4 Weeks Later - How am I doing?

I'm talking again!

Had my Week Four follow-up with Dr. Li. I was hoping I'd be immediately cleared for wearing my rubber bands only at night, but he wanted me to go a few more days wearing them full time. That means a liquid diet until Saturday. Not un-doable, but still an exercise in delay of gratification.

On the plus side, I'm down to two (instead of six, followed by four) rubber bands, which means that I don't have to talk through clenched teeth. It is such a relief to be able to communicate verbally again. Friends don't have to be staring right at me to read what I'm trying to say and conversations don't have to pause while I frantically get my thoughts onto the whiteboard or angle a monitor in someone else's direction.

My jaw still isn't super flexible, so I'm a little stiff while talking (above and beyond the resistance caused by rubber bands) and I still have a nerve in my left jaw that gets tweaked when I make certain movements too quickly. That seems to be getting better each day, though, so I think it's just a matter of getting everything used to mobility again.

Other than the irritation caused to my lips by the surgical hooks on my braces, that's about the only pain I have now, and it's pretty infrequent. I'm off pain killers entirely.

I do think I forgot to mention canker sores and irritation to inner lips in previous entries. Basically, my teeth push more against my lips because the entire jaw has been moved forward. To add to that, before surgery, the orthodontist puts on these little hooks (not scary, sharp things, just little nubs to hook rubber bands onto), which are a little pokey. I think weeks 2-3 were when I had the most irritation - right when the stitches were dissolving, but not all of the healing was done. It's not so bad now, but having wax on hand is a must!

Numbness continues to improve - although I kind of feel like my left chin lost a little sensitivity when I started talking. Increased inflammation? My imagination? Who knows.

At any rate, starting Saturday I can "chew" again. That means I can add non-blended soft foods like eggs, well-cooked pasta, fish, etc. to my diet. My eating schedule for Saturday is already mapped out:

Breakfast: Red Hots at the Doyle Street Cafe (Red Hots are pancakes made with sour cream in the batter - they are incredibly soft and delicious)

Lunch: Macaroni and Cheese at Homeroom (I've never actually been here, but a friend recommended it for Mac and Cheese)

Dinner: Fish with mashed potatoes - Location TBD (Maybe a home-cooked meal?)

After that, THE SKY IS THE LIMIT! Ok, the limit is probably still pretty soft, but I am excited to able to use a spoon, for goodness' sake.

The thing I'm most excited about, though, is that I find that for the first time in a very long while, I am able to concentrate on what I'm doing and even multi-task when necessary. I really do want to write a post about why things like that are such a big deal for me, but I haven't quite worked up the courage yet to put it into words. Suffice it to say that I simply haven't felt like myself for many years now - I lost huge parts of my self-identity to sleep apnea (motivation, inspiration, curiosity) and now, even four weeks after surgery, I feel these pieces slowly resurfacing.

Part of the reason I've been loathe to put into words my experience with sleep apnea is that I'm wary of coming across as melodramatic. But sleep apnea has had a dramatic impact on my life, and the changes that I've seen and hope to see really are and will be life-altering.

Like I wrote on facebook yesterday:

For the first time in a very long while, I feel like I've made it to the end of the tunnel and, instead of discovering a sputtering florescent light illuminating the way to new series of catacombs, I'm standing out in the open air. I've got about 100,000 bad habits to unlearn... but it feels good to breathe.

Recipe: Pureed Carrot Soup

Woo - two posts in one day!

This was the first soup I tried in my personalized cook-book. It was delicious. I recommend making at least the full recipe (as long as you're confident you'll like it) and refrigerating/freezing single-serving tupperware with the left overs. Less work and as long as you make a few recipes a week, you'll have some good variety.

What you need

• 2 tablespoons unsalted butter, or the same amount of vegetable or olive oil
• 1 medium onion, 3 medium shallots, or 1 medium leek (white and light green parts only), chopped
• 2 tablespoons dry sherry or white wine
• 1.5 lbs carrots (about 8 medium), peeled, halved lengthwise, and sliced thin (about 4 cups)
• 2 cups low-sodium chicken broth or low-sodium vegetable broth
• 1 teaspoon table salt
• ground white pepper
• pinch ground nutmeg
• 1-1 1/4 cups whole milk
• 2 teaspoons minced fresh tarragon, mint, chives, or parsley

What you do

• Heat butter or oil in large saucepan over medium-high heat. Add onion; saute until golden, about 5 minutes. 
• Add sherry and carrots; stir constantly and cook until sherry evaporates, about 30 seconds.
• Add broth, salt, pepper to taste, and nutmeg to saucepan; bring to boil. Reduce heat to simmer cover and cook until carrots are tender, about 20 minutes.
• Ladle carrot mixture into blender. Add 1 cup milk; blend until very smooth. Return soup to saucepan; cook over low heat until warmed through. If soup is too thick, stir in additional milk to thin consistency. Adjust seasonings.
• The tarragon, mint, chives, or parsley are meant as garnishes - you can either skip them or toss them in the blender with the soup!
• Soup is good in the refrigerator for about 3 days

Day 3 - First Full Day at Home Retrospective

Just lost this ENTIRE post when it mysteriously got overwritten with the text from a previous post. I feel like I've come of age as a blogger. AAAANYWAY, I will attempt to recreate the magic.

