Monday, March 25, 2013

Surgery "Must haves"

3 Posts in 2 days... I am on a roll I guess. After giving it some thought, here is my list of "must haves" after surgery.  Please note all brand names I mention are my own personal experience and am not receiving any kick-backs :)

At home: * week 1 another adult was a MUST for me to help with children.
1.  Water pik/flosser- A MUST have if you have braces and especially if you are having jaw surgery.  There is no way to explain how difficult it will be to get your teeth/mouth clean after the surgery.  I purchased mine after my braces were put on because it was taking me 30 minutes to floss my teeth each time I brushed... I am quite OCD with my teeth and it was making me miserable.  My orthodontist and her staff all commented on how I had the cleanest teeth of all their patients... it was truly the water pik/flosser- Again, I am not getting a single kick back from them I promise.  I had to wait a week post op before my surgeon allowed me to use it (didn't want to disturb the incisions.)  You can feel the food collecting in the splint and a tooth brush just can't get to it... it was my only relief.  Should your significant other try to lean in for a kiss they will appreciate it as well.
2.  Lap tray and a good transportable mirror- I combined these because together they made my life much easier, especially the first week.  If you don't mind eating away from the table, the tray will bring food higher than the typical kitchen table and make eating more comfortable....a mirror will allow you to get food to your mouth easier.  As you get braver and go out to eat, you will want to use this mirror so that you don't embarrass yourself by having your food pour down your chin, sticking to the corners of your mouth/lips, as well as, sticking out of your braces/splint, all without you realizing it... you will want a small mirror that can be propped up and used hands free.  At 4 1/2 weeks post op I am still using my mirror when eating.
3.  Cloth Diapers/dish towels- At least half a dozen. I went through at least 2 a day, 1 for drooling and 1 for "bib" while eating.  Around day 4, I began drooling like crazy... continuously plus the fact  when you eat you will get food all over yourself.
4.  Vaseline- yes- basic, cheap vaseline is all you need.  I had aquaphor, and carmex, all the things I used for chapped lips in the past and they did not help.  Vaseline was the only thing that healed the corners of my mouth from the irritation caused by the constant drool.  Your lips will get so dry over night and you will want the Vaseline.
5.  Hydrogen peroxide and q-tips- for your nose... it will bleed a lot especially the first week and q-tip with hydrogen peroxide will clean everything up with the least amount of discomfort. You won't be allowed to blow your nose ... this is the only thing that will help.
6.  Ice packs/heat pads.  Ice packs for swelling the first week, then later when the nerves and muscles start "twitching" heat and cold helps relieve the pain.
7. Blender- I have a braun stick blender/with food processor I bought several years ago.  This works great for pureeing, creaming soups and vegetables. This $70 blender/food processor did just fine compared to my friends' high end blender/processors.
8.  Boxes of 5 weeks I have gone through 2- 180 sheet boxes for drooling, eating, and nose bleeds.
9.  Cool mist humidifier was nice at night if you have one.

Not a "must" but helpful:  I found a flat tongue brush that actually came in handy after the splint was taken out ... I still had difficulty getting a baby toothbrush to the back of my tongue without gagging while brushing.  I also found this rubber, pointy tooth pick kind of tool that was helpful in getting food out of my braces/splint when I couldn't use my water flosser.  I had some baby food fruit with rice cereal on hand for little snacks .... not horrible but not something I "restocked."

Food: because eating took so much energy I tried to make sure everything I ate was high in protein, and nutrients with minimal empty calories. Being lactose intolerant limited my dairy options but I managed.
*Drinks with electrolytes- I was really dehydrated when I got home from surgery was 7 hrs so my mouth was extremely dry and you are so swollen and congested the first week or so, that you breath out of your mouth and that keeps your mouth VERY dry...  I preferred SOBE lifewaters because Gatorade has so much sugar.  There are other options out there just look before so you have it on hand when you get home from the hospital.
* Of course there are lots of recipes for smoothies and soups you can find online and cookbooks but I got to the point where I NEEDED food textures rather than liquid.  Homemade soups were no problem blending and tasting good .... flavor after blending seemed to only be an issue with prepackaged soups that had pasta and/or meats in them.  I am a huge tomato soup fan so of course they were not an issue....BUT in my childhood, tomato soup always meant grilled cheese...I was going crazy for a grilled cheese... that has yet to happen.
*Apple sauce of course...mixed it with different fruit puree's to make life a little more interesting.
*Greek yogurt and cottage cheese with pureed fresh fruit or Trader Joe's Fresh fruit preserves are really good in a pinch (blueberry is my favorite.)  If you are lucky you can find some granola without nuts or chunks of dried fruit to add to your yogurt... I ended up having to pick out nuts and fruit...that just made me mad cause I REALLY wanted to eat them.

