Had my consult with Dr. Gunson on Friday.  First, I will say you get what you pay for with these guys.  In this whole process, I don't think I've ever had so much undivided attention and attention to detail given.  It just really blew my mind.  I don't think any of my appointments have been more than 10 minutes with my surgeon.  My orthodontist is always pretty rushed too.  For what it's worth, I know they are busy doctors, but somehow this guy in Santa Barbara manages to schedule his stuff to where you get his time and you are not rushed.  My appointment was close to 3 hours total.  I got all my questions answered and more.  My head is still spinning from all of it, but it feels so good to finally have my brain wrapped around exactly what is wrong with me and a little more understanding of what went wrong.

Seems like the issues I'm having post op are worse than what I even thought.  I thought most of my issues were confined to my top jaw and that it was off in every direction possible. I was right about the every direction possible, but what blew my mind is how far off my bottom jaw is off.  It's also canted, but yawed and twisted so bad that the buldge I have on my left side -- you know, that one my surgeon said was just swelling/infection and a hematoma from me ripping a stitch the first week post op?  Yeah, not so much.  My jaw is yawed so significantly that the bone is basically sticking out more on that side and causing that lump/bulge. This is not a hematoma that will go away.  This is a permanent disfiguring of my face now.  This was probably the most disturbing news that I got in the appointment. I guess I was just surprised because even though I've wondered in the past if that bulge on that side was really the jaw or not, I just talked myself into believing it was a hematoma and extra swelling that would eventually go away. 

The other surprising bit of information (well, not super surprising since I also suspected this and didn't want to believe it) is my top jaw is moved too far forward.  I've been having trouble closing my lips and again kept telling myself it was residual swelling that needed to go down.  My top jaw is too far forward and making my top lip and area between the lip and nose way too full, making it hard to close.  This is also causing some of the chin dimples and mentalis strain in my lower lip and chin.  Otherwise, everything is about what I thought-- midlines shifted over to the right (my bottom too), canted to the right, and in general everything is just sitting right except for the yaw in the bottom jaw to the left.  No wonder everything has felt so screwed up on me!

So, what do I do now?  Dr. Gunson drafted up a surgical plan.  This system he uses gives all the numbers.  I don't quite know what I'm looking at, but this is what he comes up with:

He suggested my top jaw be taken a smidge back and seated center.  Bottom jaw gets moved a smidge forward and centered with a small genioplasty on my chin to balance out my face.  I forgot to mention that in new news-- Gunson suggests a small genio on me.  I am not sure it's something I would do since it's purely for cosmetic reasons, but I'm also not 100% opposed either.  I would have to think about it for sure.  Now the bad news-- as much as I would love to get my work done with this doctor, the price tag without the genio is 68K.  With the genio, around 73K.  I would also need to be out of work for two months and find temporary housing down in Santa Barbara during the first part of my recovery.  I'd then need to plan on being down there once a month for the rest of the year after that for check ups.  I really wish money wasn't a factor, because hands down I would get the work done with this doc.  He has the time for me and I feel like he would get it right.  I'm thinking about approaching the administration board at Kaiser and asking them to cover the revision since the first one was their mistake and I've now lost faith that the doctors here will do it right a second time.  Not so much just because they don't have the skills, but they honestly do not have the same time this doctor in Santa Barbara has.  Kaiser is like a factory.  In and out, treat em' and street em'.  I don't want to go back to that.  This is not just my face.  It's my skull and jaw bones.  I want this right so I'm not living with messed up bones for the rest of my life.  Have a lot of decisions to make now, and I don't even know where to begin.

On a totally different note-- got home from the trip down to Santa Barbara in one piece, but both of us woke up the next morning with mild food poisoning!  No beuno!!  We both shared food at a local fish and chip shop and both of us were pretty sick.  Had to take another day off of work today since, even though we're not curled up on the bathroom floors puking our guts up, we're now just totally drained.  Might try to get some soup in later, but for now we're good with gatorade and saltines.  Seems I just can't catch a break lately!!

