I was going to wait to make a post next week after I saw my ortho, but a few house keeping notes from this week.  First off, my nerves are going crazy.  But, crazy in a good way.  My chin has been driving me bonkers the last week or two, and then every now and then I get these sharp pains like somebody stabbed me with a needle with an electrode on the top of it and it just goes off for a few minutes. And then the itching!!  Gggrrrr...the itching!  These were the nerve zingers I was expecting the first few weeks post op again and didn't really happen much.  Now we're a few days short of 10 weeks post op, and I am getting them.  And everything is opposite.  First time I got the zingers week 1-3 while still dead numb, and then slowly became less numb.  This time I have gotten more feeling back faster, but it happened without the zingers and now the zingers are hitting.  Weird.  Oh well, at least it all seems to be coming together finally.  Left side of my lower chin/lip is still tingly, but the kind where I am pretty sure I'm going to continue to get everything back on that side.  And then the edges on my right side have the tingles like they'll shrink in too. I am cautiously optimistic that I am basically going to get all feeling back after this surgery (well, at least down to what I started with, which was a numb strip down my right side of the lower lip/chin).  So, again, bravo to my surgeon.  Another thing he did well with.  I am pretty sure at my age in a revision surgery, there was a pretty damn high chance that I was going to have additional numbness, and it feels like I might get lucky on this one and get it all back.  Woohoo!  Huge bonus, as I was already at peace with the fact that I was probably going to end up with more numbness.  Actually love having good surprises on this journey for once!  Anyway, along with the other things coming back are my gums.  Holy hell... hypersensitive again!  My teeth are super sensitive too.  I absolutely hate brushing my teeth right now.  I've been cheating and brushing a little shorter, but it's all I can do to not go off a cliff over it!

And in other changes....  I am officially open 3 fingers!!!

I feel like I've been stuck a little over two fingers forever, and then in the last day or two-- bam.  3 fingers like a boss!  My right joint flared up on me bad earlier this week.  I was really worried again.  Pretty certain it's the disc slipping out and once it starts, then it has to have it's little fit for a day before calming back down.  So far no issues since, even when getting all the way open like this.  Hopefully that continues to be happy and healthy from here on out, but I wouldn't be surprised if it continued to have little flare up the next few months of recovery. 

And then.... then this happened: 

It was another one of "those" moments.  Not just for this revision recovery, but for the whole process to get to this point in general.  Class II patients commonly complain about eating pizza.  You bite in to it and drag ALL the cheese and toppings off in one bite.  Half the time I just do a fork and a knife to eat pizza so I don't get pissed off not being able to bite clean with it.  I was out at a concert with my husband the other night, and for the first time in my life, I bit clean through a piece of pizza.  No mess, no fuss.  This was on my list of wants after jaw surgery, and I got it.  I've thought about that moment for years.  So, even though I don't like to cry in public, I totally cried in public over this one.  They were happy tears though!  I even sent the bite picture to my surgeon and told him that so far the only undesirable surgical outcome I've had this time is getting a bite good enough that now all I want is greasy pizza that isn't good for my waistline!  He got a chuckle out of it, I'm sure.  Now next on the list is a sandwich or hoagie to bite through and get cleanly through the lettuce/tomato/etc in it without pulling it all out.  Not going to happen quite yet (especially with my loose front teeth), but I know I'll get there eventually.

Speaking of my bite, I decided to snap a few pics of my bite since I am updating this post with some pictures.  Of course I chose to take these after eating curry, but oh well.  Don't judge.  My teeth are still coming together nicely.  Actually had to email my ortho and ask what I knew was going to probably end up being a dumb question, but I did it anyway and figured worst case they get a chuckle out of it.  My bottom front teeth are hitting the back of my upper front teeth when I bite.  Since I've never had my front teeth touch in any way before, I wasn't sure if this was good or bad, so I had to ask.  Turns out it sounds like it's not an issue and the treatment coordinator who responded to my question did in fact think it was cute that I had to ask and got a chuckle out of it.  A few notes-- my teeth are not perfect.  My front teeth have some work left on them.  They're all kind of tipped (not proclinated or retroclined, but actually tipped in the direction like if you were waving with your hand) and need to be righted.  The loose tooth 7 needs to be extruded some more (you can tell it's shorter than the rest of the teeth), my ortho is still fine tuning my gum line, and my midline appears quite a ways off, but it's actually not that far off-- it's my nose that is crooked!  I've also got a tooth size discrepancy thanks to my first ortho bonding my two front teeth in the wrong shapes (one is bigger than the other), so that is throwing it off too.  So, hopefully that looks better after I get my deviated septum fixed and restoration done, but as it is now, I don't really care about it much in terms of the way it looks.  As long as my bite feels good and is functional, then I am good! 

