Friday, August 31, 2012

0 Day 7. 7-Day Checkup, and Shaving a Numb Face

I had my 7 day checkup with the surgeon today. Thank you Paul for driving. One of the first questions Dr. Hoghooghi asked was if I had been charting my weight day to day.

It completely slipped my mind.

Otherwise, my stitches are healing very well, and the swells are improving.Unfortunately I'm to remain on  a full liquid diet for another 2 weeks. He would rather not take any risks on my plates moving or snapping. I can't tell whether this is punishment for me not charting my day to day weight.

Either way, I went straight to CVS afterwards and bought a bathroom scale, as well as grocery shop with kids pointing and exclaiming "look, Mom, he's got the mumps!"

I weighed myself in the bathroom once I got home. And the magical number was....

.... 120.0 lbs.

I weighed in at 129 lbs on the morning of the surgery. Assuming that the scales are comparable in accuracy and calibration, and igorning the fact that I was weighed in at 6am surgery day as opposed to 10am today, this means I lost 9 lbs in a week.

I have made a spreadsheet to keep track of my weight every morning. The flashing 120.0 is definitely a concern; I am 5'6", a mid-long distance runner, cyclist, and my weight's been 125 - 128 for as long as I can remember. According to ever changing BMI charts, I am borderline underweight and cannot afford to lose anymore. I had 2 Ensures.

Later that afternoon, I shaved my face for the first time. As illustrated in my previous post, there are many numb portions on my face. This makes shaving a difficult task as I cannot feel the pressure, and angle of the blade. Every stroke felt like I could easily slice off a part of my face.

Surprisingly, I made it through the ordeal without a single cut, but it took nearly 20 minutes. I imagine this is something I'll be getting better at.

Thursday, August 30, 2012

0 Day 6. State of Ray: One Week Recovery Analysis

Tomorrow is my 7-day appointment. I am going to give a full break down of how far I have come in the past week, and will try to organize this into useful, searchable segments:

Facial Swelling

My swelling was at its worst Monday, Day 3. Since then, swelling has substantially subsided, though, still is overwhelming. The photo below was taken this afternoon and shows my most recent swelling situation. I was trying to smile, but lips are still swollen, and not very responsive.

There is significant improvement from the previous photo I posted  on Monday.   However, as mentioned a couple of entries ago, I had noticed that my right side was "deflating" faster thanmy left, as can be visibly observed. My left cheek still appears to be fuller, and rounder than my right. The same can be observed for the upper lip -- the left upper lip is fatter than the right, though this was actually more prominent yesterday than it is shown here. I am not sure what is the cause of this inconsistent rate of healing, but as long as both sides ARE healing, I don't see any potential problems, though I will bring this up with the surgeon tomorrow morning.

 The facial swelling still fluctuates, but the area of effect is shrinking. My worst swelling of the day happens in the evenings, and today, it's only affecting the lower lip and area directly below it, compared to much larger areas and cheeks just some days ago.

  Facial Numbness

Using the photo below, I've color coded the areas based on sensation:

Red: Numb
Blue: Partially numb/dulled sensation
Green/uncolored: Full Sensation

As expected, everything from my lower lip and below is numb. The surgery causes trauma that lines the mandibles (lower jaw bones on the left and right), and so they kind of "shut down" temporarily. My surgeon was pleased to share that none of the nerves were severed in my case; in some cases, the nerves cannot be avoided and are reconnected in hopes of self recovery. This increases my chance of regaining full feeling over the next 6 months, which according to my surgeon is over 90% of his cases.

The other red and blue spots lack sensation probably due to the swelling. I expect feeling to regain over the next few weeks as the swelling dissipates further.

It is interesting to note that my lip sensation is NOT symmetrical. As can be related to the previous diagram, the more swollen left side of the lip is also more numb. This is also reflected on the inside of the mouth, where I have feeling throughout except the inner upper left lip.

The hope here is as the weeks continue, the area of red diminishes and the areas of green grows.

