotions last night. Lots of rushing around, big change of plans for my day, lack of trust in God that He does have all these details under control, anxiety about the outcome of surgery, etc. I was really feeling swell until about 10:00, then it hit me. I slept poorly and woke up at 4:30 am. Thankfully, this gave me time to blog here :) and pray about my day.

OK, back to the pre-op recap: Both Dr. C, the Chief resident, and Dr.T, the attending surgeon, spent several hours with me. Dr. T did an excellent job explaining the intricate steps of the procedures, the risks of making so many small cuts in the bones of the face, and what happens when "those littler arteries don't read the textbook". It was relaxed, overall, as Dr. T peppered his explanation with comments like, "Well, now I've been doing this surgery for over 30 years, and have never personally seen it, but this (inset really scary outcome) could happen..."

Humor aside, what helped me most was reviewing my ceph x-rays another time, talking about the molds, and hearing the various complications. Such as:

• if a patient experiences too much blood loss during the Lefort, they'll postpone the BSSO until later.


• if i wake up and my mouth is completely wired shut that means my bite was wobbly in the operating room, and they wanted to be certain the new bite sticks (usually due to thin jaw bones making for a more complicated BSSO)


• if at anytime I experience breathing /anesthesia problems, they'll halt the surgery, and I might wake up without having had the procedures, kinda of a better safe than sorry approach.


• what make a nose move and how this surgery will likely affect my nose

We took a bunch of molds during the appointment. Sadly, I came down with a cold on Saturday, and still couldn't breath well nasally, which lead to a whole lotta gagging during the process. It was pretty funny when I started motioning,"I cannot breath!", and the tech, two detnal students, and the surgeons all dashed in to rescue me. Trying to pry gooey, wet alginate off the back of my throat was actually a bit scary.

Here is the technical news: It was wonderful to finally have a plan before me. First, the Lefort I will remove 3 mm of bone from my maxilla, then the bone will be slid back into a proper position, and the lower jaw aligned. Because the mandible swings forward, the current plan is to move my mandible forward about 2-3 mm with a BSSO, for a total of 5mm movement. They not moving my chin. I was kinda hoping they would, but trust their judgement.

To be honest, when I first heard the number 3mm and 2mm, I thought, wow, this is a WHOLE lot of angst for a few mm. Then I remembered that the little 3mm movement will allow me to close my lips without strain...how cool is that gong to feel, I wonder?

Ah, my writing is so choppy today, but I wanted to share the other excellent news. Dr. T thought I only needed to wait 3-4 months post surgery to get pregnant. Yeah!!!! He was not at all worried about the bones shifting, and agreed that I should plan for adequate nutrition. He said soft tissue heals really well.

Oooo, my morning time's up. I'm off to wake up the babies for our morning drive to chuck town.

This is what my babies looked like eactly one year ago...my time flies.

Orthognathic surgery - improved airway, breathing

This post is not a real discussion on sleep apnea issues. I don't have much to contribute there. However, when I saw this picture in Hupp, Ellis and Tucker's book, a big light turned on and I finally understood how a BSSO might improve one's breathing. So, I'm posting it here. May it help someone else on this journey.

Class II - vertical maxillary excess, mandibular deficiency, lip incompetence

Here is an example of a female with a Class II malocclusion, vertical maxillary excess, and a mandibular deficiency. Her treatment plan included a Lefort I, a BSSO and genioplasty. This patient also has a slightly shorter upper lip like me. I will be having these same procedures in less than two weeks.

Before:

After:
doesn't she look wonderful? Like herself, only better. :)

Class II compensation

Does my title seem strange? I've been titling my posts for easy reference when it makes sense in hopes that others researching these same topics will find what they need. It is so frustrating to spend hours online without answering medical questions that seem answerable.

I have high esteem for anyone who has completed the tests, study, training, and Boards that our medical field requires. The authors of Contemporary Oral and Maxillofacial Surgery 5th Edition have invested a great portion of their lives helping people. I highly encourage any fellow info junkies out there (and you know who you are!) to locate a copy of this medical textbook through your public library.