I took some pictures of my bite in the same spot 2 years ago.  Actually almost two years ago to the day!  This is what my bite looked like 3-4 weeks post op last time:

What a difference two years, a round of good revision ortho, and a successful revision surgery makes!  Really sad looking at the bite pictures from the first surgery.  So sad!!

Anywho.  This was supposed to be a quick update, but those of you who know me or know me through this blog... you know my posts are never quick ;)  I see my orthodontist in a week and Dr. Karas in two weeks.  Crossing my fingers I can get out of rubber band jail a little finally!  I think that is what is making my right side all pissed off-- or at least helping that along in that direction on top of the normal aches/pains of healing.  We'll see!

Even though I knew this part of treatment was coming for a long time, I was still dreading it.  I talked in my last post about my extremely loose front teeth when they were out of the arch wires at my last appointment.  This has been an ongoing issues since my first surgery when I found out that my roots were disappearing on my teeth without any word from my treating ortho or surgeon about it.  They just let it happen and like everything else, turned the other way.  When it finally got brought up, they told me it was just hints of some root blunting and nothing to worry about.  Well, here it was some severe resorption going on and not just hints of blunting, which really wouldn't have been a big deal.  Bad enough resorption where great care should have been given as to how my teeth were being moved, and instead my first ortho was super wildly yanking them all over the place to try and compensate for how messed up I came out of surgery.  So, like everything else in my treatment, I took it upon myself to get with a prosthodontist and start monitoring the root health of my teeth.  He's been wonderful.  He's also super honest, and has told me from the start that the prognosis on my upper front teeth was not good at all.  So, I proceeded with my second round of ortho (because I was in that much face and jaw pain that I didn't have a choice and had to risk more damage and possibly losing these teeth by going through ortho again) and knew we would be revisiting the state of these teeth.  Well.... we're finally at a place to do that.  So, lets break today's appointment in to the good, the bad, and the ugly.

The good:  I've got about 6 months of braces left.  That is what my ortho said when he called my prosthodontist to talk.  So, yay for that.  But then it's a huge boo, because that was literally the only good out of this appointment.

The bad:  The resorption is bad.  Really bad.  He didn't even take new PA's (which I am surprised at, because I think I am due for them soon anyway), which means he probably just talked to my ortho and heard from him how loose those teeth were.  My ortho had a face on him like, pure shock, where he had never seen teeth that loose before.  I am not too worried about not having the PA's today because today was just a rough meeting to start to pow wow on what we want to do.  We've got 6 months to stew on all of this.  My prosthodontist is actually going to try to get back together with my ortho and surgeon to talk about everything and decide best course of action for us.  The other bad is the beginning of what is going to be an endless money pit.  I had nothing done today.  No xrays, no nothing.  Just to sit and talk with my doc for 15 minutes, that was $125.  This is just the beginning of all of this.  I've been trying to stash away what I can to cover what's coming, but just thinking about the numbers makes me sick.  Luckily my first orthodontist refunded me back the $8300 I spent for treatment with him, but that totally just turned around and went to my next ortho.  So $8300 for braces, and we're sitting at $6000 for surgery (including the cost of the copay for my surgeon and cost of picking up the extra medical for him. Surgery costs will probably go up since I haven't gotten the hospital bill yet), and all the restorative work is going to be in the $10,000-$15,000 range if I had to guess.  So I'm looking to be up around $30,000 for my mouth the last 3.5 years when this is all said and done.  No wonder my savings account keeps going down instead of up the last few years!  Ugh!

The Ugly:  The teeth are goners.  My 4 main upper front teeth (the 4 teeth in between the K9's, teeth 7-10).  We were hoping teeth 8-10 could maybe stick around for another 5-10 or maybe even 15 years, but they seem less optimistic now.  Actually, my prosthodontist today said something like "actually, I can pretty much be 100% certain if you try to keep these teeth, it's only going to be a couple years.  Maybe 2-3."  So, they sound pretty damn sure at this point.  So, what are my options?  Do we rip them all out and go straight for the gold as soon as my braces are off?  Do a wait and see approach?  Do 4 implants on all of them, or go for an implant on each lateral incisor and bridge the two main incisors in between?  The prosth is leaning towards the outer implants with the bridge.  I am super hesitant on this, as I've done some research that says that is not good for bone.  I'm young, and that is an awful lot of years for bone to shrink away and it ends up looking like dog crap later.  But he says it would be worse to do 4 implants next to each other, because you end up losing gum/tissue when they are right next to each other and that ends up looking like crap later.  So, sounds like I am damned if I do and damned if I don't.  I definitely trust his opinion though, and I really want to hear what my surgeon has to say about this.  He does implants all the time, and last I talked to him he was down with 1.) me keeping the teeth as long as I could to preserve bone, and 2.) I think he was also thinking implants for the same reason I was, but I'd have to ask him again because I am not 100% sure on that since it wasn't a point blank question and more of just a sum of some things he's said over time.  I definitely for sure trust his opinion too.  I wish I was seeing him sooner than in 3.5 weeks because my mind is going to be spinning wondering what he thinks.  All of them are going to talk about this, and if I had to guess, they'll tap in to their study groups and get the other docs opinions too.  So, there will be lots of eyes on my planning again, which is really fantastic. 