 *Protein powders that you can add to fruit smoothies or milk. Atkins Protein drink- Milk Chocolate Shakes are very good....Thank you Wanda!
*I had friends who made me incredible soups so I will try to get recipes and their permission to post the recipes...Thank you Erin, Linda and Matt!

 Here are a few "textured" foods I found I could eat.
*Sweet potatoes... for those local- we have a local Deli- Village Deli at Cameron Village that has sweet potato fries that were soft enough for me to swallow without chewing :) dunked/combined with their Cheese Beer Soup.. excellent lunch!  After splint was removed I could eat their cream of mushroom soup... great choice as well.
*Creamed corn.
*Grits with cheese- plan to spend extra time getting your teeth clean :)
*Oat Bran made with Almond Milk- smaller grain than Oat Meal found it easier to eat.
*I found it hard to eat scrabbled eggs alone but if I added salsa the added moisture helped make it easier to swallow.
*Mashed potatoes- different gravy helped to keep this from getting old too fast.
*Refried beans with cilantro, cheese, chopped tomatoes
*when I got really hungry for fresh vegetables I chopped tomatoes, cucumber, peppers, black olives, with oil/vinegar/dressing, and pureed in blender- it was more of a salsa consistency but gave me the taste of fresh vegetables.

*Shaved ham- talking very shaved deli ham- didn't try this until around week 3 when I was really desperate but it worked well.. it was literally shredded into little pieces...thank you Melody!

*Angel hair pasta over cooked and chopped with marinara sauce.
*After a couple weeks with a little more feeling in my mouth I could eat Salmon, Tilapia and Cod.
*If you have a sweet tooth... cheese cake was pretty easy to swallow without chewing :)  Also when completely desperate a tub of icing works... Thank you Claire!

*Once my splint came off I was able to eat rice, finely chopped chicken and lasagna... before that it was too difficult.

*After week 1 when I had some feeling mixed with numbness inside my mouth, really cold things were actually painful. At 5 weeks still having this issue.

That is all I can think of right now.   For those preparing for surgery please let me know if you have any questions.

Sunday, March 24, 2013

4 Weeks and 4 days post op

My attempt to smile.  A natural smile is still impossible because of numbness.

I just realized I don't think I have shown you a side profile before or after ... when you have "chin issues" you never truly allow or show profile pictures.. after surgery this is where the most dramatic difference is seen.  I'll see if I can dig up a before profile picture... I know the surgeon took profile pictures... will see if he will share.

At 4 weeks and 4 days:
WEIGHT: still 10 lb weight loss total.  Appetite is definitely back so I don't anticipate any more.  Dr. encouraged me to gain some of that back... Ha! For those having this surgery your body truly needs a lot of calories to heal.  I will make a list of my favorite meals/snacks soon.
PAIN: I haven't had to take anything stronger than Ibuprofen since about day 8 for pain.  I did take Tylenol with codeine 1 time this week when I had really bad nerve pain around my chin and nose/cheeks combined with a horrible headache.   
SWELLING: significantly reduced..still a little around my nose and chin.  
NUMBNESS: First I must say it no longer feels like anything is sitting on my face :)
 I would estimate I have 70% feeling back around my nose/cheeks and upper lip.  I am still completely numb from my bottom lip to bottom of chin at jaw line.  I have no numbness under my chin.  My gums are still mostly numb. Outer gums are completely numb but I can feel a little behind my teeth on the top left side and behind my teeth on the lower right side when I brush... odd to me it is opposite sides.  The left half of my tongue is about 50% numb and the right half feels completely normal.  So, between numbness in my lips and tongue, my speech remains unclear even with the splint gone.
DROOLING: Significantly better!  I have graduated from a wash cloth to a couple of tissues on hand at all times to catch drool that occasionally makes its way down my numb chin.  More often it is a problem after I have eaten or drink something.  Better is the fact I can make something for my kids to eat without drooling in it.  Still need a mirror to eat.
NOSEBLEEDS: Continue to be a daily occurrence... mostly after I am up and moving around.  The more I move the more often it happens... nothing too bad just enough to make sure you always have a tissue handy.  Happy to say no major bleeding issues since my aneurysm 2 weeks ago today.
ENERGY:  I would estimate myself to be at 75%.  Because I work with infants and toddlers... even if I could speak clearly, I would have a tough time getting through a whole day of work without sitting for several 15 minute breaks.  I am not napping during day but definitely feel like I have to pace myself... not sure if this is a result of having 2 surgeries in 3 weeks or if I would feel this way after having just the jaw surgery.
HIGHLIGHT:  I was told by 3 different/unrelated people this week, I look significantly younger... not sure if that is a result of my new jaw line/chin and residual swelling or that I am actually sleeping at night without affects of obstructive sleep apnea.