I am going to share a few pages from the book, but there is a plethora of excellent research, photographs and analysis inside its 700 pages. Yup, I've read through the entire book. Twice. :)

This first picture explains why many of us orthognathic patients feel "it gets worse before it gets better". Here is an example of a Class II bite.

2 week countdown - I will sing a new song

I am writing a quick (and randomly organized) post while my babies nap. Much to do today!

Just a year ago I knew very little about orthognathic surgery. I have grown so used to thinking about the BSSO and Lefort I that I forget how gruesome the procedure can sound. What an amazing journey so far. I am immensely thankful this week for a sense of peace. Bono’s lyrics have been floating through my mind all morning.

Words from Psalm 40:1-3 come to mind:

I waited patiently for the Lord;
he inclined to me and heard my cry,
He drew me up from the pit of destruction,
out of the miry bog,
and set my feet upon a rock,
making my steps secure.

Here are my latest molds. Isn’t the difference fabulous? It will be a grand day when I can chew without the “going in a circle round and round” routine. I am really curious what my surgeon will say about the narrow bite on my back right molars. Will he recommend a 1-piece or 2-piece Lefort? My OD thinks he can correct it with braces post surgery. I hope so…it seems like the recovery would be better.

Pre-op on Monday.

Oh, and I borrowed a copy of Tucker's new book (thanks Dr.B!). The new color photos are AMAZING...I'll try to post about these over the weekend. It has been a real encouragement.

Well, babies are awake now. Better run!

1, 2, 3, jump!

This has been a good week for my teeth. I saw my OD, who adjusted some upper wires, I think, to further pop out my front 2 teeth. He also crimped the lower wires on a back molar to help push it into proper place.

Each night around 3 am I have awoken to dental pain, and though not fierce enough to warrant pain meds, it is a constant ache.

In general, I'm a long term thinker, some might argue to the point of dysfunction. When my doubts plague much of my waking moments, it can be hard to remember that distant picture of health. At my last appintment, when I saw how well my molds fit together I almost cried. It was a tangible reminder that this difficult journey is all worth it. Yeah for molds!

Other good news to share? I chatted with my surgeon on Friday. He arranged to import my digital profile into the Dolphin software. We'll review it together at my pre-op appt on Oct 6th. I doubt I can put into words how amusing this discussion was. Here is my surgeon, giving me instructions for emailing him a photograph. It's just my face. I'm no beauty queen, it's totally legit, and I am an ultra-conservative kind a gal, but let's just say it was awkward.

Thank you Dr. C for accommodting my request.

I am really starting to grow excited about surgery. Finally! I feel some pressure to complete all those projects I assigned myself in August (what was I thinking?!), though no one but me will really notice. Also, the volunteer work I do has kicked into gear, and I'm finding it difficult to relinquish control over projects I've nurtured for a few months. It's been another opportunity to "die to self", that is, to let go of my prideful ambitions. It's easy to write that last sentence but terribly difficult to live it.

To close this post, I want to share an anecdote. My husband is the love of my life...so I asked him if he wants me to freeze some meals in advance. You know to help him while he nurses me and cares for our very active children. He said, "Nah, don't worry, you won't be able to eat much, and the children don't eat that much, I'll be fine, thanks." Now, my spouse is the sweetest, most noble, loving husband a girl could pray for, but I gave him one of "those looks". A look that said, "I don't care if you feed our toddlers pb&j for 2 weeks, but I will need F-O-O-D!"

Next week I am connecting with my inner Julia Child & our extra freezer. A girl has got to eat.

do I really need to stock up on Zip n Squeezes?

I am getting my supplies in order this weekend, and wondering if I really need to order the ZnS. They sound really helpful, but could I live without them? What do y'all think?