I know it's taken me four weeks (has it really been four weeks??) to get to the third day after surgery, but I've been feeling increasingly productive/social over the last few weeks, so I've been applying my newfound energy to other endeavors. Not to say that I'm not still tired/sleepy sometimes (I still haven't quite found a groove in my sleep schedule)... but more on that in my week four (!!??) update.

Okay, Day 3 Post-Surgery (Friday, Sept. 2nd):

I hadn't struggled with nausea at all in the hospital, but on my first morning at home I felt a little queasy. To be fair, in the hospital, they'd first supplied me with anti-nausea medication and then with antacids... plus I'd been eating mostly clear liquids. But on that Friday morning I was hungry but nothing sounded even remotely edible. I had some apple juice and an Ensure with my medication, but they tasted disgustingly sweet and the idea of drinking enough to make me full sounded terrible.

Enter the Breville Juicer:

Breville BJE200XL 700-Watt Compact Juice Fountain 

My parents bought me this sucker before the surgery and I cannot recommend it (or something similar) more highly. My dad peeled and pitted a mango, turned on the juicer, dropped in the fruit and voila! Real food! Fresh fruit is sweet, but it doesn't have that same cloying sweetness that bottled juices and pre-made smoothies have. As soon as I started drinking fresh juices, smoothies, and soups, I felt infinitely more human and my appetite stabilized.

While I'm promoting home appliances - I also needed to purchase a new blender before my surgery. I wanted something with good reviews (I wasn't interested in combating chunky smoothies post-op), but wasn't up for spending the big bucks for a mega-blender. I settled on the KitchenAid 5-Speed Blender and have been very happy with it so far:

KitchenAid 5-Speed Blender

Also on the menu that day was a delicious Pureed Carrot Soup (recipe to follow soon). Even pureed to smithereens, home made soup is about 1000% times more food-like than boxed soup, no matter how tasty the boxed soup. I think that eating home made-meals (fresh fruit juice, home-made smoothies and soups) were key to maintaining both my weight and sanity this past month. It upped both the tastiness and variety of foods I was eating, meaning I stayed interested in food - and healthy food at that!

Having people around (particularly that first week) to help prepare meals for me was vital. My parents stayed in the area for a week after surgery and boyfriend, though busy building us a house (!) made sure he always left me with a breakfast smoothie and soup in the fridge when he went off to work. I had a few friends stop by to make soup for me as well, which was so lovely.


Anyway, enough about food (for now). How was I feeling?

Day 3 was pretty much a series of intense naps interspersed with meal/medication breaks. That being said, I was still way more active than I thought I would be at this point. I got out of bed for my meals and I think I surprised a friend by being up and "chatting" with my parents when she came by to drop off some beautiful sunflowers. I even took a little walk around my back yard with my parents and posed for a chipmunk-cheeked photo op.

This is how I look with a rectangular face.

I was still on Vicodin at this point and that took care of most of the jaw pain. Icing took care of the residual aches. The hospital had sent me home with ice-packs and an ice-pack sleeve (which was GREAT - basically a long tube of fabric you could slide the ice-packs into and then tie around your head). The ice-packs were refillable with ice-cubes, but we ended up getting some gel packs. They were easier and less messy.

So jaw pain was under control, but this was the point at which my neck pain was bothering me the most. Also, though my sinuses weren't excruciatingly painful, they definitely felt like they were going to airlift me into space. Showers helped a lot with both issues, so I ended up taking three... which prompted me to purchase a shower cap... which I proceeded to use non-comedically for the first time in my life. (In retrospect, I am seeing so many missed photo opportunities...)

I guess I'd summarize my general state of being as "Groggy, achy, but generally upbeat."

I think I covered everything I did in Draft 1. Even this PS:

P.S. Ground pills are disgusting. One of my friends made a lot of fun of me for complaining about this, in particular, when I'd just paid someone break my face, but seriously. There are some Rx's that just shouldn't be allowed out of their protective coating. I even resorted to mixing them with prune juice because the strong flavor managed to overpower my meds somewhat. Desperate times call for desperate measures!

3 Weeks Later - How am I doing?

Let me see...

Shall we temporarily ignore the fact that the hospital had an out of date number for my insurance ID code? It's only a $91,000+ charge. No sweat. Right?

Yes. Let's ignore that for now.

Aaaaaaaaaanyhow.

On Monday I had my weekly follow-up appointment with Dr. Li. Everything is looking good and he loosened my rubber bands once again. My nose and sinuses are healed to the point that I didn't require any clearing. The most exciting part, though, was that it signified the beginning of my one week countdown to being able to really talk.

