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The Little Gap That Could

4/29/2015

The little gap that could! Choo choo! Need to keep that train movin! It's closing...slowly, but surely. The last image is a comparison with the day I got the incisor out around Jan 20th (left) and yesterday April 28th (right). There is some closure there, but the progress is slow. And rightfully so. My orthodontist is doing everything he can to move the teeth REALLY slow and avoid any more damage on my already severely damaged roots thanks to my first orthodontist. The only thing standing between me and surgery is the closure of this extraction space. I hate to be that patient that asks about timing, but for planning purposes, it needs to be asked. So, after 3 months, I finally asked. Doc said don't plan on surgery before December. I find it hard to believe that even at this slow rate it will take until December to have that closed up and my teeth surgery ready, but I'll take his word for it at this point. Just in case, I am stopping any travel plans as early as November. Another thing I asked is when the upper braces will be put on, which as far as I know was going to be closer to surgery, and he said expect end of June or into July. I figure they'll want to step me through the flex wires and on to the surgical wire, which will probably take 2 months alone, so with that timing, you would think surgery could be as early as fall, but who knows.

I thought feeling a smaller gap would be more noticeable, but it's not. What I can feel is the difference in my bite, and wowzers, does that feel odd. Some days I can really feel it shifting and teeth are coming down on other teeth where they shouldn't. The worst is when they feel tip to tip, but then quickly they settle in it seems. I can definitely see and feel my overbite and overjet getting bigger, which is exactly what they are going for by doing the extraction (can definitely see it in the one picture up there). Sucks. I feel like I have these giant buck teeth again, but I know it's all part of the plan. I wasn't biting in to much to begin with because my loose upper front teeth are sensitive and can't bite in to much, but it's getting to a point where even if that wasn't what was holding me back, I wouldn't be able to bite in to much now anyway with the overbite. I've had some issues with food falling out while I am chewing too. Fun times, I tell ya!

Next adjustment is in 2.5 weeks. I am going in about every 4 weeks now. No more wires for me. They said this is the heavier surgical wire I am already in, so that will stay with me through surgery. They're not really moving my teeth any more, hence the wire staying. It's just the gap closure, so every adjustment will just be to shorten my power chain and keep the forces closing that space. It will close....slowly, but surely.

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1 Year Post Op

4/9/2015

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In recovery after double jaw surgery 4/9/2014

I usually don't post back to back, but I think today deserved another post. Yesterday I concentrated a lot on the emotional state of where I am 1 year post op. I wanted to dedicate this post to the more tangible physical aspects of where I am now. It's 9am Pacific at the moment. So, exactly 1 year ago right now, I was smack in the middle of double jaw surgery. Time really does fly, I guess. A lot of patients ask how that first year goes, so I wanted to update where I am.

Anybody reading the blog probably remembers my state immediately post op. I was pretty swollen, bruised, and numb up to my eye ball on my right side and had pretty decent feeling on my left. My swelling didn't peak as bad as most, and what I did get went down pretty quickly the first few weeks. Residual swelling was mostly just some puffiness around my upper jaw, lips, and nose. I think this lasted for a good 2-3 months before finally seeing a drop off back to a more normal state. I still think I am a little puffy, but it's something I notice and nobody else. Some days are worse than others, but overall I feel like 95% of the residual swelling is gone. It's tough for me to report on the jaw pain since my bite is so far off that it's causing continued discomfort. I think at this point I have a good handle on what was discomfort from surgery and recovery and what is discomfort from the bad positioning of my jaws. I would say discomfort from surgery is mostly gone. I haven't had jaw aches/pains in a while. A few months ago I did get tired/achy after giving a presentation for an hour, but I feel like that has gotten better in the last 2-3 months. I was able to open pretty wide even shortly after I was unwired. I am definitely back to full range now, and was probably there within a few months post op. My right side clicks, but I have a feeling that is more from the fact that my jaw is crooked and causing tension on that side. I am hoping this will resolve itself with revision surgery since I didn't have any clicking/popping before the first surgery. Numbness has not really changed much in the last 4-5 months....maybe even 6. My gums still have a few spots that are hypersensitive around my right upper K9, and large areas mostly along the bottom front/right teeth and gums that are numb and tingly. When I bite down it sends tingles through the right half of my bottom lip and chin, which is still numb and tingly. It's not dead numb, but it's numb enough where I sometimes don't realize if I have a piece of food hung up there or if tooth paste drips and gets stuck there. I was SO concerned about the possibility of numbness (funny, since that is the least of all the evils now), but you hear a lot of patients tell you it's something you get used to and it really is not a huge deal. For me this turned out to be totally true. I definitely have gotten used to it. I risk more nerve damage with the revision surgery (actually, much higher risk for it now since they will be cutting through old hardware, new bone, and a lot of scar tissue around the nerves), but I'm not as worried about it this time around. Whatever happens will happen with that.