I go for my consult with Dr. Gunson on Friday.  I am nervous, anxious, and excited at the same time.  I'm kind of expecting him to look at me and give me the same look that everybody in my orthodontist office gave me when they first got a look:  "oh, let me see!" and then they get this look of "oh, ddaaayyuuummmm."  It's disheartening, but at this point I'm used to it.  I'm interested to hear what his plan is and how he'd fix things.  Maybe I'm super eager to hear it at this point because I've basically been left in the dark with my team.  My surgeon is almost not even giving me the time of day outside of answering a few emails.  My orthodontist has tried to explain to me what he's doing, but it just doesn't sound right to me.  Nothing is making sense to me.  I don't know much about tooth size discrepancy and I don't understand the whole end game of what he's doing (he's making spaces in between my front teeth right now-- like, am I going to be left with space in between each front tooth?  WTH?).  And I for sure don't understand what is going on surgically.  I have no clue what I would need to be done for a revision.  I don't even know what my problem is right now-- is this a cross bite?  Is it an over bite?  I know I'm canted, but I think there is a bunch of other things going on too.  I want to be told I have X wrong and Y is going to be done to fix it.  That is what I got the first time around and I am seriously not getting any of that this time.  And why?  I dunno the answer to that, but I know I should probably be getting it.  Hopefully Dr. Gunson can shed some light for me with what I need to know.  A shame that I have to spend $300 for the consult (not to mention the overnight hotel stay, the day I have to take off of work, and the 10 hour round trip drive to Santa Barbara) to find this out instead of hearing it from my surgeon and ortho.  I'm starting to doubt my faith in my team more and more.  I keep trying to hang on, but as more time passes I just keep getting further and further from where I started thinking I would be OK going into this again with them.  If I'm not, then that is going to open up a HUGE new set of problems for me.  All I know is if I have to sort myself out with another surgeon like Gunson, I'm not going to be the one footing the $70,000 bill!

Few positives and negatives the last week or two:  on the plus side, I am super stoked about the feeling almost all back in my chin.  I feel like it's come so far and just a little more to go.  On the not so great side, my weird gum sensitivity in a few spots continues (although I don't think as bad as it was when it started, but then again maybe I'm just getting used to it), and I started having some soreness just under my left nostril.  I have an area there where I can totally see the plates/screws under the gums.  Not in all their glory, but the gum is stretched so tight/thin over it that I can totally make the plates/screws outline out.  When I touch it it gives me the heebie jeebies.  When I first noticed it I didn't have a good feeling about it.  I can't see plates/screws like that anywhere else at this point, and it looks like the gum is so tight over it that the screws might start popping out.  So, the soreness is gum soreness I think, and maybe the first hints of the gum wearing and the hardware wanting to start poking out. Add that to the list of crap that just keeps going wrong and will need to be fixed (plate removal is another surgery and I'll be out of work for a little bit again).  We'll see. I am not even going to bother sending my surgeon an email about it because she'll probably just brush me off and not make an appointment to see me anyway.  Guess I'll get the most out of this consult and ask him about it.

I got some of my newest records from my orthodontist so I can take them to the consult I have with Arnett & Gunson in a few weeks.  I look at these as the straw that broke the camels back since it's what made my ortho finally sit back and realized it was probably a lost cause trying to fix everything.  Well,  not everything, but particularly the molds are what made all the hope drain from his expression the day I saw him mount them and get a first look.  And it drives me crazy that I wake up one morning and my bite feels better and I think "wait, maybe he can fix it!" and then the next day it feels so far off again and I truly believe there is no hope.

THIS is the cool looking 3d xray thing I was trying to get posted a few weeks ago.  I can not for the life of me figure out how to view and get it off the disc they gave me.  Maybe it's just not there. 

So... those were kind of the good.  Well, maybe not good per say, but at least better.  Now for some of the ugly.

I almost want to say my teeth meet up better than what is actually in these models, particularly on my right side, but for the most part you can see how bad my bite is here.  Teeth aren't sitting together in the right spots at all.  My left side is so screwed.  Definitely feels better after some of the adjustments he's made though.