Next Monday, my rubber bands come off and I only have to wear them at night. At this point, that is feeling like a pretty momentous occasion.

Confession: I did quite a bit of research about Maxillomandibular Advancement Surgery and spoke to a number of doctors before deciding that it was my best option. I read several blogs, flipped through some of the research, etc. That being said, I didn't really realize until my pre-op appointment that I wasn't supposed to speak for four weeks. I knew I'd be on a liquid diet for circa six weeks, and I knew that I'd have rubber bands to keep my jaw closed, but I figured that with the progressively loosening bands I'd be back to talking in no time. So, when I was told at my appointment about a week before surgery that, even though I'd be physically able to talk, I was advised not to for four weeks... I was a little surprised.

In retrospect, it was something I should have asked about. On the other hand, I was actually pretty okay with not knowing it way in advance. It was just another thing to dread that wouldn't have been worth stressing over.

In the end, not being able to talk hasn't been nearly as bad as I would have made it out to be, had I given myself the time to blow it out of proportion.

Still.

I miss being able to talk.

A lot.

So I am a little excited about being able to hold a real, adult conversation again without scribbling on a white board. If this had been a longer term/permanent issue, I certainly would have invested in a portable electronic device either for typing, text-to-speech, or scribbling notes. As it was, my mildly (ha) retro equipment served me fine. (Yes, yes, yes - it's appalling I don't have an iPad or smart phone. Blah blah blah.)

Pain levels have been good - very consistently tapering off. I'm taking Ibuprofen once or twice during the day and once before going to sleep. After week two's follow-up appointment I developed some pain in my left jaw/ear. I think it was caused by my new found ability to move my jaw laterally. Anytime I shifted my jaw slightly to one side, it causes a considerable amount of pain. For obvious reasons, I try not to do this.

For a few days I had a consistent ache in/around my left ear, but Ibuprofen, warm showers, and gentle massage of the surrounding muscles helped. I had one bad night where the pain kept startling me awake when I inadvertently moved my jaw, but for the last few days, both pain and sleep have been much better.

Sleep has been good for the last week, as far as I can remember, besides the one pain-interrupted night. One thing I've noticed over the last few days, though, is that I'm having trouble falling asleep. I'm feeling very jazzed up when I try to go to bed, even if I'm feeling quite tired. I'm trying not to nap, I'm trying to confine what little caffeine I'm consuming to the mornings, and tonight I'm going to throw in some relaxing music as well.

There is still some numbness in my chin and lower lip, but there is now some feeling in all areas, even if it's somewhat muted. Some parts seem to be recovering more quickly, but I'm feeling more confident that Dr. Li is right to think I'll recover all sensation. My upper gums continue to be just about completely numb, but I've been told that it will be the last area to return to normal.

As for eating, I've actually managed to maintain my weight pretty successfully. I intentionally put on a few pounds before the surgery and lost a bit of that weight, but have otherwise remained steadily in my normal weight range. I think the trick has been to keep a variety of food options around at all times and to make sure I'm snacking/eating throughout the day.

This week has been a little rough on the solid food jealousy front, though. For the first two weeks I was blithely content with my smoothies, soups, and milkshakes... but for the last few days I've felt like Pavlov's dog whenever the refrigerator door opens. I can't help but imagine what crunchy goodness my boyfriend might be obtaining.

Right now I am dreaming of a breakfast burrito. Is it too much to ask for? So soft and delicious!

My energy levels definitely feel like they are improving - though I had a little bit of a setback after overdoing it last week. I was relatively active last week and over the weekend I attended a wedding ceremony and had a house guest. Though I enjoyed my weekend immensely and neither the wedding nor the house guest were particularly demanding, there is most certainly something different between vegging out/relaxing on your own and maintaining attention on other people.

After a few nights and days of recuperating, though, my motivation, energy, and attention span all seem to be increasing noticeably. Instead of watching TV or movies, I find myself more interested in working on little projects or having a friend over for a bit.

A friend recommended I keep track of my moods to see how having a good night's sleep for once affects my outlook on life.

My mood today: Grumpy for about ten minutes this morning, then mostly optimistic, upbeat, and productive. Weird.

Dr. Li says this is just the beginning. I hope he's right with all my heart.

Surgery Tip #2: Put together a collection of recipes ahead of time

Or, better yet, have a really really excellent, kind, and thoughtful friend put it together for you!

A close friend of mine sent out a call to all our friends and colleagues for their favorite smoothie, soup, and cocktail (for after I was done with Vicodin!) recipes and then put them all together into a cookbook of straw- and squirt bottle-friendly foods.

Have a friend facing a liquid diet? Make one of these.

Best. Gift. Ever.

(remember to change the name...)

My birthday was just a few days before surgery, and it was the perfect gift - everyone who submitted a recipe also wrote me a little note to go along with it. Not only was it incredibly practical, it also made me feel truly supported by my community of friends.