I went in to get a plain old overbite/overjet and gummy smile fixed. My surgical results left me canted about 5 degrees down to my right. I was left with about 2-3mm more of gum/bone/tissue on my right side vs. my left. I was left with a crossbite and a class II overbite/overjet still. My bottom jaw is significantly yawed out to my left, only one side saw rotation, and has caused the left side of my face to jut out and right side of my face sunken in, leaving my face asymmetric. My top jaw was moved 4mm forward (which was 4mm too far since it wasn't supposed to really be moved much at all) and has caused lip/mentalis strain, cramping, and bad lip incompetence. My lower jaw was only moved forward 3-4mm, even though my surgical plan called for 6mm. My bite post op was originally edge to edge on my left, and about a 3mm overbite on my right. I was impacted up front, but not at all in the back, leaving me with a slight anterior open bite. My orthodontist covered up (eerr... I mean, "corrected") a lot of the surgical mistakes to make my bite appear better to the eye, but I am still left with a huge jaw discrepancy. Gaining 12 lbs back after surgery has also helped fill in some of the asymmetry that was more visible in my face. As of now, I am sitting around 6mm for my overjet, I'm still canted 2-3mm down on my right side, and the rotation and yaw in both jaws is still present. With my current surgical plan having my lower incisor extracted, my overjet is going to get bigger in the next few months, and in revision surgery this will give them room to move my lower jaw forward more to the original 6mm that was supposed to be done the first time, my upper jaw will be moved back to where it started so I can close my lips comfortably without strain again, impact me more on the right to level out the cant and in the back to level out the anterior open bite. They'll do their best to unravel the yaw and rotation to both jaws, but they said this will be the hardest to accomplish perfectly and there are no guarantees. Unfortunately the new bone that has healed over the bad placement of the fracture on my left is here to stay. It will require a third surgery down the road to go in and recontour/reshape everything to make my face symmetric again. I'll cross that bridge when I get to it, but as of now I am not interested in going in for yet another invasive surgery that could cause more damage to my already beat up face.

I am back to doing all of my activities. I would say I returned to normal with all of that the last 3 months. I probably could have been scuba diving at this point, but I wanted to wait until at least a year post op, per recommendations from a few surgeons I've seen. I've got my first dive trip booked to Mexico in about a month, I'll report back and let everybody know how that goes in case there are any other pre op scuba divers wondering. Outside of not being able to bite in to anything with my front teeth (due to my wonky bite, missing lower front incisor, and loose tooth on my upper right lateral incisor thanks to the severe root resorption on it), I am eating pretty much anything I did pre op. I would say by 6 months post op I was back to complete normal for my diet. So, that is that. I would say had everything gone right for me, I would call me pretty normal again by the 1 year post op mark. Now to continue the count down until surgery number 2. ETA is about 7-8 months.

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If I had A Time Machine.....

4/8/2015

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I would set it for exactly a year ago today. I would go back and scream at myself, "Don't do it!!!" Shake myself by the shoulders, slap myself across the face, punch myself in the throat, tie my limbs to a permanent structure in my home so I couldn't leave for the hospital. Anything to alter the course I took during the next 24 hours. This time last year I was less than 24hrs out from surgery, making last minute preparations and slinging back xanax like a banshee. I was nervous, anxious, and oddly excited. This problem that had loomed over my head for most of my life was finally getting taken care of. It was such a long road to finally get to where I was. I would be normal after this. A normal bite, normal teeth, and could continue normal 6 month cleanings and check ups like everybody else. I was looking forward to biting into pizza, or clean through a sandwich with lettuce and tomato in it. I was looking forward to chewing with all of my teeth, instead of just my back molars. I was looking forward to biting in to an apple and corn on the cob for the first time in years. I wondered what that felt like to bite in to something, and actually bite through it with your front teeth. The thought seemed so foreign to me, but I was excited to get to a place where it would finally happen. Even something as simple as a slim jim. I have to use my side/back teeth to bite it. I've never known any different. And the thought of having a smile I could be proud of instead of embarrassed of-- this was just the icing on the cake.

Nobody expects to get butchered in any surgery, especially one on parts so critical like your teeth/jaws/face. But, I'm a pretty pragmatic person, and often adopt the mantra of hoping for the best but prep for the worst. It also helps that I am a scientist in an imperfect science (meteorlogy... you know, the guys who "get paid to be wrong all the time"), so I understand things do not go perfectly all the time. That is the reality of it. I guess what soothed me going in to this and wondering "what if things go wrong?" is knowing that my surgeon had my back. That if things weren't right, my team would fix it. I think this is the most fair a patient can get in terms of being a good patient, team player, and have super realistic expectations. I don't expect perfection, but I expect their best effort to fix things if it doesn't go as planned. And this is where my story turned in to a nightmare. People ask me all the time if I am angry and upset over the fact that somebody can put my face back together crooked and worse than what I went in to fix. Obviously yeah, it sucks. There are days where I am more sad than angry over all, but now, a year later, I am still not angry that there were copious surgical errors. I am instead angry about everything after the errors. My post op care after (or lake thereof). I mean, let me throw this out there right now since I am thinking about it and it's a real possibility that it happened-- if my surgeon did in fact let her resident do all of my surgery, then I am angered with the errors themselves, and the act of the errors, as I did not sign up to have the resident do this surgery on me. For argument sake, I am going to continue this post as if this was all at the hands of my skilled surgeon.