Jaw Position

This is the ONE most exciting part of my recovery so far. as of today, enough swelling has dissipated around my mandibles (lower jaw bones) where my teeth now fit together, and my jaw joints now rest squarely in the sockets. This was something I could NOT do prior to the surgery with my rotated jaw. As a recap, I had a longer left mandible, and a shorter right. The comfort of this new resting position makes this entire surgery worth it despite the other ongoing factors, pain, and challenges.

It is no wonder that Dr. Hoghooghi had been so excited about the success of procedure on Day 1. He was more than enthusiastic to share that everything during the operation went very, Very smoothly.


Am still on a full liquid diet. Tomorrow is the verdict on whether I will graduate into the blended diet phase. The prune juice addition to my diet seems to have paid off. I am now experiencing easy bowell movements, and what is hoped to be regular as I will be observing in the next few days instead of once every 5 days.. In retrospect, I should have started having a glass a day since Day 1.


Pain medication is still a must. I am taking it every 5 - 6 hours. Usually by the end of the 6 hours, my facial and jaw muscles start throbbing with overwhelming soreness and pain. Therefore, it is particularly bad in the mornings when I wake up after 7 - 8 hours. However, so long as I keep up the regular doses, I am functional throughout the day, and am feeling the effects of drowsiness less and less.

 I still have about 6 days left of regular antibiotics intake.

Am still required to do a chlorhexidine gluconate mouth rinse at least 4x a day and after every meal. As with the diet, I have not progressed into teeth brushing phase yet.

Other Notables

My airway have finally cleared -- the regular saline inhalants and sprays are no longer dripping dark brown but running more clear, signifying that most of the dried blood from the overflow of days 1 - 3 have been washed away. Two hot showers a day have also helped in this process.

While Syringing some tea this afternoon, I think I may have snapped one of the bands that's holding my teeth closed together on the left side. While I think it's a redundant band, I will also bring this up with the surgeon tomorrow. It currently feels to be hanging on to one of the braces.

0 Diet additions, and syringe maintenance

I started incorporating prune juice into my diet as of dinner last night. As it is already common knowledge to just about everyone at every level, prune juice is nature's "laxative", with its fiber content, dihydrophenylisatin, and sugars such as sucrose, fructose, and sorbitol, I am not sure why I didn't think to add this from day one. I blame medication.

My third of four feeding syringe got "sticky" again. This is caused by the rubber ring of the plunger drying out. As I force the plunger up and down with increasing effort when it gets stuck, it would result in over drawing or over injecting when the plunger hits non-sticky spots. This resulted in quite a mess this morning with my green juice. Buying a new syringe ever 2 - 3 uses is just a waste, exacerbated by the fact they are made of purely non-recyclable plastics and rubber.

Turns out a quick fix for this is just to dab a little vegetable oil over the rubber gasket of the plunger after washing, rinse and re-assemble.

Note that while I recommend using this method for feeding syringes, this should not be used for medicine and needle syringes.

Now my syringes are good as new.

Wednesday, August 29, 2012

0 Day 5. Chores! Juice! Less Swelling on Right..

Today is the first day where I felt  good enough to perform activities. Even though I've been trying to keep up some walking and pacing, it's finally starting to feel less like a burden.

Which is actually perfect timing, since the fruit and vegetable juices that my mom, sis, and Paul had prepared for me my first day home have just about run out. So, I decided to do some juicing this afternoon.

Being on a liquid diet, these are really my main source of nutrients supplemented by nutrition shakes, which are quickly getting distasteful.

I made two different types of juices; red, and green.

Red juice: Watermelon, kiwis, cantelopoe.

day 5 post double jaw (orthognathic) surgery watermelon kiwi juice prep

Green Juice: Cucumber, Celery, Kale, Apples, Ginger, Lemon.
day 5 post double jaw (orthognathic) surgery green juice prep

It's like making superfood, but so much better!

