7 Day 34. Dark discolorations on Back Molars, and Justin Bieber Hair

I was able to open my jaws wide enough today to brush my back molars with my kid's toothbrush normally. In other words, from the top, instead of at an angle from the side.

As I was enjoying this new-found ability, I noticed something peculiar. The entire top of my back  molars was covered in dark stains. I immediately panicked thinking that during my 2 weeks or so of limited teeth brushing, the entire top of my of my back molars were in decay.

Suddenly, my new-found ability to open my jaws wider was used in an expression of horror

 

Note the improvement in jaw opening

I immediately emailed my surgeon about this.

One thing to note is that for my first 2 weeks, I was using a prescription strength Chorhexidine Gluconate Oral Rinse, that warns of increased tartar build up and teeth discolorations. While I was aware of this,I assumed that discoloration meant some minor yellowing here and there, and not the propagation of a dark, almost black layer over the entire top of my molars.

Well, turns out that this propagation is normal, which is unattractively fortunate.

Unfortunately, what this also means is that I will have to get the discoloration buffered away by a general dentist, which means sitting through a session of having a rotary grinder passing over my teeth, listening to that high pitched buzz vibrating through my skull.....

My sister commented on my entry from Day 31 that I now have Justin  Bieber hair. My stud of a buddy Brian Baumgartner claims I've been afflicted with Bieber Pyrexia.What do you think?

The similarities are uncanny. I desperately need that haircut.

3 Day 32. Video Update! And using a kid's toothbrush

Being able to open my jaws a fingers width apart is still not sufficient to pass an adult-sized toothbrush through to brush the back of my teeth. So, I decided to get a kids toothbrush, and it worked like I charm. Though maneuvering the toothbrush in a brushing motion through a limited gap still isn't easy, just doable.

At least I chose one of the best of childhood memories: Winnie the Poo!

I'm starting to talk a lot more with the splint removed. The best part is, I am understandable. However, there are definitely still areas of my face that refuse to cooperate with speech causing my facial muscles to move lopsided. Instead of trying to describe it using words, here's a video update to demonstrate first hand what I mean. 

Yes, I still need that haircut; it's been 6 weeks and counting.

4 Day 31. Splint removed! But liquid diet continues...

The good news is, I got my splint removed!! And for the first time in 31 days, I can talk without a lisp through clenched jaws! Though I am still encouraged to stay banded when I can.

Still, I mean, just look at the things I can do!

 Impressive! I can also open my jaws about a finger's width apart today, an improvement from a half width a week ago.  Apparently this issue fixes itself when I start to use my jaws more. I guess removing the bands for teeth brushing paid off more than just oral hygiene. I can opt for physical therapy if it doesn't improve any further in the next few weeks.


The splint removal was actually a very simple procedure involving the unwiring of the splint from my surgical hooks, and removing it. But upon arrival at the surgeon's office, I was made to sign a local anesthesia waiver, and then play some dressup with the nurses:

It was all a false alarm; I think they just wanted me to wear the hat around the clinic for fun. The whole procedure took about 3 minutes.

Dr. Hoghooghi, then performed a test on my right chin numbness.  I cannot feel dull pressure, I cannot feel a point, but I can feel a pinch! Great news, considering I could feel absolutely nothing weeks ago.

And to everyone wondering just what the heck IS this splint, say hello to my dear friend,

It is this dirty stained plastic piece that fits  my lower teeth against my upper teeth, and when my jaws are wired together with the splint between them, I cannot move my jaws at all.  It is this plastic piece that has made my recovery a huge success.


For the bad news, my high hopes of being advanced beyond a liquid diet came crashing down when I was instructed to stay on a liquid diet for 2 more weeks.

I think I'm going to need more Ensure nutrition shakes.

0 Day 30. Tingling's getting unbearable, last day with the splint!

My tingling's progressed beyond just "tingling". As a recap, the tingling went from just tingling, to a tingle/scratchy feeling near the surface. But today, it can be described more as an unscratchable itch. It feels as if a fly or ant (or both) is crawling around my chin causing it to tickle and itch, while holding feathers for some further tickling, but when I scratch it -- numbness.