Thank you to those reading and commenting!


"You shouldn't have eaten rocks!"

This is what the Resident said to me when I had to go in Friday morning with a broken splint. Thursday evening my splint broke in half.

My response to said Resident was "No one told me I couldn't eat steak, no nuts, nothing was ever mentioned about rocks."   He laughed though I am not entirely sure he believed I was being sarcastic.. I truly wasn't eating rocks or anything on the "no eat list."   I simply call it "Divine intervention."  My friend Linda made this amazing chocolate chip cookie dessert... I took some of the under baked portion, put it into a glass of Almond milk to make it even more soft ... and "ate small bites"... no chewing was involved.. it melted in my mouth, I promise. 

Apparently splints do occasionally break.  They try to make splints as thin as possible in the front to make it easier to pass a spoon or tooth brush through... they also pre-drill small holes in it for the wires.. it broke at a pre-drilled hole in the front. Since my bite was as it should be and I was 5 days out of having the splint removed anyway, they did not put a new one in (good since I had just seen the cost break down and the splint itself cost $1000- thank God for insurance!-certainly wouldn't want to pay for a second)  However, there are still entirely too many wires in my mouth.  I am to go to my scheduled Tues appointment for the removal of all the other wires/metal and x-rays.

 I had planned to provide you with great before and after pictures of splint removal process.. now it is just a little less "wow!"
Broken Splint.  It broke in front at a weak spot.  4 weeks and 2 days post surgery.
After splint was removed this is the metal that remained.  Though my diet restrictions remained the same, it is much easier to get food into my mouth.  Speech is a little clearer as well. 

Monday, March 18, 2013

What a week!!! 26 days Post Op... 3wks 5 days

First I want to say I am feeling great today.  I woke up with energy. A part of me thinks it is the cheesecake and chocolate icing I learned I could eat over the weekend- first real naughty pleasure since put on a liquid/pureed diet. My jaws are healing better than can be expected...healing so well I am getting my splint off a week early!!! Yeah- 5 weeks rather than 6 weeks. A week from tomorrow I should be able to chew once again :) NUMBNESS: My bottom lip and chin are still completely numb with an occasional itch or tingle.  I am beginning to have some feeling along the sides of my nose, however the "cheek bone" area under my eyes and along side my nose are still completely numb.  It feels very weird to put eyeliner on my lower lid.  I have about 60% feeling in my upper lip and about 70% feeling in my tongue.  Gums are still completely numb but I can feel when my cheek tissue gets caught on the wires from my splint.  My teeth tingle quite a bit.  Approximately 75% of my swelling is gone.  No bruising.  If people are looking at me and I speak in short phrase, they seem to understand most of what I say.  Drooling has finally decreased a little... I have graduated from needing a cloth diaper to a wash cloth. Made it to church for the first time since the surgery and ate my first public meal out in a restaurant with friends....I asked them before please forgive my table manners (slurping, food running down my chin, pushing food between my teeth, mirror on the table) and they said "no problem as long as you forgive us for taking pictures/video of your eating".... thanks Christopher :)