On a related note, does anyone have extra jaw surgery stuff there willing to recycle? I'll be glad to reimburse you through pay pal or something.

Thanks in advance!

a great overview of Orthognathic surgery

As my surgery quickly approaches, I'm re-reading the available medical articles on orthognathic surgery, specifically anything on "Class II + long face syndrome + Leforte". I am still uncertain how to predict & accept how the upper jaw surgery will change my face. This morning's google search turned up the following website. The pictures are quite clear, and provide an excellent overview of orthognathic surgery types.

http://reynoldsoralfacial.com/oral_surgery_loveland_co/rec_orthognathic_surgery.html

Be sure to scroll all the way down!

more tweaks

A quick post to journal about my adjustment:




I am SO glad I scheduled an extra appointment with the OD. Today's 10 minute power chain exchange morphed into a 90 minute wire-bending party. Everything took so much longer than any of us had anticipated. I dashed out of the office at one point, retrieved my youngest toddler from a friend's house ( thank you dear Laura), and then sat her down in the chair with me for the last 30 minutes. The office staff absolutely dotted on my sweet Buttercup. Phew, my morning was completely shot, but at least my teeth are once again on the move.


Both steel wires were removed. New bends and such, new power chain, and a special something or other was added to widen my lower arch as much as is possible. It's painful but bearable. My OD also took a set of molds - and I may go in again next week for more tweaking.



I don't really understand why two weeks ago, the office was like, yeah, we'll see you in 5 weeks for your hooks, and now they are moving so much it translates to 1 appt a week. Oh, well.



At this point, I am ready for the whole orthodontic process to be over. That said, I'm not interested in postponing surgery. I'd rather wear braces for a year while pregnant than postpone that 3rd baby another six months....SweetPea needs another playmate to help her eat all that chocolate frosting. :)

It's also time I stop putting so much thought into my teeth. In the end, I'll become dust again no matter how perfect my bite is!

I am proud of my homemade birthday cake. I used a recipe from my grandmother's old Fannie Farmer cook book. It's a classic, with a torn binding and food spots throughout! SweetPea helped with each step, and based on the mess we created, I think she truly enjoyed her birthday.

My feelings are mixed. Today, I am once again apprehensive about surgery. After months of this self-focused jaw study, the good news, it that all I need to feel better is a glance at a bad picture. This one shows how my recessed chin follows me everywhere. Ha ha... I am immensely thankful that there is a re-/solution in the near future.

Dentofacial deformities

taken from Correction of dentofacial deformities with orthognathic surgery: Outcome of treatment with special reference to costs, benefits and risks by Karin Panula

"2.3.1. Psychosocial profiles of patients and their expectations regarding orthognathic surgery

Orthognathic surgery is a complex process leading to changes in the appearance and functions of the dentofacial structures, including respiration, swallowing, speech and mastication. These alterations take place in a single moment during the operation in contrast to the traditional orthodontics in children, which produces small, gradual changes during growth. Thus, orthognathic surgery may seriously challenge the patient's capacity to adapt. This adaptation may be easier if the psychosocial indications and implications are thoroughly evaluated prior to any treatment and also during the presurgical phase. "

I have been talking up my forthcoming surgery to just about everyone I see. It's been theraputic, kinda, though I think my need to tell everyone is to control how they'll react to my new face. Perhaps the new me will not look that different. And then everyone will really think I am crazy!

Besides the physical aspects of jaw surgery, this quote often comes to mind when I perceive an expression that says, "So, what's the big deal? Why are you talking about that jaw stuff again?"

No one has actually said this to me. :)

Certainly, this journey has given me more compassion for others in a state of waiting. My single friends, who long to be married, must grow weary of the "you dating anyone?"question. My childless friends, who long to care for children, must grow weary of the "are you getting any help?" questions. We all have some needy area in our lives. My hope this week is that when I find myself wallowing in self pity (which, trust me, I can do with the best of 'em!) I will seek true comfort...and be open to provide comfort to others.

scary braces

I think I scared off all my readers with the palin pic. I sure hope not...'cause while I was really psyched by her speech a week ago (though by no means blind to her weaknesses), this is still a blog about Babies and Braces. :)

Just spoke with my surgeon today. He listened to my concerns (again), and confirmed our dates are set for October. He was fine with the recent movements my ortho made to wires, bite, etc.