It is driving me insane. I can't focus on anything.

However, I have to remind myself that this is all good. My traumatized nerves are working hard to recover, and I should embrace this... unscratchable itch.

Today is the the last day I'll have my mouth splint, and so I hope, the last day I'll have my mouth banded shut before tomorrow's appointment with the surgeon. I can't wait to start jaw exercises to strengthen my jaws to start chewing some solid food. The idea of soft foods sounds overwhelmingly tempting after the past 30 days, even if it means eating white bread soaked in prune juice, to be washed down with some Ensure nutrition shakes.

But more realistically,  I will be having pasta, ravioli cut into bits, and a blended hamburger pie.

I also desperately need a haircut. My last one was 2 weeks before surgery day. The hairstylist must be so worried.

 A little recognition to the splint and rubber bands that have kept my jaws secure and safe for the past month. I'm sorry to say I will not miss you guys:

Hey Technorati, I just met you, and this is crazy.. but here's my number ( HPC3KJ53GKAQ ), so call me, maybe?

0 Day 28. 4-Week Update

4 weeks down, and I think I look 100% normal at this point.

No major differences between yesterday and today -- notable changes are now only occurring once every few days, and will likely follow this trend until I start post-op orthodontics.

I'll just end this post with today's photo.

5 Day 27. Feeling in lower lip

Feeling started returning to my lower lip today! Though only on the left side, similar to my chin. My partially numb upper left lip corner is also improving, inside and out. The right side is still completely numb and tingling.

I noticed today that the cheek areas lining the nose have full feeling. Not sure when my senses came back completely; it could have been days ago. Either way, I'm sure glad it did.

I have gotten bolder about spending more time at home with my jaws unbanded the past 2 days, specifically around meal times. I am supposed to take the bands off only when brushing my teeth, but they are causing my teeth to hurt by being so tight. I figured an extra 10 - 15 minutes of unbanded time couldn't hurt anything, especially when I'm only days away from having the splint removed. Oh I can't wait to chew again.

I also have reason to believe my teeth have been clamped so tight together that the splint between the back left molars has actually cracked. I will find out at my Monday appointment if this has indeed happened.

Not much else to report -- the day to day changes have greatly diminished. My face, while mostly deflated, still has stiff areas that are fading every day. Smiling is becoming a more natural task, but I still have stiffness and resistance in the areas directly around the nostrils and chin, which actually distorts the shapes of my lips a little. My hope is that by Monday, these stiff areas will be completely gone. But something tells me that is just unreasonable.

0 Day 22 - 23. Starting up an exercise routine.

I started going to the gym early morning the past 2 days for some long treadmill walks, and short light-resistance elliptical sessions. Typically I've been doing 15 minutes of the elliptical, followed by 30 - 40 minutes of walking.

It's a lot less stressful on the treadmill without other people rushing about; the 1.5 blocks walk to the gym is the worst part, even then, it's not so bad in the early mornings.

I look almost completely normal at this point except for the lips and surrounding area, as usual. I'd like to think the gym sessions have significantly helped reduce the swelling with the higher blood flow.

I'm getting pretty tired of being a recovering patient... So I decided to be a play-surgeon this weekend on the Wii. We were glad to have all my medical supplies on the coffee table for backup.

0 Day 21. 3-Week Post-Op appointment

3 weeks down. The surgeon inspects the inside of my mouth, and then exclaims I've healed beautifully.

My next appointment is in 10 days where I'll have my splint removed, or so I understand. He said lower splint, but I do not have a splint on my lower teeth, so I can deduce that he actually just meant splint.

I think this means I'll be upgraded to a more solid, blended diet....? I didn't ask, but... I can hope!