With that being said, last week I had the 2nd most personal scare of my life on Sunday morning, about 4am (2nd only to my sons accident a couple years ago,)18 days post surgery.  Apparently, I suffered a side affect that only affects approx 1 in 800 patients so they don't specifically go over this risk in the 5 sheets of risks you sign off on before surgery.  I woke with a ruptured aneurysm of my Maxillary Artery (this runs from the back wall of your sinus cavity to your Maxilla- explains why blood comes from nose and mouth)... I am not telling this to scare those who might be in the process of having this surgery but to let you know if it happens to you, which it most likely will not, it will be o.k.  FIRST: call 911 - apply pressure to the front of your mouth with a towel and your nose (pinch the very top of your nose.)  I woke with blood gushing out my nose and 2 seconds later it was gushing out of my mouth as well.... not really knowing where the bleeding was coming from was frightening.  Husband called 911- and my surgeon, ambulance got here in about 10-15 minutes.  My wonderful surgical team (Dr. Turvey and his Residence) were waiting for us at the hospital.  About 90 percent of bleeding was stopped in route to hospital, EMTs began pumping me full of fluids to replace the approx 3 liters of blood I had lost.  My surgeon requested a VIR (vascular interventional radiology- Arteriogram) to look at all my cranial blood vessels to see if there were any other weaknesses in the vessels- they found another that had not ruptured and repaired it requiring 48 hours bed rest following surgery.  I got to come home after 4 days - with strict instructions to stay stress/anxiety free with the help of other words keep the blood pressure down.  I was very tired for the first 2 days and now 5 days later am beginning to feel a little more like myself again.  I have a Dr. appointment tomorrow so I am hoping to be put off "24 hour watch" for chances of another bleed.  Apparently the stress of the surgery can weaken blood vessels... there is no way to predict who this will affect.... less than 1%.  Again, if your reading this post it most likely will not happen to you :)

With all that I am still so happy I went through with it.  If you are thinking of having this surgery and you can get to NC, I highly recommend Dr. Turvey and UNC hospital... the expertise, compassion and care I received was more than I could ask for....even the pureed/mechanically soft menu was good.


Tuesday, March 5, 2013

there's an Elephant sitting on my face!

Hello!  I am sorry for taking so long to get to this update.  Honestly, the first week was so intense I couldn't focus on anything beyond "the Elephant sitting on my face."


Warning!!:  pictures are self portraits on phone.

Today is day 13 since surgery.  I must say I was so happy with the care I received at UNC Hospital.  Because of my past experiences with University Hospitals, I was very nervous as to the care I was going to receive post op.  They were incredible. 

Day of Surgery:
I was supposed to check in at 6:30 am with surgery scheduled for 8:30am.  At 8:28am they were rolling me back for surgery ... during the prep procedures learned my surgeon actually planned for me surgery to take 7 hrs rather than 5 hrs as previously stated.  Before they rolled me into the OR, the anesthesiologist put something to "relax me" in my IV, they put me on the OR table, I remember seeing a funny "O" pillow on the table, and that is all I remember until they were rolling me into my hospital room.  Because it is a teaching hospital, apparently there was a whole team of Residents looking at my mouth in the hospital room but thankfully I have no memory of that.  One of my major points of anxiety was the fact that most of the people I heard from who had gone through the surgery had major issues with nausea following the surgery... happy to say I had absolutely non of that!  Another area of anxiety was how the first night would go.  The Chief Resident Surgeon who was assisting, told me before hand "the first night will be the hardest."    After I was settled in my room, Henry left to get the kids and get them settled at home- that was at 8pm.  So, I was left to the care of my nurse who had other patients to work with as well.  That night went smoothly- my wonderful nurse Erin was there when I needed her with compassion. I was pleasantly surprised she could understand my "speech."  My face was wrapped with a compression mask (jaw bra) and ice packs, teeth banded shut and felt like an elephant was sitting on it. My lower jaw was achy and my neck muscles were very sore.  Pain meds took care of that.  I had to push myself to drink water but knew it was part of getting to go home.

Next morning they got me out of bed and took me to the Dental Clinic for x-rays.  Wow!  I got to see immediate results of the surgery.  Maxilla and Mandibular advancement with Genioplasty- pulling the tongue muscle forward 1cm.   My new airway was truly amazing.  How was I breathing before?  While trying to eat breakfast, I realized my tongue was numb, as well as my cheeks, lips, and chin.  Basically everything from my eyes down to my jaw line was completely numb.  Throughout the day I was able to get up, walk around, and take in fluids on my own.  So, when my surgeon came to check on me (his team of residents visited me at least 3 times throughout the day) he remarked how well I was doing and asked if I was anxious to get home.  Yes, I wanted to get home to my bed and family so he agreed to release me that night so, basically 24 hrs later I was on my way home.