 I used a Black and Decker juicer that I had bought a week prior to the surgery on DealGenius. The timing could not have been better--had been looking for a discount Juicer for a while. This one was only $30 with free shipping.

day 5 post double jaw (orthognathic) surgery juicing

And the final results: Delicious, nutritious, liquid.
day 5 post double jaw (orthognathic) surgery watermelon kiwi juice

day 5 post double jaw (orthognathic) surgery green juice

And of course, it's important to sanitize my feeding syringes after every use. 2 minutes of fill and soak with iodine solution should be plenty. I knew my beer brewing and wine making supplies would be useful in other applications.
day 5 post double jaw (orthognathic) surgery syringe sanitation

My face is still big, and interestingly I feel the swelling on the right side is dissipating faster than the left. This is resulting in a rather unbalanced look, and more sensation (less numbness) on my right side as well, but, as long as the swelling is improving, things are going good.

I can also feel my lower jaw resting more and more into place as the swelling subsides, and the bite itself is getting  more comfortable. A very welcome observation, since the whole point of the surgery was to fix the bite.

2 Day 5. Poopity Poop

I had bowel movement for the first time since the surgery. That would be 5 days.

TMI? Maybe. But this is big. If I keep up this liquid diet, I would have to go regularly at about this interval. It's still not necessarily healthy, but it's a baseline.

I can't wait to be upgraded from a liquid diet to a blended diet. My first post-surgery checkup is this Friday. I'm hoping I would have recovered enough to do so, to be determined by the surgeon. I could definitely eat something other than broths and nutrition shakes about now.

Tuesday, August 28, 2012

0 Day 4. Kitties!

Just wanted to share something Paul had sent me Saturday night when I was hospitalized. I had intended to post this on Sunday but it sort of slipped.

They are really Paul's kittens, but since I am the one with all the strict rules for them around the apartment, I was nicknamed "father". Oh I love these two!

P.S., Those are my bedsheets they are rolling around in. They are slacking on discipline already. Tsk. Tsk.

Monday, August 27, 2012

2 Day 3. Is it over yet?

I spent most of my day today sleeping, waking up, pacing back and forth a few minutes in my room, "eating" some liquids, taking antibiotics and pain meds, then falling back asleep. Throw in some antenna NBC bay area here and there. "Scene in California" can be a very intriguing show.

My mom, sis, and Paul setup the room for me so that I can take good care of myself without moving around too much. I have a costco box of nutrition shakes, and a table setup with my antibacterial mouth rinses, antibiotics, pain medication, vaseline lip balm, spit bucket, sanitizing solutions, gauze, syringes, sodium chloride rinse and nose sprays, etc.

Day 3 post double jaw (orthognathic) surgery medicine table
One thing I noticed about my swelling today is how much it actually fluctuates. I went through some parts of the day with the swelling feeling pretty minimal (admittedly, I still look bloated), to moments where I REALLY swell up. I was really hopeful during those low moments that I was near to being done with this phase, but lose that hope pretty quickly. I am not sure what causes these fluctuations, but on average, the peak swells day to day are improving. Either way, I am no exception to a slow, long recovery.

I do need to remember to stay better hydrated. It's just such a chore to sanitize my syringes  before and after every time I drink water.

Face shot for the day:

day 3 post double jaw (orthognathic) surgery front swollen

Sunday, August 26, 2012

0 Day 2. Discharged!

Just took my first shower since Friday morning, at home. It's weird not being able to feel any water running down your face.

I am glad to be home though. Currently have the living room/my bedroom quarantined from the kitties. Say hello to my at home nursing team!

day 2 post double jaw (orthognathic) surgery at home nursing team

My swelling has dissipated a good amount since yesterday. According to my sister, it's still big but not "buzz lightyear" big. She cracks me up.

Now that I don't have an IV, I must remember to keep drinking water. Staying hydrated with this much pain meds and antibiotics in me is a must.

I'm also gaining an addicition to the Ensure nutritional drinks.Mom and sis are looking for a costco-sized pack of it right now. Doctor says I should have about 4 a day, but I'm thinking maybe one or two more than that...