My insurance company also decided to change things up a bit since my birthday. The once approved $12,000 for the $13,500 procedure is now "in-progress". The $13,000 posting is still "awaiting action". However, the previous amount of $2713 or so that I owed to Stanford Medical Center has been reduced by a full $1000. I don't know how, but I'm certainly fine with that. Win some, lose some.

A new claim showed up today listing an Edward R. Baer MD for $2,640 on service date 8/24/2012, the day of the surgery. I have no idea who that is or what it is for, and will have to verify with CIGNA come Monday that this is valid. My best guess is that it's for anesthesiology, but somehow I feel that would have been part of the $112,252.85...

For now, I'll just not worry about the credit card due dates, and continue to drink water from a cup.

0 Day 19. Drinking from a cup, and feeling in left chin

I managed to drink water from a cup today without a syringe! It took some practice in front of a mirror to get my lower lip bearing against the cup correctly, since I cannot feel it. But having feeling in the upper lip helps at least with the actual act of drinking. This is how I felt:

In my excitement, I shared this new feat on Facebook and directly with a few friends, including my stud of a buddy Brian Baumgartner, who in an overwhelming act of encouragement, responded with this:

Ignoring his sarcasm, I proceeded to drink a few more cups of water consecutively just because I could, to which he called me a show-off.

And as I was sitting in the lazy boy working away on my laptop and playing with my numb chin every now and then, it suddenly occurred to me that I was partially FEELING my fingers on the left side of my chin. This is a huge step forward in a much shorter-than-expected period of time, a milestone I decided not to share with my stud of a buddy, Brian Baumgartner.

Hopefully this means I'll be regaining feeling to my chin and lips faster than average.

0 Day 18. Happy Birthday To Me!

I turn 26 today. And, I quite literally had one of my best birthdays, thanks mostly to Paul for a surprise, but also to my insurance company.

Shocking.

I received a posting on my insurance account days after the surgery for the surgery fees, and the hospitalization fee. The claims were being reviewed.

Today was the day the insurance company completed some of the processing. Here's a summary of what I saw:

I was ecstatic. There's still procedure 2 awaiting action, but I'm deducing it will be covered since they were all pre-approved. My surgeon just needs to submit some notes on the procedure.

 And yes, $112,242.85 is ridiculous for a 2 night stay. 

Apart from that, most of my birthday was spent working from home, doing a little studying, until Paul came home with bags of groceries for a surprise liquid dinner. After his slaving away in the kitchen for about 1.5 hours, this is what I got:

Fresh homemade cream of mushroom soup, Fresh homemade gazpacho, cucumber pear juice, and homemade orange-cranberry spiced tea. Everything was absolutely delicious! This was a very welcome break to the simple soups, broths, and Ensure nutrition shakes I've been having day to day. 

And what's a birthday without a dessert shake? Though, to spite me, Paul put a candle in it. What I mean is, I can't blow out a candle with my teeth banded together. So i had to find some alternative method.

1 Day 17. Deflation appears to be permanent, cats go balloon crazy, master of shaving

I'm starting to run low on ensure.Going to need a Costco run favor from somebody soon.

The sudden deflation I experienced late yesterday afternoon appears to be permanent. The only times the swelling worsens is if I attempt to talk too much. But once I stop, I deflate shortly after. This means I get to enjoy a relaxed face much more frequently!

I still have parts of my cheeks, chin, and under chin that still have yet to improve, but I am getting more hopeful all that will change this week. 

Shaving this morning took me about 5 minutes. I've finally mastered the art of shaving a numb face.The trick is to pretend you're a barber shaving someone else when looking at the mirror. Once you can ignore that it is your own face that you're not feeling, things get a lot easier.

Mommy swung by today with more homemade soup. It was some beef, vegetable soup slow cooked for hours, and then strained for my liquid diet with some vegetables remaining blended. It was indescribable -- mom's cooking is never a disappointment. As much as I like to think of myself as a pretty decent cook, mom's food always puts mine to shame. 

I later had a couple of friends visit after work hours. I hadn't seen them since days before the surgery so it was a very welcome visit. They brought get-well-soon balloons! That certainly made the day even better.