I'll be posting some or all of the recipes my friends shared with me on this website, but I also recommend that you send out the call for recipes (or have a friend do it) to your friends and family. It's a great way to make sure that you have a diverse diet, even if it's all through a straw, and I found it was also a great way to let people know about the surgery I was about to undergo without spamming everyone with a lot of pre-surgery information.

Trust me, you'll be happy you're not flipping through cookbooks once your jaw is rubber-banded shut.

And THANK YOU again, to the lovely folks who contributed to this project, particularly to one who organized it and the one who helped her put it all together. You have no idea how much more pleasant the last three weeks have been because of you.

Day 2 - Going Home Retrospective

After two nights in the hospital, I was discharged at around 10 am on Thurs, September 1st. My last IV was removed, I was allowed to change into my clothes, and had another delightful breakfast of broth, juice, tea, and jello (or maybe it was a sorbet?). The hospital staff filled a paper bag with giant syringes and tubing so that I might eat and medicate at home, as well as some post-operative care instructions and a pill crusher.

I was able to walk out of the hospital, which felt good (if exhausting) and then we drove to Dr. Li's office. Costa met us there, so we were a nicely sized party for my first post-operative appointment. We were shown right into a room and, once there, Dr. Li cleared my nose with a little suction tube (an admittedly unpleasant, but effective procedure). Along with his four rules, he suggested that I try to irrigate my sinuses regularly to help keep sinus output from building up. Also, since tooth brushing, even on the outside, is out of the question for the first few days, I was instructed to rinse with salt water frequently to keep my oral hygiene up. 

Side note: I had purchased a Waterpik prior to surgery, which turned out to be pretty helpful in getting food out from between my teeth. Word to the wise, though, be careful of stitches, particularly in the first few days. 

I showered when I got home, which was lovely after being in the hospital and also helped keep my nasal passages cleared.

Courtesy of being hardly 48 hours post-surgery and being regularly dosed with Vicodin, I slept a lot during my first day at home. I was pretty groggy and had only enough attention span for TV episodes that I'd already seen. We wrote up a little medication schedule, which I highly recommend, to keep on top of daily (my regular medication), 4-hour (Vicodin), and 6-hour (antibiotics) doses.

My first few meals at home were pretty basic. I think they consisted of vanilla Ensure Plus, Trader Joe's Butternut Squash Soup, and some Odwalla juices.

I very quickly started to dislike how sweet pre-made juices and drinks were and the next day I made the switch to primarily homemade meals and freshly squeezed juices. (I'll write more about this!)

My first night at home was a little bit long - my neck was sore from sleeping at strange angles, and I consistently woke up around the time that I was due for another round of Vicodin. I ended up sleeping on the couch for a lot of that night just because I was sleeping so lightly and because it was easier to keep somewhat propped up.

That being said, I was still doing remarkably well considering I was fresh out of the hospital. Puffy and sore, but in good spirits. It felt great to be back in my own home with my boyfriend and dog (who was VERY excited to see me) and no longer hooked up to any tubes or wires.

Day 1 - Day After Surgery Retrospective

On the morning of August 31st, the day after surgery, I was "freshened up" (the hospital's euphemism for a sponge bath), changed into a fresh hospital gown with some pajama bottoms, and was pronounced awesome enough to move out of the ICU (That is the technical term for not having a fever, having pain under control, and drinking enough fluids.)

That meant I got to get up and go pee for the first time and take off all those sticky electrodes they sneak under your hospital gown to monitor heartbeat, breathing, etc. Having a catheter was something I was not looking forward to but, in the end, it was one of many things that I just couldn't muster the energy or sense of indignation to care -- modern medicine is great that way. And in truth, it wasn't until they removed it that I could even tell it was there.

So, I went from this:

Notice the many many tubes and wires.

To this:

Notice the many fewer tubes and wires.

It also meant that I got a "real" meal for the first time since the evening of the 29th. I didn't get any pictures of my meals, but they essentially consisted of: Beef or chicken broth, a little plastic carton of juice, warm water for tea, and some jello.

Doesn't this meal look filling? Meal time actually made me really happy. 

I am a simple creature.

All of which I consumed using a giant (needle-less) syringe with a helpful tube at the end:

One for food and one for meds. SO much easier than a straw for the numb-of-lip.

The jello was incredibly difficult to get into the syringe, so I resorted to melting it with a bit of my tea water. I am nothing if not resourceful... and determined to eat my dessert.

Anyway, the day after surgery was a series of naps and brief visits with my parents, Costa, and a good friend.

Since the previous day I had been wearing leg circulation pads, which wrapped around my calves and contracted and expanded to keep blood moving in my lower extremities. Once I started to be on my feet a little, they removed them. I was encouraged to get up and walk around as much as I felt able, so I did a few treks down the hall and gradually upped my path to a full circuit of the wing. I had to roll around my IV stand, but it was nice to get out of the bed.

Being up and about also means that they start making you pee in an upside-down hat-shaped container so they can measure your liquid intake/output. (Sorry for all the pee-talk, just though interested parties might want to know... I'd never stayed overnight in a hospital before!)