Paul did a great job of cleaning and sanitizing the apartment. I owe him one.

0 An awful night's rest

I woke up in the the middle of the night feeling, actually feeling my face swelling up. As this happened, i was able to breathe less and less through my nose.

I panicked with images of my face blowing up and suffocating.

The nurses tried to reach my doctor as I had ice packs pressed against my face, breathing through my mouth.

After some time, I calmed down, and just lay awake most of the night breathing through my banded teeth.

The morning came peacefully, and I just did my 5 minute walk around and had my liquid breakfast. My face is still extremely swollen, and my nose feels really stiff and tight, but if the doctors are right, I should start "deflating" tomorrow or even later today.

Saturday, August 25, 2012

0 Day 1. My sister's present

My sister's sense of humor never fails. She for me a lookalike:

Now I have another patient to share the room with.
Day 1 post double jaw (orthognathic) surgery monkey face swollen
Day 1 post double jaw (orthognathic) surgery monkey face swollen 2

0 Presents, pain, blood, food.

Woke up to Sammi walking into the room today with presents! She got me some whiteboards, one in the shape of a floppy drive so I can communicate, and a cuddly!

It was good start until my surgeon paid me a visit about an hour later. No bad news, in fact, very good news. He reiterated that on the operation table , everything just fell right into place. However, he decided to tighten the bands that's keeping my jaws shut and my face has been sore all day. painfully sore.

Thank goodness for this sack of ice packs that I am able to tie around my head.

I was given instructions to start walking around and eat more. As usual, the moment I stand up my nose is a bleeding fountain, but I walk around with a gauze mustache.

Had my first real meal since the surgery: cream of chicken soup liquified and a V8.

Got some chocolate flavored nutrition shakes for snacking the rest if the day.

4 Vomit

The time is 12:20am, and the side effects of anesthesia finally got to me. I sat up and threw up all over the bed.

It actually wasn't too bad. There were no solids, and everything flowed through the little gap I was able to make through my bands. A change of clothes, quick water rinse, then saline rinse, and suction tube later, I was back in bed ready to fall asleep all over again.

But now I am paranoid about drinking too much water and having the nausea return...

Friday, August 24, 2012

0 Overflow

I just stood up for the first time today to go to the restroom. Blood poured out of my nose, apparently over flow blood. I was also stark naked, but luckily I have my own room, and a nurse helped me get dressed.

It hurts to swallow, and I am completely dehydrated. They are adding an additional IV line since I am not drinking enough orally.

Blood pressure and body temp are good.

The swelling has gotten worse, and I think will further worsen tomorrow.
post double jaw surgery nose bleed

2 Surgery complete!!

According to my mom and sis, my procedure was done in less than 3 hours. It went smoothly.

I was kept at a recovery wing for 2 hours before being transported to my room. I could hardly stay awake.

During this time my heart rate was at a low constant of 43 beats per minute for most people this would be a red flag, for me this was just the mark of an efficient heart. Nurses referred to it as the runner's heart. It pays to be healthy.

I have been told I should not eat all day today. Good thing too, I hardly have an appetite.

As a side note and big coincidence, one of the cyclists who got bumped from Caltrain with me yesterday is a nurse here. Small world.

0 Pre-op!

Healthy, and ready.

1 Surgery day! Location and details

The surgery is scheduled for 7:30am, at the Ambulatory Surgery Center, 3rd floor. Check in is 5:30am.

For anyone interested in visiting, My recovery room will be in Wing C, second floor. Case number: 242539.

It's only a short 2 night stay, and  I will not be able to chit chat, so visits may not be worth it, just to be honest, but will always be appreciated.

Just for fun:

Thursday, August 23, 2012

0 The Last Supper

This is my final solid meal before my 4 - 6 week liquid diet phase. Ton Katsu, Spicy Tuna roll, flan pudding with green tea ice cream and fruits. This was after a BBQ pork bun and Shu Mai snack. I certainly made the most of it:
I can't say I have successfully put on any weight. Maybe half a pound to a pound, but I did try. Some of the meals I did have in the past few days:

Lori's Diner fried chicken, rolls with butter, and an "orange dream" milkshake.