Day 2:
Woke up to see the children before they were off to school.  They were not sure what to do with me :)  They kept looking at me like they were waiting for anything to happen... my face to pop off or something.  I think everyone was amazed how large my lips were... even I didn't think they could get any larger.

Flowers I got to look at while recovering that first week when I could do was sit and breath through the discomfort.

Day 4:
My face is a constant faucet.  The drooling is completely at a new high. Nose bleeds are constant and annoying.  I actually needed to get OUT of the house.  Took a short walk down the street, the kids were outside playing with friends, when Christa saw me, she called out "Hey everyone come an look at our mom!"  Apparently I didn't scare anyone too much.

Day 6:
 This is the worse bruising I had on my face.... pretty amazing to me.  My arms are black and blue from IVs but my face has only a slight yellow hue around the jaw line and neck.  Sores on the corner of my mouth are bothersome but the constant drool makes it impossible for them to heal.

Friend Stephanie came and took me to a movie: Safe Haven ... was pleasantly surprised by ending, glad it ended differently than most Nick Sparks movies.  That is why you will notice a bit of eyeliner and mascara.

Day 7:
Check up with surgeon.  Everything looked great... not infection.  Weight loss: 10 lbs.  Nights have been very rough because of congestion and pressure.... did I mention "the Elephant sitting my face?"  Well, he's still sitting there.  Dr. suctioned my nose and mouth.  Didn't feel great but was definitely worth the discomfort when he was finished.  I could BREATH!!!!  Up to this point I was still feeling pain in my lower jaw and breathing was difficult because I couldn't breath through my nose and everything in my mouth was swollen, breathing through my mouth made my mouth uncomfortably dry.  No more JAW BRA!!! and 1 less band on my teeth during the day!!!! YAY!  Next Dr. appt. 2 weeks.

Day 9:  
Melody came and took me out for quick errands and a little girl time.  Nose bleeds have gotten much better :)

Day 13:

So, I received 2 emails over the past couple days requesting updates... See, I was just really waiting to see if anyone was looking at the blog :)

I promise the next picture I will make more of an effort to not look like a pale face!  This has to be the longest I have gone without wearing make up since I was 16 yrs old.  Loving my new jaw line and chin.  Numbness:  still numb from eyes down- as if you made a vertical line from the outer corner of my eyes all the way down to my chin and all the space in between.  My bottom lip and chin are completely numb they began "itching" a couple days ago so I am hoping this means feeling is coming.  The left half of my tongue is numb but tingling today so that is good.

                 Swelling: definitely decreased...this picture seems to make it less obvious.. angle and lighting I think.  The swelling you cant really see remains around my nose and mouth.  Drooling has slightly decreased.  Still can't make my lips seal so this is contributing to the drool factor.  Since about day 8 I haven't had to take the strong pain meds and sleeping had definitely gotten better.  The Diet however is getting OLD!!!

See, I rewarded you with the longest post ever!!!


Tuesday, February 19, 2013

8:30 AM

It's official.  Surgery start time is 8:30am.

Thank you Stephanie and Eric for taking the kids at 5:45 am and making sure they get to school and home.

Thank you as well to all my dear friends and family who fed me wonderful crunchy, chewy, "big" food over the past few days. 

Going to make dinner, do a couple loads of  laundry, pack my hospital bag and take a Valium (Dr.'s orders) so I can hopefully find my "happy place" and get a little bit of sleep before 5am.


Monday, February 18, 2013


O.K.  I am officially in "Ready mode" for this thing called Maxillomandibular Advancement or Maxillomandibular Osteotomy.
1. Surgical wires and hooks in place.
2. Extra work hours complete. 
3. 50th Anniversary Celebration for in-laws complete.
4. Birthday celebration for my son complete.
5. Baby Shower for good friends complete.
6. Post-surgery oral care items purchased.
7. Smoothy mixes, protein powder, sippy cup, jaw wrap purchased.

a close up of the surgical wire and hooks... note the sore on my bottom lip from the hooks ;(
Yes that is right, a hook on either side of each tooth.

Met with the surgeons last week.  Thank you Dr. Fisher for your calm and patient spirit.  I am ready to be on the other side of this thing I have been anticipating since June.
All I am waiting for now is the call from the hospital tomorrow telling me what time to be there on Wednesday.  One work appointment in the morning then I am officially on Medical Leave.