Pain again was pretty manageable for me. My throat and ear bothered me the most at this point. The throat pain, again, was residual from the breathing tube. The ear pain was the result of general congestion and stretching/swelling caused by the surgery. I started having pre-sleep falling sensations which weren't fun, since I inevitably would jerk my head and tweak my jaw. Also, this is when my neck started really hurting - probably from sleeping at funny angles so as to keep my cheeks from banging around on the pillow. Ice and painkillers definitely helped - so say yes to them if you're uncomfortable.

I found Stanford hospital beds to be pretty comfortable as far as hospital beds go. They are designed to minimize bed sores, which is a little surprising at first (especially to any guests foolhardy enough to sit on the edge of your bed), since various portions of the cushion inflate and deflate sporadically. 

The staff also switched me from an intravenous to an oral pain killer and I was able to start taking my usual medications again - some of which they had liquid forms of and some of which they did not. There is a reason we generally swallow pills whole. Bleh.

One thing I found very odd was that the hospital happily provided me with all my prescriptions EXCEPT birth control. So ladies, you can leave any other Rx at home, but if you want to keep taking your BC on a regular schedule, you have to have someone smuggle it to you.  One of my nurses may or may not have been kind enough to crush it for me (wink, wink), but if you don't feel comfortable asking - just have a friend or family member use the pill crusher they leave near the bed and mix it with some juice in your medicine syringe. This is frowned upon by the pharmacy, but smiled upon anyone with some common sense. 

(EDIT: Before you start self-medicating - check with your surgeon about taking your birth control after surgery. I had already asked Dr. Li whether I could continue taking birth control and he told me it was not a problem. HOWEVER, I take the mini-pill: a progestin-only form of contraception, which does not carry as high a risk of blood clots as estrogen-based birth control. Your doctor's instructions will likely vary based on your doctor's philosophy, the type of birth control you're taking, and your overall health.)

Dr. Li visited me at some point during the day and asked if I felt like going home the following morning. My response was a resounding thumbs up, so he told me he would have me discharged the next day and that I should stop by his office on my way home.

So, one more night in the hospital - this one a little more quiet with just one roommate. All of the nurses continued to be unbelievably nice and responsive, and I got another surprisingly good night of sleep, considering the intermittent interruptions for dosing with pain meds and antibiotics.

I'll try to think if there was anything that really surprised me about my hospital stay, but the only thing I can think of that really didn't match my expectations was my boredom level. I guess I had thought I'd be pretty bored bumming around the hospital for two days straight, but I didn't even once flip on the TV or try to fumble through a few pages of a novel. I was pretty exhausted and my attention span was just long enough to visit briefly with my loved ones. So instead of dragging, the time went by pretty smoothly.

I'll post about my first few days at home and start adding some smoothie and soup recipes that have been my much-beloved sustenance. Also, I'll be working on a few posts about how I (finally) got diagnosed with Sleep Apnea and why I chose surgery over other treatments. I feel pretty strongly about the last couple subjects, so it might take me awhile to organize my thoughts.

2 Weeks Later - How am I doing?

Not bad, is how!

I've managed to keep my weight up by perpetually eating fresh, tasty smoothies and soups. I've managed to keep my spirits up by spending time with friends and laughing as much as the stitches in my mouth allowed.

On Monday I had another follow-up appointment with Dr. Li and all seems to be going well. He loosened my rubber bands, so my jaw is slightly more mobile. However, it had the unexpected side-effect of upping my pain levels a smidge. Mostly I think it's because I've been a nighttime teeth grinder/clencher for many years now. I believe that with the increased freedom, my jaw is going a little crazier at night, making for some achier mornings. Ibuprofen still seems to be doing the trick, for the most part though, so other than a few painful tweaks of my jaw, it's been okay.

My sleep has been a little disrupted from the increased achiness, but my energy levels still seem to be increasing a little every day.

Dr. Li gave me the go ahead to talk a little, but before surgery I was told to give it the full four weeks before talking, so other than a few words here and there, I'm trying to stick to my relative vow of silence. Just two more weeks! Communicating via the written word and pantomime hasn't been as bad as I thought it would be. A friend of mine bought me a small whiteboard before surgery, so I pretty much just carry that with me everywhere I go. It's made me a little more selective about which thoughts I think are worth communicating, but it hasn't stopped me from having real conversations with my friends and family.

Also, if I want to be able to communicate with someone without them having to check my whiteboard every three seconds, I found a few hilarious online text-to-speech programs. A quick Googling will give you a slew of options. I've used this one a bunch: http://www.oddcast.com/home/demos/tts/tts_example.php. My favorite accent is Veena's.

For those who are farther away, I have Pidgin, where I can talk to my friends on gchat, MSN, and yahoo.

Skype has been a great way to keep in touch with my parents after they left last week. We've been video chatting - they talk and I type my responses back. It feels more like a real phone call than instant messaging does, so I really recommend it as a way to touch base with those you're used to calling on a regular basis.