So, I have really mixed emotions over today.  This is not necessarily new news.  They've slowly been prepping me to hear that this wasn't going to work out.  They've been honest with me from the start on the prognosis of these teeth, but I guess in the back of my mind I had a secret hope that we could make do with teeth 8-10 for a good long while and take care of them later.  I am not worried at all about 1 implant, but the thought of losing all 4 upper front teeth at once is completely devastating for some reason.  I originally embarked on all of this work so I could save my teeth, and here I ended up losing at least 4, and possibly more (my bottom incisors actually don't look great on xray to me, but my team has not said anything about them....yet) because of it.  So, in terms of tooth health, I was better to begin with when they told me I wouldn't be!  Ha!  Funny how life works sometimes.  Despite this not being new news, I managed to still get a little rocked by this today. I think the prosth was waiting for me to lose my shit in his chair,  but as always, I remain composed.  I know at an appointment when he first told me I was going to lose these teeth, he said he was surprised I wasn't more emotional.  Like, maybe he thought I didn't get it or it didn't sink in what he was telling me.  Nope.  I am just usually not a crier, especially in public places in front of strangers.  So, I did what I normally do in these situations...... I lost my shit in my car instead.  I got in my car and had to pull over and just have 10 minutes to let it go.  It's teeth.  Why is it such a big deal?  Well, it's something so permanent to each of us. Something to integral to our health and well being.  It's quite a big deal, actually.  Think about it-- have you ever had a nightmare about losing teeth or getting teeth pulled?  There are even definitions in dream books about this because the dream is that common.  I also think another reason I am so upset is because this was something that was probably preventable. I am not 100% sure, but I am pretty sure that my first orthodontist was a huge cause of this.  Could I genetically be prone to resorption?  Yes.  But that guy moved my teeth SO hard and SO fast.  Ridiculously hard and fast.  I had to eat vicodin through my whole round of treatment with him, and my second round of ortho I haven't needed so much as an advil.  I am not sure, but I think if you look at my xrays, they show that the amount of resorption I have is not typical of somebody experiencing normal resorption from normal orthodontic movement.  It's definitely trauma induced.  And once it started, that was it.  No matter how gentle and slow my second ortho is (and he has been amazingly gentle, slow, and attentive to my roots), the damage was already done and going.  So, just the force of being in even the lightest wire is going to keep the damage coming no matter what we do.  So, that is the deck of cards I have been dealt here.  And on the tangible side with all of this, it sucks that I am again left paying for damage somebody else did to me. When I am all done with this, I'll probably have spent $30,000 to fix what my original surgeon and orthodontist have done to me.  All the while, they just get to keep on keepin on. 

So, last tid bits and on to a different topic(s)--- I sent letters to both my first ortho and surgeon.  I let them know how I feel about everything that has happened to me, let them know that their treatment for me was not only wrong, but down right immoral, and I updated them with some records to show them what good work and at least the standard of care looks like.  They might not even read it.  Who knows, but at least I feel like I've said my final word and can hopefully get some closure from it.  It's probably the closest thing I'll get to closure there.  Otherwise, my bite is still looking great!  Actually, it's starting to feel really good. My bicuspid on the left is no longer tooth tip to tooth tip and everything is now seated in their new little homes in their grooves.  I wouldn't be surprised if I am officially class I all the way around now. At least it looks/feels like it to me!  Still getting used to it, even two months in to this now.  It will definitely take much longer to feel normal again.  Like last time, it didn't happen over night, so I am in no rush.  Pain wise I am doing pretty good.  I think the worst of it for me is in the morning after clenching at night, my upper jaw across the osteotomy site is sore and around the plates and screws are puffy/sore.  I remember this happening a long while last time too. I'm still puffy in the same spots.  My numbness has gotten a smidge better on my lip/chin.  I feel like I can definitely feel my lip more, and I am getting some bad shocks and zingers this week.  One yesterday was REALLY painful and lasted for a good couple of minutes where I was out loud saying to myself, "wtf?!"  I've also hit the super sensitive phase where my gums/teeth are sensitive.  I think this is the feeling coming back in the gums.  I hate brushing with my electric tooth brush right now, but it has to be done.  I think this lasted 1-2 months last time. Ugh, no bueno for that.  And last but not least in other news.... I got a hair cut!  I made the big chop back to a pixie cut (see pics below).  Hard not having a mop to hide my puffy face behind, but oh well.  I started losing hair again bad like I did after the last surgery, so I am not dealing with it again.  Off it went!!  I am still not sure I am in love with it, but it will be fun to have while my hair goes through this weird shock and shed cycle again! 