Sweet Tomatoes all you can eat salads, pasta, and soup bar

Friend's birthday BBQ feast in Berkeley. 

Jumbo Chorizo Suizo quesadillas from El Farolito.

A picture of me taking a picture of the quesadillas.

Saag Gosht (lamb and and spinach , creamy), garlic naan, mango lass, from Pakwan Restaurant.

A multitude of desserts, courtesy of Boris and his grandma, who just about handmade everything on this table.

I even cut down my running from 4 days of running a week to just... well... once.

We will see how much weight I lose the next 2 weeks. Hopefully it won't be too drastic.

0 Verifications Verified

Surgery is confirmed at 7:30am tomorrow. I will be the first case as hoped. Just got the stents fitted to my upper and lower teeth. Some minor adjustment was needed for the lower, but everything is now finalized. Surgeon says to relax, and eat, but I have a ton of errands to run. Hope to make it to bed at a decent hour since I am required to check in at 5:30am.

Wednesday, August 22, 2012

0 Unexpected appointment

Just got a call from the Surgeon's office that I will need to go in tomorrow late afternoon. A bit unclear on what this short notice meeting is for, but Pat said the surgeon would like me to "try some stuff on"? I could have misheard. My best guess is that she is referring to the templates he's been preparing. I'll find out tomorrow.

Tuesday, August 21, 2012

0 Payment like a high roller

Paid the $31,500 up front this morning. The other patients in the waiting room were probably wondering who the hell is this kid as I anounced the amount to be charged on my 3 main credit cards, totaling the stated amount.

Also was pleasantly surprised to find that the surgeon's office will be filing the claim for me after the surgery and will hand me the check, so I will not be dealing with the insurance company during my recovery.

Shoutouts to Pat, the lady at the surgeon's office who's been helping me with claims, reviews, and approvals every. step. of. the way. For a year. You are top notch.

Monday, August 20, 2012

0 More Insurance Rants

I still have not been reimbursed for the $495 skull imaging performed in July. Turns out they have been calling my Surgeon's office for verification, which is silly because all they did was refer me to Bay Area Imaging.

CIGNA noted that the receipt includes the surgeon's name and number, and therefore, they keep calling him instead of the actual imaging clinic..

.. well, is it that difficult to call the OTHER number on the receipt that does belong to the imaging clinic?

I have asked the customer rep to leave a note on the case stating to call the other number. Let's see if the reviewers can figure this one out.

Seriously, it's been "in progress" for too long.

Saturday, August 18, 2012

0 Obtaining Financing

The surgeon's office requires payment up front, and then I can claim reimbursement from my insurance company after the procedure.

But where am I to obtain $31,500?

There is a service called Springstone Patient Financing that provides various terms and interest rates depending on term duration. But best of all, they have a 6 month term of 0% interest. However, they have a cap of $25,000. In any case, $25,000 is interest free leaves me with just $6,500 left to worry about.

I got approved for a maximum of $12,000.

At this point, I am in a mild panic. If the payment doesn't happen, the surgery doesn't happen.

So, I take a easy morning run to my credit union to discuss a loan:

I was approved for a $15,000 VISA card with a flat interest rate of 7.2%, the lowest offer they have due to my A-rating credit score. Making the payment this week would mean getting the statement on september 15th, and having the payment due by mid october. That should be plenty of time to get insurance reimbursement, so I took it.

My credit union was able to print a card within 10 minutes after I accepted, and told them about the urgency of needing it by Tuesday.

In case you are wondering what wonderful credit union I canceled my national bank accounts for, it is the San Francisco Fire Credit Union, in my opinion, the best one around.