As the balloons floated around the living room while I typed away in our conversation, one of the cats, Otis started going crazy. I think I'll have to start buying balloons more regularly to keep the cats entertained; they have never been this enthusiastic about anything besides the red dot, but I don't have to do anything manually with balloons. It'll at least stop them from laying on my keyboard and blocking my screens:

1 Day 16. Sutures dissolving, and falling apart

For some reason in the late afternoon, my swelling suddenly died down about 90% within a few minutes, for a while. It was the best feeling in the world. I don't know what I did, or what caused it to happen, but having your face feel like it's NOT exploding is something everyone takes for granted. My jaw also settled completely into the proper position, and I thoroughly enjoyed that sensation.

 After dinner and spilling soup while syringing it into my mouth, I removed my bands and brushed my teeth, the usual routine. However, today I had to spend a good 5 minutes rinsing and spitting over the sink as bits and pieces of my dissolved sutures fell apart. It was very exciting to see the dark brown pieces of threads and knots falling into the sink with every gurgle. No blood. My mouth is definitely recovered at this point. Gah, I'm so excited!

Anyway,  I decided to take a Saw-movie-esque photo with my banded teeth.  I now have this as my screen wallpaper in full-size on my media system's 46in TV. I find it inspirational.

0 Day 15. Apetite's picking up, and the cats are finally allowed in my prison.

I am starting to feel hungry all the time now, and I spent some hours today just prepping food. This is much more like my normal self. Unfortunately, I'm not getting a whole lot of exercise these days, so I'm definitely being careful of the types of food I'm eating; the high protein, low sugar and carb variety, and healthy fats. Lots of vegetables soups and juices, some fruit juices, yogurt/milk blends, and of course, prune juice. But oh, do I miss meat...

Instead of having my mom or Paul do my grocery shopping, I gave safeway delivery a try for the first time. They deliver right to your door! I got free delivery for my first order, but even if it wasn't free, it'ts only about $7 for a 4 hour window, or $12 for a 1 hour delivery window. I used my freebie on a 1 hour window, obviously. I need to be careful not to get addicted to this service -- I could get really lazy, really fast.

I had another visitor today, and we "chatted" for a couple of hours. Throughout the conversation, the tingling in my chin kept distracting me enough to lose track of the topic. It definitely still affects my sleep , and I wish there was some way to ease it..

My face still swells unevenly, and fluctuates. It's starting to get really irritating -- I always hope that every deflation is a new permanent step forward, but then i swell up again some minutes later, especially when I try to talk. Then my left half of the lips just swell shut.  I hope the deflating becomes a little more even and consistent over the next few days.

Dinner consisted of 3 different soups today, including the freshly made tomato soup shown above, followed by green juice, fresh juiced watermelon juice, some other juice blend, a bottle of Ensure, milk and yogurt shake, and prune juice to end it. I totally binged, naughty me. The other two soups were Corn-Lemongrass, and the last serving of the Thai Curry soup that I cooked up some days ago. I am definitely making that again tomorrow.

Since I ended my antibiotics 3 days ago, I figured I'm no longer at risk of infection. So, I allowed my cats into my room for the first time since the surgery.  They were very wary at first, and then started knocking over all my medicine bottles and syringes. At least I remembered to fold up my murphy bed so they can't scratch at the sheets. Oh, how I've missed them. And, is that really what I sound like with my teeth banded shut? That's just unattractive. Paul, do something.

Smile is definitely improving. 

0 Day 14. Two weeks down, halfway till partial freedom

 

That's right. Two weeks. Time flies. 4 weeks is the target time where I can start being more carefree about my activities and start light jogging, stationary biking, etc. 

I did try going out for a walk last night after all the shops and restaurants in my neighborhood closed. Of course, being San Francisco, there was still a good amount of people out roaming and hanging out. I walked about 3 miles, stressing out at every corner about being bumped into. Thank goodness that didn't happen, but the stress caused me to swell up all over again. Puffer fish reflexes.