After some discussion, he explained why their office doesn't use the Dolphin imaging program to generate my new face. Don't have a server for it. Hmm. We brainstormed that the Ortho dept at MUSC, which does use this software, should be able to help us. We'll see. I know in the end it's the surgeon's hands I'm trusting, but I'd like one more peep at my proposed face. Of all the details of surgery this freaks me out the most.

Maybe it's better not to see the future? Maybe the future would freak me out more? When my hip bones rotated forward post baby girl #1, it was really weird. My pregnancy weight came off quickly, and one day I felt courageous enough to try on my skinny jeans. Surprise they fit, just not cross my hip bones. After another 9 months of body sculpting and nursing, I gave 'em to goodwill. They just didn't look the same as they had before la bambina.

And la bambina now? She turns three next week. Here is a snapshot of her on her way to the first day of preschool. I just had to dress her in my first sewing project...a very fine pair indeed.

Steel wires are back

I had a good adjustment yesterday. New steel wires were placed on both U/Ls. My OD shaved the wires near my front two teeth to "pop them out". He also put an upper type wire on my lowers, trying to pull the back molars out to a wider arch. When the technician cut the back wires, I swore I heard a molar shatter...thankfully, it only felt like it did. I'm beginning to think "regular ol' plastic surgery" would be way better than what I've agreed to.

Beware anytime you hear the words "torque" and "molar" in the same sentence. Owieee!

I pushed for one more adjustment appointment before my surgical wires are placed, just to make sure everyone is on the same page. Too much has been arranged at this point to risk moving my surgery date again. :)

I snapped some pictures yesterday which show how my two jaws line up Before surgery. The persistent gap was much improved going into my appointment, but within minutes of my teeth being strapped onto the steel wires, it opened back up again. Argh...It's true what everyone says, it gets worse before it gets better.

Orthognathic surgery before & after

This week I’ve been thinking A LOT about Before and After.

What will After look like? Feel like?

I have been pouring over the usual suspects (other blogs & archwired) to prepare for surgery. I named this blog Babies and Braces because that’s where I am right now. Most of my analogies link these two ideas. I feel just I did when I was 34 weeks pregnant with my first baby. Every physical sensation (i.e. chewing anything) reminds me that the Big Day is coming very soon. Excitement and anxiety collide in my waking thoughts. Just like reading birth stories helped me prepare for my labor, so has seeing others’ After photos. Thank you y'all for bravely posting your shots of swollen cheeks, bloody noses, and bizarre elastic configurations. Will I be as brave?

Here are links to a few of the Before & Afters I admired. (Of course, there are others, but I focused on the easy-to-navigate-pages for this post). If you have one to add to the list, please note it in the comments. I hope this will serve as a quick reference instead of scrolling through the yahoo group photos.

· Karl http://www.thisisjustwrong.com/
· Rachel http://breakrachelsface.blogspot.com/2008/08/one-woman-two-faces.html
· Kelsie http://orthognathicsx.blogspot.com/2007/03/looking-back.html
· Leah http://leahsjawsurgery.blogspot.com/2008/05/last-post-before-surgery.html
· Amie http://amiesjaw.blogspot.com/2008_07_01_archive.html
· Lisa http://s67.photobucket.com/albums/h287/npfieldhockey/jaw%20surgeries/?action=view&current=ca25e93b.pbw
· Tori http://www.archwired.com/phpbb2/viewtopic.php?t=27353&postdays=0&postorder=asc&start=15
· Arvensis http://www.archwired.com/phpbb2/viewtopic.php?t=27529&highlight=pics