I was a little anxious going in to this appointment.  I noticed over the last 7-10 days that my bite was feeling a little different and my right lateral incisor was looking a little wonky.  My bite is for sure going to feel different, but since I have never been through this phase of ortho, I am not familiar what is different good and different bad.  I think I can definitely spot uber bad, but what is that kind of bad but not the end of the world?  Who knows!  This is why I am not the doc. But, I kind of was questioning if the left side was supposed to feel a little wonky like it didn't quite fit together yet, or was that something I should call and get seen for because whatever movement he's doing with the band is throwing it off in a way he didn't want/expect?  Anyway, I upped my Mon appointment to today because I didn't want to stew over it all weekend.  Turns out, I was mostly worried about nothing.  Thankfully!

My ortho's office was dead.  Like...dead dead! Spring break for Danville this week, and all of those families up there get out of dodge for vacation, so the kids aren't even around to be seen.  I didn't mind.  I pretty much got my ortho's undivided attention in an unusually quiet office.  Not that he ever doesn't give me his proper attention, but it's nice to not wonder in the back of my mind, "crap, is he running behind? Does he need to get with the patient that just sat down next to me?"  So, he spent a lot of time having me bite, and relax my bite so he can try and see where my teeth are lining up organically without me thinking about it. He stewed over this for a few minutes and then untied me and took the wires out. Turns out there was a sneaky broken bracket!  It didn't even look broken when everything was on.  I couldn't tell either! So it came clean off with the wire and didn't even leave any glue behind. It's my doomed tooth 7 that needs an implant asap after treatment, so he took the chance to give it a little wiggle.  "Oh my goodness this tooth is so loose!" and he went on to give 8, 9, and 10 a wiggle while they were out of the wire and he said all of my front teeth are very loose. Ugh.  I am not surprised now when it's discussed, but it still sucks to get reminded how bad my front teeth are and the restorative work I need on them.  Speaking of that, my ortho suggests I start getting together with my prosthodontist and starting some work.  Especially my missing back molar can be started since my teeth are already in the position they will be in post op and I can get the implant post in there now before the braces are off.  But I guess we can start talking game plan on the front teeth, which my ortho offered to call him and consult in case the prosthodontist wants my front teeth in a certain position to set him up better for the implants.  So...again, more bad news for my front teeth.  But, all of this restoration work and talking about kicking me over to my prosthodontist means that the end of ortho treatment must be in sight. I still haven't asked because I hate being that guy, but if I had to guess, I would say we must be no more than 6-8 months from getting my braces off if they are allowing me to start some of this work. 

So, bracket rebonded, a few new bends in my top wire before it's put back in, OK'd to get with my prosthodontist, and then we start looking at elastics.  Doc said the fact that my left side is not quite sitting right yet is not something to worry about.  He'll bring it together and he's got plans. He said he wanted to put me in looser bands and I think he saw a concerned look pop up on my face. He assured me right now that I can relax a little. He said we're officially past the point of being worried about the bite floating off right out of surgery, and worrying if the surgery was a success or not and if it was going to take.  I am officially now in the stage where the bite is solid after surgery and now he is just doing the fine tuning and guiding, so the lighter elastics are OK.  Man oh man, was that nice to hear!  And I think he knows I needed to know that we're out of that danger zone!  PHEW!!!  So, lighter elastics with one triangle on my left, one on my right, and then a class II still on my right as well. You can check out the new config in the vlog below.  I can already feel my bite feels a little better after the tweaks today.  I can also feel my top teeth are sore.  The one tooth was not engaged the last however long (probably 2 weeks) and the power chain was old and lost it's pull a long time ago, so the fresh one is definitely a little snug and I'm sore for it.  Not awful though, as always with his adjustments. 