And new head shots.  I'm still pretty puffy in these.  I've dropped a bit more swelling just in the last 10 days or so around my upper lip and nose and under my chin, and still think there is just a little more to go.  I kind of feel like I have a chimp face.  I really hope that is just swelling and not that they advanced my jaws too far forward.  I guess at this point if they did, then they can go in and redo that too!  Just add it to the list of crap that needs to be fixed!  ::sigh::

And just for a little comparison for grins:

Is there aesthetic improvement between the two?  For sure.  Even with my crooked smile, left over swelling, and everything else, I think there is improvement there.  But I didn't do this to look better and loose functionality in the process.  I'm 30.  I'm married.  I spent my whole life with my face like it was and I've got no reason to go out of my way to try looking like a celebrity or something at this point.  The whole reason I invested this much money into my mouth to this point was to get my teeth to a 'normal' state where they could be cleaned better and I could better take care of them to have them the rest of my life.  At the state I started with, it wasn't going to happen.  I would loose teeth early.  I'm already down that one molar in the back and I am way too young to be having teeth pulled already.  I wanted teeth that would bite into certain foods that I spent my life not biting in to, or biting in to and having problems.  So, my problem now is I could care less about any slight improvements there might have been from this surgery-- and I didn't even care that much to begin with.  The one thing I cared about, the one thing that mattered most to me, was functionality, and I'm now sitting with a worse bite than I had before the surgery... and even before I was in braces for that matter.  My gummy smile is mostly gone (well, on one side anyway).  Whooppedty freaking do.  I'd trade that back for my old bite in a heart beat at this point.

I did a lot of planning and prep before my first surgery.  I made a ton of pureed soups, bought fruit to do smoothies with, bought a lot of supplies.  First, I am glad I didn't get rid of some of those supplies!  I got a lazy boy chair off of craigslist that I slept in for a few weeks post op.  I couldn't wait to get it out of my living room since I really didn't have space for it, but I'm glad I hung on to it!  I thought my blendtec was going to be my savior while wired shut, but it actually did not do me a ton of good.  I had some issues getting anything thicker than a water or broth consistency in without it clogging up my wires and making me feel like I couldn't breathe.  I think I lived off of Pho broth, juice, and water for the first 10 days wired shut.  My solution this time?

I splurged and got a juicer.  I have a Jack Lalane juicer now, but it oxidizes all the fruits and veggies that go through it where they turn bitter quickly and have no shelf life.  This is a masticating juicer that allows me to keep them in the fridge for a few days and retain all the nutrients without it going bitter.  I hate to say there is something nice about this experience when there is really nothing nice about having to go back and do all of this again, but it's nice having hindsight to help with planning now.  So, hopefully that gives me some better nutrition post op.  If it wasn't for the liquid multi vitamin I was taking this last time.... well, I can't imagine how much worse I would have felt.  I already felt weaker and more out of it than I've ever been in my life, and I think a lot of that was just being super malnourished when my body needed it most in ultra healing mode.

In other news, I made an appointment to see Arnett & Gunson for a consult down in Santa Barbara.  These guys are private docs and the best of the best.  People from all over the world fly in for them.  Price tag is about 60K+ for a full surgery with them, which I can't afford, but I think the consult will be worth every penny, even if it's just for peace of mind.  Not that I don't trust my team, but it will be nice to have an outside opinion on the whole thing.  More than likely he'll tell me exactly what my team here tells me and I can walk into all of this with better confidence that we're doing the right thing, or maybe he'll see something differently and that will give me more to stew over.  I guess we'll find out in a few weeks.  I requested all of my records from my surgeon and orthodontist and plan on being honest with them that I am going for a second opinion.  I don't think my ortho will care, but I hope my surgeon isn't insulted.

And in other other news, I've started to gain some weight back.  I hate that I'm doing it purposely, but I've got to do it before being wired shut again.  It's been a little more difficult this week because my teeth hurt from the adjustment on Thurs AND my bite is now so far off that I'm actually having issues chewing things that need a lot of grinding or small things that your teeth need to fully meet to grind down.  I'm still having good luck with most indian food though ;)