I'll try to get up a Day 1 Post-Surgery retrospective tomorrow.

Surgery Tip #1: Follow Dr. Li's four rules

Dr. Li has four rules for post-operative recovery:

1. Don't blow your nose.
2. Drink lots of water.
3. Get up and walk around.
4. Practice deep breathing.

Rule No. 1 is the most annoying. A lot of the surgery is done via the sinuses and many people undergoing MMA surgery will also be having some work done on their septum. That makes for a nose that you'd really really like to introduce to a Kleenex. The good news is that on the way out of the hospital, you stop in at Dr. Li's office and he cleans out your nose. In between nose-cleanings by Dr. Li at your once-a-week followup appointments, I highly highly highly recommend you do some form of sinus irrigation.

Sinus pain was the most pervasive discomfort I experienced once I was out of the hospital and keeping my nose and sinuses cleared and moisturized was a life-saver.

I used this:

NeilMed Sinus Rinse Kit

But any form of Neti pot should do the trick. I had never irrigated my sinuses before this surgery and was pretty loathe to do it (seems kind of gross and uncomfortable to pour salt water up your nose), but once I got going it really wasn't bad and it helped. A ton. So do it. Really.

Rule No. 2 is one of those sage pieces of advice that everyone gives you, making it really easy to ignore. Take this one seriously for once. It really is good for recovery, and with your mouth rubber-banded closed getting enough food and liquid can take a little bit of persistence. I just carried around a squeeze bottle of water with me everywhere I went and tried to be sipping on it all the time. It also helps with sinus pain, so double win!

Rule No. 3 is key. Getting up and out of the house will make you feel like a human being, even if it's just to walk around the block. It also really helped my sinus pain (sorry, broken record here) to get some fresh air and be upright and moving. It's also not particularly good for the body to sit around as a lump for too long. If you mope around the house the entire time you're convalescing, you'll a) feel like a lump and b) it'll be way more difficult to get back into normal shape when you have to get back to your regular life. ALSO, I had lots of tight muscles (particularly in my neck and shoulders) after a couple nights in the hospital. Walking helped get everything back to being nice and limber.

Rule No. 4 is probably good advice for everyone, but I took it to heart after surgery. I keep meaning to ask Dr. Li why, specifically, deep breathing made his four-rule list, but I can think of a number of reasons it's a good idea. The first is the boring (but extremely valid) biological reason - oxygen is good for your body, particularly when it's recovering from some sort of injury or stress. The second is that I found that it helped keep my nasal passages clear if I took slow, deep breaths. The third reason is that it's the easiest way to tone down stress levels, particularly if you have a claustrophobic moment when it feels frustratingly difficult to breath.

I actually haven't been that stressed out at not being able to breath through my mouth. For the most part, even with some congestion, it's been way easier to breath through my nose than ever before. Ironically, the only moments where I've had brief moment of breathing panic were during some of the first sinus rinses I did. If, for whatever reason you do start to feel a little edgy about air - stop and take a slow, deep breath. If you need to, take that breath through your clenched teeth. It won't be quick, but you'll get the air you need!

Day 0 - Surgery Day Retrospective - 2 of 2

Here I am in Pre-Op:

Hurrah Jaw Surgery!

And here I am on the other side of surgery in the ICU:

One unexpected side-effect of surgery was the emergence of compulsive thumb-upping behavior.

You'll note my shoulders are bizarrely bare in the ICU picture - this is because as soon as I arrived in the ICU I began (to the horror of the nursers settling me in) to sweat profusely. And I mean profusely. Not a fever - just my body's reaction to stress, I guess. Happens to me sometimes after stress dreams too. Who knows? I was pleasantly sedated enough that I didn't really care one way or another. The plus side is that, in addition to airing me out in general, they took my socks off, so the whole world got to see my AWESOME nail polish.

See? Nurses in the ICU probably don't see bare feet that often... It was the highlight of their day.

And just so you can get an idea of the swelling I experienced (pretty minor, considering the intensity of the surgery!), here I am on Day 2:

See - there's that damn thumb again! 

On the other hand, my swollen cheeks and numb chin/lips made it virtually impossible to smile.

To all those not under general anesthesia for the duration of my surgery, the procedure took about 5 hours, from the time I was wheeled into the operating room to the time I was brought into the ICU. For me, surgery seemed to last approximately two whole seconds. At that point someone told me that surgery was over and I could feel myself being rolled to the ICU. I could tell that my mouth was rubber banded closed and it felt as though my chin and lips had been pumped full of Novocaine (I guess having facial nerves moved around will do that to you).

I know a lot of people struggle with coming out of anesthesia (experience disorientation, anxiety, nausea, etc), but I woke up ridiculously quickly and painlessly. My parents and Costa headed to the ICU as soon as they got the phone call from Dr. Li saying I was done with surgery, and by the time they got there, I was alert and could communicate with them via pen and paper. Not to mention my incredibly expressive thumbs. 