Anywho.... it's just nice to know we're still OK!  Other house keeping to report is not much different than last time.  Numbness on my lower lip/chin is very very slowly getting better I think.  Swelling and soreness is still up and down.  I have a good day, and then the next day a bad day.  Most of it is self induced though.  Like today I woke up swollen, but it's because I was bending over doing a lot of weeding in my garden all day yesterday and that irritated everything.  Oh well.  Right TMJ still a little sore.  Had a little crunching in there yesterday, but not major slips like I felt a few weeks ago.  Hopefully we're done with whatever that was!  Next ortho appointment is in 4 weeks, and I see Dr. Karas in 5 weeks. Now I guess I'll be seeing my prosthodontist sooner rather than later.

One last note-- two year anniversary of my first surgery coming up in 2 days.  Time flies.  I am not making a dedicated post to it this year, but it deserves to be mentioned. Last year when I wrote my 1 year anniversary post, I was hoping and praying the next anniversary post would be written from a much better place after revision.  It most definitely is, and for that I am thankful.  I am still not emotionally fixed, but physically I am much better.  Again, something I can not thank my team enough for.  At least now the anniversary of this surgery will be something to celebrate instead of be sad over!

And then check out this little gem I recently came up on (thanks to fb memories) from 3 or 4 years ago....... good reminder that although the road has been bumpy and long, now having teeth that are in line with the teeth below it is not only healthier, but SO much better looking! 

I was just glancing through a few old blog posts to refresh my mind exactly how the feeling came back in my face after my first surgery and compare it to how I've been healing this time, and wow....  I am kind of depressed after reading the posts from around that time!  Here is my post from 6 weeks post op after that surgery.  I'm not lying when I say that I just reread some of those posts and I shed some tears.  I mean, it's definitely sad for me to go back and rehash what I went through.  I even had some of the emotions from that time come back and hit me-- the confusion, anxiety, and just genuine sadness.  God, I was SO sad and confused!  Notice I didn't say angry.  I seriously wasn't angry then.  Everybody is always surprised when I tell them that, but if you read the posts around that time, you'll get my reasoning.  My take on the surgery at the time was "shit happens."  Your doctor is not God.  They make mistakes, and unfortunately somebody has to be the mistake every now and then.  An honest mistake that causes an undesirable surgical outcome is a risk of any surgery, and I understood that risk and had the surgery.  It's life when it comes to this stuff, and I wasn't angry... at least not while I thought I was a part of an honest mistake and my doctors weren't about to do some major moral injustices to me. But, we all know what happened with all of that and after that, yes, I had every single right to be not only sad, but also angry after what was done to me.  Even now that it's all said and done, I think overall I took things like a champ and deserved to be a little more raving angry, but I didn't go there.

Reading those posts has just made me reflect for a second and be even more thankful for the experience I am having this go around.  I am pretty damn thankful all the time (as you've read in more than a few blog posts lately!), but now after reading my words and thoughts from this time post op after the first surgery, it's made me even more thankful for the team I have and the care I've received this time around.  This all has actually hit me at a time when I was already reflecting on some things and thinking about how this has all impacted me.  I chose to take what happened to me and try to take it in a positive direction.  Being involved helping other patients out and being vocal in the online jaw surgery community has given me quite a bit of joy.  It's actually one of the reasons I keep this blog going-- in case my experience can somehow help another patient out.  There's been a few cases I've helped where I convinced the patient to advocate for themselves, seek second opinions, etc, and they end up finding out things weren't right and it puts them on a path to hopefully getting fixed like I have.  Off and on over the past year or so, the thought of doing something professionally has popped in my head here and there. But what can I do to satisfy this new passion of using my experience to help other patients while satisfying my science/technical brain?  There are positions out there like treatment coordinators and specialists in orthodontic offices.  It would be a huge pay cut for me though.  Same with ortho assisting.  I think the more technical and hands on aspect would be satisfying (although, I am not a fan of being all up in peoples dirty slobbery mouths, so that might be a problem), but it too would be a pretty significant pay cut.  I am not sure what the deal is with something like the assistants in my surgeons office.  That might be better pay AND it's more technical.  Two of the assistants got to scrub in and assist my major surgery-- how cool is that?!  Sadly, it's too late in life to go full on DDS.  And again, there is that whole issue of I don't like slobbery fluids.  Even when I see people spit it makes me gag.  So, my options are pretty damn limited, but it's neat to think about how I could jump both feet in to something COMPLETELY different than my current career/passion.  I definitely would love to use this experience to help others.  From a selfish standpoint, at least doing that helps me feel like going through all of this nightmare wasn't for nothing!

Anywho, 6 weeks post op is MUCH different this time around, and I am VERY thankful for it! :)