So, the limbo has ended...but it's also opened up new questions.  Saw my orthodontist today and when he brought me in to his office instead of a chair out on the floor I knew it wasn't a good sign.  He's looked more at my models and xrays and is pretty confident that the revision surgery is the way to go. He said my teeth are absolutely not meeting up in the molds.  No offense to him, but I'm not surprised since that is what I've been complaining about the last month.  When I said things were off, I didn't mean a little off-- it was a LOT off.  Pretty bad if I preferred my pre braces bite to the bite I have now.  He confirmed my suspicion about things being off in multiple planes and not just the vertical cant.  Everything is essentially shifted over to the right with my top jaw-- horizontally and vertically.  If I had no root issues, he could maybe have the time to fix it on his end, but even then he didn't sound confident that it would be a sure thing.  He again placed some of the blame on his end, this time saying he thinks I have a tooth size discrepancy (TSD) that he didn't catch and is now a contributing factor as to why things just didn't meet up post op.  I didn't ask if this was on top of the misplacement during the op, but I'm pretty sure he was saying it's that, plus some things he's done to make this all the perfect storm it ended up being.  Again, me talking about this or thinking about it is not me placing blame.  I just need to understand everything and have my head wrapped around the technicalities more than a normal patient.

Here I am, a pre op patient once again.  He's taking a different approach right now to properly position my teeth and take care of it from an angle of tackling the tooth size discrepancy to get everything lined up in a way that is needed before surgery again.  I'm scheduled for pre op molds again in 4 weeks.  He said there is a chance my teeth might be good by then with the adjustments he made today-- and holy crap did those suck!  Because of the TSD he needs to open up spaces in my upper fronts, so I got some springs (really really tight ones) on a few spaces today.  Got a power chain all around my bottom teeth to bring those guys in smaller (my lower arch is bigger than my top arch, as well are some of the associated teeth as well).  He shaved a little of my bottom teeth from the top corners to make some new spaces.  I don't know how that is all going to come together with these new developments, but he was working on them like he has a plan.  Also got heavier wires swapped out on both top and bottom.  Getting the springs in was rough.  Last time he used a spring on my front two teeth it went down as one of the worst adjustments I've had so far.  So, I'm sure wine and pain killers will be on the menu later tonight when my teeth get so sore I don't even want to let them rest together.  So, when will the surgery be?  A lot of factors will decide that, but if all goes well with my teeth movement it could be as early as late July or beginning of Aug.  If it doesn't go well, then probably sometime in Sept or Oct.  I had some fun stuff already planned and paid for in Aug and Sept (concert tickets, plane tickets for trips, etc), but that will all have to take a back seat now.  I also have my sisters wedding in the Dominican in Nov, and then my snowboard season starts in Dec.  Sounds like I'll be out the first few months of that, and by the time I start skydiving again this will almost be a year of no skydiving by the time this is all done and over with.  All I know is when I am finally healed up from all of this, I am treating myself to an awesome trip somewhere to go crazy!


Feeling continues to get a little better in my chin.  Guess that doesn't matter now that it will all be messed with again and I'll start from the beginning with the numbness.  My sinuses continue to feel funny with the whole slightly clogged up in my upper sinuses and in my right ear.  When I talk I feel like I sound as if I were pinching my nose.  It's not something I can blow out.  Instead it's way up there.  Maybe it's just swelling inside my upper sinus cavity?  I don't know, but I know my right ear is bugging me with a slight ache here and there.  It ached on an hour flight I took to and from LA this week, and is especially achy today after the return flight yesterday and my mouth having to be open for a while at the ortho today.  Hope there isn't a little something going on there and it's just normal post op stuff.  I think I'm starting to get more feeling back in my gums because all of the sudden I'm having weird sensitivity pains.  At first I thought it was the tooth, but it's the gum just above the tooth in a few of my upper teeth.  Really weird, but it's made me hate brushing my teeth.  Doesn't hurt when hot/cold food or drink hits it.  Just when it's physically touched with my finger, floss, or tooth brush. I hope it's temporary, because I don't want to dread brushing my teeth every day for the rest of my life!

A few pics from my LA trip.  I realize looking at pictures that I am still pretty puffy.  Makes me look like I have a fat face, which is even more obvious since I've lost weight and the rest of me is skinny.  I usually have a slender/square face.  I think it's the residual swelling making it look round/fat, but who knows, maybe it's a little of my new face that I just have to get used to too.