In between visiting times, I listened to music on my mp3 player and slept A LOT. Once I was up to drinking fluids, they started me on water and then juice... that part was tricky because my lower lip and chin was COMPLETELY numb. 

Besides a sore throat (the only evidence that a breathing tube had been used that I was ever aware of) and some general achiness, my pain was pretty under control during my entire stint at the ICU. My nurse, Jen, was absolutely phenomenal. She was warm, responsive, and very very funny - which made my stay over night in the ICU pretty pleasant. Between Jen, ice packs tied around my face, the humidifier keeping my nose clear, and the morphine, I was pretty content. There was some noise from other patients and from the hair-trigger vital sign alarms that go off when jostled by the butterfly passing by the ICU window... but that's to be expected. I was tired and comfortable enough to get a reasonable night's sleep.

I was very surprised by how un-miserable I was after surgery. I know that some people might have a rougher time of it than me (the nurses were all impressed by how little swelling and bruising I had, and by how quickly I recovered from anesthesia), but for anyone considering the surgery - the experience really isn't as bad as you think it's going to be. 

Since I did great overnight and was already drinking lots of fluids without issue (besides spilling), I was released from the ICU the following morning and relocated to a normal hospital room.

Day 0 - Surgery Day Retrospective - 1 of 2

D-Day for surgery was Tuesday, August 30th. Just for fun, my insurance pre-authorization didn't actually come through until Friday, August 26th, when I resorted to arriving at the student health insurance office before it opened and sitting there until the case manager saw me personally. The delay was, in part, due to the fact that my academically-based health insurance begins its coverage year on August 15th and, in part, due to the fact that I had been authorized for the surgery during a previous coverage period. The case manager had submitted the authorization as a renewal, and hadn't realized that the maximum time between renewals had elapsed -- it needed to submitted as a new pre-authorization.

Surgery was scheduled for 8:45 am at Stanford University Hospital, and I was asked to arrive two hours ahead of schedule - which meant an early morning from the East Bay. I'd received three calls from the hospital the day before.

The first was to preregister me for surgery, which would shorten the amount of time I'd have to spend on paperwork in the morning. The man I spoke to (Jack) was incredibly helpful and quickly had me set up with my emergency contacts and general information.

The second call was from a nurse with some instructions for surgery (i.e. No eating or drinking after midnight prior to surgery, reminding me when and where to arrive, etc.)

The third call was from my anesthesiologist, which I hadn't expected, but was actually quite reassuring. Anesthesiologists aren't people you think of seeing much of (since their job is to keep you unconscious), but then again you're putting a considerable amount of trust in their hands (their job is to keep you unconscious...) My anesthesiologist (whose name I will look up), was incredibly personable over the phone, asked a bunch of questions about my previous experience with anesthesia (wisdom teeth) and told me a little bit about what to expect the following morning.

All in all, I arrived at Stanford University Hospital feeling pretty confident about things.

Upon arrival, I checked in. It was a pretty fast and painless process. I signed some waivers (yes, letting someone pump you with anesthesia and then muck around with your jaw carries some risks), assigned someone (my mom) to make medical decisions for me in case I couldn't make them for myself, gave them numbers to call for surgery updates, and got ID and allergy bracelets.

This is a good place to mention that I was incredibly impressed with the hospital facilities and staff from beginning to end. Everyone and everything was comfortable, friendly, warm, and professional, with a mind to reduce the stress inherent in the process for patients and family alike.

In the waiting area, there is a patient update screen where every patient is listed by number with their current status (e.g. Patient in the Facilities, In Surgery, Surgery Completed, etc). Soon enough, my status changed from Patient in the Facilities to Pre-Op, and I was escorted to the Pre-Op area to exchange my clothes for hospital gear. Then an overview of my health history with the nurse (they make you confirm your name and date of birth about every three seconds which, while somewhat repetitive, at least made me feel like they were unlikely to accidentally amputate a foot.)

My parents and boyfriend were allowed to come wait with me after that. Dr. Li came to check in with me and answer any last minute questions and then the anesthesiologist arrived to prep my IV. Cue sedatives, at which point things begin to blur a bit around the edges... but I remember waving goodbye to Costa and my parents and being wheeled off to the operating room. The last thing I remember is being lifted onto the operating table.

Vital Signs

So, I may or may not have dozed through quite a bit of yesterday (I guess two guests and my longest walk yet on Wednesday was overdoing it a bit), but I'm working on a post about the actual surgery and how I fared in the days afterward.

Since that's taking a little time, I thought I'd write a little bit about how I'm doing right now - It'll also give you an idea of some of what it's been like so far.

Pain

My sinus pain - which has been, by far, the most unpleasant and painful part of this surgery - has pretty much gone. In the mornings I feel some pressure, but a shower or some sinus irrigation (Oh yes, I will be talking about this) seems to do the trick.

The muscles under my chin are still sore if I stretch them and tender to the touch, but don't cause me any persistent pain, and the achiness  in my cheeks and around my jaw is pretty manageable with ibuprofen. I'm not even taking pain killers on a regular regimen anymore, which seems like pretty good progress to me!