I think I will wait until the 4 week mark before attempting this again. That or walk at 5am when the streets are bound to be empty.

Overall, my cheeks look mostly deflated, and the improvement is more evident, though the swelling still fluctuates and worsens by the evening. Again, it is an amazing feeling to be able to relax my jaws, AND have my upper and lower teeth fit together at the same time, as opposed to closing my teeth, and having my right jaw be in tension.

The asymmetry however is not completely fixed. While my chin is now much closer to my facial center line, there are other asymmetries in my lower jaw that now stand out as my cheeks deflate -- I have a fuller left mandible, which is unsurprising since my right mandible was under developed in both fullness and length which was the root reason of my jaw rotation.. After this surgery, the length has been fixed, but not the fullness, so my right face looks "flatter". This is fixable by an implant if needed, but may not be that big a deal. Another side effect of this is my chin is still slanted slightly to my right. This is fixable by genioplasty, where they cut off my chin and slide it into the proper position. Both are much simpler procedures with short recovery times.

These issues were all brought up to me pre-surgery, and if I do want to proceed with fixing these trivial issues, I can opt to do so 6 - 9 months from now after recovering. These are more for cosmetic purposes than medical necessity. I will probably opt to have these issues fixed, because now that I know these problems are there, how can I ignore it?

My upper lips have deflated significantly, but both lips are still slightly swollen. My lower lip has taken a reverse role to my upper and is now more swollen on the right. I find that when I try to talk, I talk primarily out of my right side where my lips can move a little more easily.

The marjority of my upper lip now has feeling, except for the outer left corner. Lower lips and chin are still completely numb. The left side of my nose has regained most feeling but my right side is still mostly numb. The insides of my mouth are starting to suffer the surgical hooks, and I am applying dental wax to my braces. It is a little more difficult to keep the wax in place with rubber bands criss-crossing in multiple directions.

My chin is still experiencing immense tingling, but the tingling now feels... different. I am not entirely sure how to describe it, but it feels closer to the surface? Last week, the tingling felt like muscle tingles, but now, the feeling is similar to when you rub your hand or a towel over some stubble, in addition to the muscle tingles. 

Speaking of stubble, I was able to shave in less than 10 minutes today. That's about 1/3 of the time it took me the first time.

I had quite a few visitors this evening, which made this Friday evening in recovery much more exciting. And, I even managed a smile for a photo shoot. All that practice paid off.

0 Day 13. Getting restless, and learning to smile

I am getting tired of sitting around in my apartment. So I decided to try standing all day today as I worked. The inspiration came from a coworker, who has his monitors, keyboard and mouse elevated on cardboard boxes in his office so he could stand at his desk instead of sit and atrophy the entire day. I decided to do the same, since all this sitting action is taking a sore toll on my behind.

I had absolutely no difficulty finding boxes to mount my laptop:

I found that I actually focus better standing up. I may consider adopting this permanently.

If you still have no idea what Ensure is, it's a well-balanced nutrition shake with 24 different vitamins and minerals at about 25% - 30% Daily Value per bottle. It's a liquid dieter's best friend. Having 4 a day is about just right. This might clarify what I'm saying:

I spent some time trying to regain control of my lips and face so I can try smiling. So far the facial muscles are still pretty stiff. I managed a decent grin after a few attempts.

I tried on two occasions to actually smile showing my teeth, which took a surprising amount of concentration. That was somewhat of a tragedy.

The surgeon confirmed that I will be starting jaw exercises at about the 6 week mark. For now, I was told to not remove my bands unless I really need to (oops , I removed them 3 times  yesterday). I guess this means I'll only be brushing my teeth just once a day for a couple more weeks instead of after every meal.