So, I am angry with everything after. I am angry that the errors went unnoticed, or even worse (and more than likely what actually happened), they were noticed and consciously ignored. And when I finally put my foot down and said something is wrong, I got brushed under the rug. I got whisked out of my surgeons office with the promise of, "I'll be in touch," and never really heard from her again. My orthodontist played along and was either working with her to just string me along in hopes that I would eventually leave and drop everything, or he completely dropped the ball and didn't step up and force me back to her when it was necessary. He never fought for me, and whether that was a conscious decision or not to do that, it was wrong either way. I begged for an appointment to be seen and examined. I begged to have all of these questions answered and find out how bad my post operative state was and what needed to be done to fix it, and all I got was more, "work with your orthodontist and I'll be in touch," with nothing but crickets after that. If it was known that I was so far off and required a revision surgery, why not book me for an examination asap and diagnose what is off? Why not get more xrays, scans, etc and tell me what is wrong? That X is wrong, and we're going to do Y to fix it? I know more about this surgery than 99% of my surgeons patients, and she was always able to easily communicate with me about it scientist to scientist. I was so open and understanding, even after it was evident that catastrophic surgical errors were made. I still can't wrap my brain around the total change in how I was handled. Why run? Why cut me off and leave me hanging to dry when I needed you most? All of this despite how understanding, level headed, and realistic I was? Again, back to the whole resident thing, simplest answer tends to be the right one in terms of wondering why she distanced herself and disappeared. If the resident did do the job and screwed it up, she would have to account for that, and instead of admitting and explaining what happened, she chose to run and leave me out to dry. Funny thing is, it all might have been OK had she at least given me an explanation and continued to treat me not only how a patient deserves to be treated, but like a human being. I wouldn't even treat my dog how she treated me post op. It is a surgeons fiduciary responsibility and duty to remain honest and dedicated to your patients ultimate well being, especially if their well being is compromised by your mistakes. This is critical for patient/doctor trust. This was grossly violated with me.

So, here I am, a year later, and I am still in the dark on what exactly happened to me. I never got the courtesy of having an appointment to ask questions, find out what went wrong, how it went wrong, and get a chance to put the pieces of the puzzle together. My orthodontist remained largely silent on this front too, so really I feel like I got steam rolled by two doctors in all of this. What happened to me should never happen to a patient. I am not saying mistakes should never happen. It's a reality that they do. Doctors are humans. But if things go wrong, you don't cut off your patient and never speak to them again. You don't leave them hanging out to dry when they need you the most. When they are the most vulnerable, the most scared, and the most confused and just looking for reassurance and some answers. All I was looking for was a plan. Not an apology, not some place to put blame. My surgeon knew this, because those exact words left my lips when I finally told her at 4 weeks post op that something was off (and it was only then that she said I could be canted and then shoved me out of her office quickly and was never heard from again). I told her I understood mistakes happened, and all I cared about at this point was that me and her were in it together and we were going to figure it out and move forward from here. HOW MUCH MORE UNDERSTANDING COULD I HAVE BEEN?!?! And then to be that understanding and have her just ignore me and leave me hanging like I never happened. Like I did exist. Like I didn't matter. A surgeon doesn't deserve the privilege of practicing medicine if they practice like this. Mistakes happen. This can be forgiven. This can be understood. You can still have the honor of calling yourself a medical doctor. But for everything else....there is no excuse; you are no doctor in my eyes, Felice O'Ryan. It pains me to know other patients could be subject to the same trauma and emotional turmoil she has put me through. But, I need to come to terms with the fact that there is not much I can do about that now.

So, if only I had a time machine to go back and tell myself to back out of surgery. To go back and change the course of all the emotional and physical heartache to come. They say things happen for a reason. Maybe this was my path for some reason. I try to look for the positives in it. I've learned that I am stronger than I even thought. I've learned that there is strength in vulnerability. I've learned that both emotionally and physically, I'm a tough cookie (my husband likes to say that I am tough as nails). I never doubted that I was, but given that I had never really been challenged like this before in my life, this has proven it to me. All the while, I am still reminded of the toll this has all taken on me. I am not the same person I was a year ago, and it's a scary thought to think I may never be my old self again. I am not the peer I was to my coworkers and friends prior to April 9th, 2014. I am not the same wife my husband married. I am not the same patient to my trusted doctors, because now any trust has just been shattered. I am hoping my new team can heal me physically, but I am pretty sure that emotionally, part of me will always remain broken after this experience. I hate to admit that my first team (yes, both the surgeon and orthodontist) took a piece of me that will never return, but it is what it is. And there is no time machine to go back and change it.

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The Little Gap That Could

1 Year Post Op

If I had A Time Machine.....

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