Numbness

One of the weirdest parts of this surgery is the massive amounts of numbness that can follow it. One of the first things Dr. Li mentioned to me when I woke from surgery was that he'd had to dissect and move the nerves innervating my chin and lips, so that I could expect to feel very numb there for some time. He assured me that all the nerves were still intact, however, so I should begin to regain sensation over time.

My upper lip pretty much has full sensation, which is great, since all of my food intake is done via drinking! So far, the right side of my chin and lower lip have begun to regain quite a bit of sensation. Feeling started as these tiny, pinpoint bursts of tingling that the neuroscience in me couldn't help but imagine as a sad little action potential trying desperately to get a signal back to somatosensory cortex. Now I can feel pressure and temperature pretty well - just a little numbness remains.

Annoyingly, my left side has persisted at being insensible. Every once in awhile some synapse rallies its forces and I feel something there, but I'm pretty sure you could poke me with the sharp end of a pencil in my sleep and I wouldn't notice a thing.

Sleep

This, obviously, is the part I'm most interested in and trying the hardest to not be anxious about. Sleep deprivation has had an increasingly large impact on my life, particularly in the last 2-3 years and I've taken, I think you'll agree, a pretty drastic step to get a real night's sleep.

So far, It's really difficult for me to tell whether my sleep apnea is gone. I never snored and I never actually realized that I wasn't getting a good night's sleep until I took a sleep test at Stanford a year and a half ago. Because of pain and nasal congestion, I haven't been a very sound sleeper in the last few weeks, though that seems to be getting better every night. And, unsurprisingly after major surgery, I've been a little sleepy of late.

What I CAN say is that, when my nose is not congested, I can breathe much, much more easily than I could before. So, I'm feeling incredibly optimistic on that front. Also, the statistics are with me. About 95% of people who undergo this surgery are successful at reducing their apnea to satisfactory levels.

Spirits

My spirits throughout have been incredibly high. Everyone, from my doctors and nurses to my friends and family, has been incredibly supportive. I'm not nearly as comatose or bedridden as I'd feared, so I'm enjoying a little time to relax and recuperate and catch up with friends via instant messaging and whiteboard.

Later today or tomorrow I'll get up my first post about my surgery experience. Thanks for reading!

1 Week Later - How am I doing?

So, I've meant to join the ranks of the jaw bloggers (yes, there are a shocking number of play-by-play accounts of preparing for, enduring, and recovering from Maxillomandibular Advancement Surgery (MMA) aka Maxillomandibular Osteotomy, aka Bimaxillary Advancement, aka Orthognathic Surgery) because it was immensely helpful for me to read first-person patient accounts when deciding about the surgery and because I thought it would be a good way of updating friends and family about how I'm doing.

If you are asking, What in the hell is Maxillomandibular Advancement Surgery?, you can check out an informational page provided by my actual surgeon: Dr. Kasey Li

He even has a podcast interview about the procedure!

For now, i just wanted to give a quick update on how I'm doing, and then I'm planning on going back and writing a little bit more about what my experience has been like so far.

I had the surgery on Tuesday, August 30th - about a year and half after (finally) being diagnosed with severe Sleep Apnea. The surgery was conducted at Stanford University Hosptial by Dr. Kasey Li, who specializes in sleep surgery and is one of the (if not the) leading surgeons for MMA surgery in the country. I believe actual surgery time was about 4 hours, and everything went as planned.

I stayed in the ICU overnight and was moved to a regular room in the morning. After one more night in the hospital, I was discharged and, after a quick stop at Dr. Li's office, came home.

I'm doing really really really well - I tried not to think too much about the procedure ahead of time (those of you who clicked through to the surgery description will understand why), but vaguely entertained the suspicion that the experience would be incredibly awful, but then, eventually (months of recovery later), over.

Instead, the surgery was exhausting, disorienting, and not particularly fun... but all in all... not that bad. I've certainly been uncomfortable, unhappy at times, and in some pain, but not NEARLY as much as I worried. I'm gaining energy day by day and have even had a few friends come over to visit. I'm still pretty easy to tire, but Dr. Li wants me up and walking around when I feel like I can, so I've tried to do some good circuits around the neighborhood.

I'm off (liquid!) Vicodin and on (liquid!) ibuprofen, which is good - I feel a bit more like an actual human being.

Anyway, I'll post pictures of pre and post surgery (I do look a little different!) and add some more details about how everything went.

In the meantime, if you want to come visit me (I love the company!) shoot me an email or text. I can't talk on the phone (or at all) until early October - so don't bother with that. Please don't feel badly if I ask to delay by a day or two. I'm still really really tired a lot of the time, and feel under the weather some days more than others. And conversing via whiteboard is surprisingly tiring!

Also THANK YOU TO ALL MY FRIENDS AND FAMILY  - You all have been more lovely than I could have imagined. Your emotional, moral, and smoothie support have been both incredibly touching and unbelievably helpful.