0 Day 12. New bands arrangement, looking close-to-normal...sometimes

I replaced my bands with the new arrangement my surgeon taught me. There is now a diagonal band running from my upper left to my lower right teeth. Since my lower jaw was corrected for an over-rotation to my right, the muscles will tend to pull my jaw back into the original position. These bands help counter that by pulling my lower jaw towards the left into the splint so my right jaw bone isn't under compression. I was able to put these bands on in less than a minute today after brushing my teeth, a huge improvement from my first time yesterday where I kept missing the hooks, only to send the bands snapping painfully into my lips.

The swelling has gone down even more today, and I am starting to look more like my regular self as I recall. I guess in truth, I will never look completely like my old self again. Upper left lip is still swollen and numb, and so are the lower lips and chin area. However, the swellings will theoretically continue to diminish and fluctuate for the next couple of months, so I am far from reaching my final look. In fact I never look the same throughout a given day due to the fluctuating swells, but at least I don't look like a fat kid from the neck up on a slim build anymore, because that was just weird.

0 Snapped band replaced, and teeth brushing with an immobile jaw

Turns out it was critical that I got my bands replaced this very day to keep my teeth closed. So, my mom drove to the city to pick me up and then drove me to the surgeon's.

I was given a pack of spare bands, and taught how to replace them myself with a pair of tweezers if I should need to.

I was also told that my sutures have healed enough where I can remove the bands myself day to day and brush my teeth.

Yes, I haven't brushed my teeth in 11 days, but instead have been using a prescription strength antibacterial mouth rinse.

After I got home first thing I did was remove the bands to brush my teeth.

However, after removing the bands, I was only able to open my mouth maybe a half  inch apart, not wide enough to fit my toothbrush through to the inside. I could not believe how weak my jaws have gotten after 11 days of liquid dieting. I may have been able to force them open wider, but I was paranoid about snapping any plates and screws and having my jaw bones shift. I will need to confirm with the surgeon if this is a normal symptom, and if I should be attempting to open my jaws wider at this point.

So, I brushed just the outside of my teeth, and then rinsed out my mouth really well before putting the bands back on. It was better than nothing, and felt great.

0 Day 11. Back to work, almost.

I start working today. Thankfully the nature of my job allows me to work from home via remote connection via a virtual private network (VPN). In other words, I am still cooped up at home.

While working from my San Francisco apartment is normally quite nice, it's depressing after 11 days. People watching out the window really makes me realize how much of life I am and will be missing. I see people walking their dogs, carrying shopping bags, running, bicycling as I gaze out at the hustle and bustle of Sutter Street, and I can't wait to once again be part of that scene. Well, maybe not the shopping; that's not really my thing.

For now, it's liquefied soups and nutrition shakes until I get there.

One of my rubber bands clamping my teeth shut snapped today. I'll have to schedule an appointment this week to replace it. 

Photo update. Lips are still swollen and a prominent feature of my face. Cheeks are still puffy:

6 Day 9. Tingling and Spasms.

The last few days my numb chin area has been tingling like mad! It is still numb to the touch, but it tingles! It's intense enough where it is actually making it hard to sleep some nights.

My jaw muscles have also had occasions of semi painful spasms.

All are good signs that my nerves are trying to wake up, I hope. But these newer sensations are extremely distracting.

I am completely off pain meds by now.

Most of the bruising along my lower jaws have completely faded. I look almost normal again, except for the still puffed up lips, chin, and inner cheeks giving me an unintended duck face. This means for now I am a natural MySpace poser.

2 Tools of Communication

Even though I am allowed to talk some, I cannot over do it, else my jaw and face muscles get extremely sore and tired.

But, thanks to technology I have a few tools set up around my room to help me communicate with any visitors. I've been using the two tools below for all my visitors this past week.

The first one allows me to type on my 46in TV screen, from my laptop. Even though they are two different computers, a software called Synergy converts my laptop into a wireless keyboard and mouse by moving my cursor on to my TV screen. See the 30 second demo below, it's awesome.

But of course, sometimes a basic text to speech works just as well.

Got to love technology. As you can tell, my swelling has gone down even more since Friday. Lips are still swollen and mostly immobile though.