$27,000 down, $4,500 to go. I have my Chase Sapphire Preferred for that, and a couple more $8000 limit credit cards. Unfortunately the credit cycle is not ideal, so they are only backups.

It's a huge load off my shoulders, and I'm very excited for the airline miles I'll be getting.

Friday, August 17, 2012

0 Face mold and a burning box

Having my face traced is a fascinating procedure. They have this contraption that they put over your head, supported in your ear, with alignmnts to your nose bridge, chin, and mouth.

I had to sit upright and stay very very still as the technician calibrated the device.

In order to properly mount my dental impressions to the rest of my face model, I had to bite into a piece of softened wax which acts as a template so they new how to align my dental impressions to mimic my actual teeth positions.

This involves using a torch to soften some wax.

My technician was having difficulting turning on the torch today and so, once she got it running, she left it running on the counter....

....facing the cardboard box that contains my dental impressions.

Luckily, we smelled it smoking before any flames started.

Next obstacle: Obtain financing.

Thursday, August 16, 2012


I find out everything the surgeon plans on doing to me today.

In a very impressive array of digital imaging. Unfortunately, I could not keep the copies so I am unable to show illustrations in this post, but I will do my best to explain.

First off, to recap my actual problem:

I have a right jaw joint that is shorter than my left, causing my lower jaw to rotate generally right. However, when I close my mouth, My teeth fit in a way that pulls my right jaw joint away from the socket, causing a whole variety of issues with muscle stress, joint degradation, etc.

Now, On to the plan:

My upper jaw is to be sawed away from the rest of my skull right below the nose line, and advanced forward by 3mm. There are no tilts, or cants relative to my eye level based on his measurements and so the vertical symmetry is acceptable. This advancement of 3mm will cause my nose to tilt up about 2mm, hardly noticeable, and my nose to widen, which will be tied back in using an Alar Cinch, which Dr. Girod will be performing.

My lower jaw is then to be rotated about 4mm left to fit my teeth into the now screwed in proper alignment upper jaw. The lower jaw is broken into 3 piece with 2 breaks at the mandables. the joints are then allowed to slide back into the proper place in the socket, and then screwed into place.

The whole procedure is to be done from inside the mouth, so there will be no exterior scarring.

I will be numb, and regain partial feeling by 3 months, and full feeling by 6 - 7 months. Swelling will occur, but will greatly reduce within the first 3 weeks, and fully dissipate by 9 months, though after the first 3 weeks, I should look more or less normal.

As a fun fact, I have the option of specifying whatever nose width I want, so I will need to think if I do want to shave off a 1 mm on each side or something. Nothing too major. My nose is pretty wide, but , it's still my nose.


My outh will continue to be wired shut for 4 - 6 weeks post surgery, with a check up at 4 weeks to determine the progress of recovery. During this time I will be on a full liquid diet, and am not allowed to talk, not even mumble. The idea is any attempts of vocal communication will cause stress on the cut muscles, and may cause minor bone shifts which could potentially lead to the necessity for a re-operation. That's the last thing I want.

Next Steps..

Tomorrow I am coming back to have my face molded and traced. Those dental impressions that I brought over will be mounted onto my face mould, and a MOCK SURGERY will be performed on the model. During this process, the surgeous will create stints and templates to use during my actual surgery so everything can be moved precisely where they want it to be.

Also, I need to pay the $31,500 upfront, before the surgery.... That's my next biggest challenge.

Wednesday, August 15, 2012

0 End Teeth Movements, Add Surgical Hooks

Big Milestone -- my pre-surgery braces are complete, and dental impressions are ready for pick up.

I can't close my mouth completely anymore, and my lower jaw asymmetry shows clear as day.  My ugly face is shown below for your own torture. Yes that's my Titanic sinkable bath toy up top. It even snaps in 2 after sinking to a point.

The rubber bands were removed, and steel wires were put in place, with hooks attached every few teeth. These will be used to wire my mouth shut for the surgery, and for some time after. I get the full details from my surgeon at tomorrow's appointment. Should be a very interesting post.


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