40/50 Cranks

I'm almost done with the expansion -- yeah! At this point I look a little cartoonish -- early on I looked like SpongeBob, but now I'm thinking Goofy or Pippi Longstocking (maybe I'll dress up for Halloween this year). My gap is so large (6.5mm) that I can comfortably fit a large straw right down the middle. I asked my orthodontist about the "tipping" on the left and he agreed, but it's not a problem and will be corrected with the bracses. When I was having fluoride varnish painted on my teeth I saw all of my stitches for the first time -- I had never really realized just how many there were! I went to my last oral surgery follow-up appointment and things are going well -- nothing new at this point. My gums are still numb, but I think that this takes months to heal.

The Gap Just Keeps Getting Bigger!

I'm now at about a 6mm gap (as you can see in the pictures). Overall I feel great, but am dying for a steak and french fries. I branched out this evening and had some salmon which was VERY tasty and went down easy. Things seem to be moving, as the gap is getting wider and wider. So far I've cranked about 36/50 times (9 mm total) The left side, though, seems to be tipping out a little, so I hope that the palate is expanding and it's NOT that the teeth are just getting pushed out. I also realized that I have upper lip edema still. I was pushing up my lip in the mirror to check out the stitches, let my lip go, and a deep crease remained for several minutes -- very strange...

I also now see what Dr. Alexander (OS) was saying about my really crooked nasal septum -- it's glaringly obvious in the pictures!

Yesterday, we went to the Fredericksburg Agricultural Fair and my husband dared me to show up with my hair in pigtails... I was a great look! The horse picture above is "The World's Largest Horse"...

Ortho/Surgery Follow-ups

I can honestly say at this point that I feel mostly recovered from the jaw surgery. As with everything, time helps. My trouble with eating and talking is now the result of the expander and the ensuing gap, NOT the surgery. So if you're considering having this surgery done, I would say "Go for it"!

I had two follow-up appointments today. At Dr. Alexander's office (OS), I was again told that things seem to be going well, though the sutures still need another week or two until they're clipped. I realized yesterday that my upper gums were completely numb (they felt like rubber), but supposedly the feeling will return in time. It's probably not a bad idea to not have a whole lot of sensation at this point. The highlight of the visit, though, was looking at my CT scan -- all I can say is that technology is amazing! The scan was 3D and the OS could click a button and the skin gave way to muscle which then turned into the underlying bone. It was very cool to see the "cuts" in the bone that had been made. He could spin my head around and upside down to get visuals through the sinuses, etc. Bottom line is that I have a very weird nasal septum which explains why my nose is crooked on my face. If you read an earlier post where I was wondering what was wrong with my nasal tip (i.e., was it too pointy), alas it's just crooked. I will try to get a copy of the CT and scan it into this blog.

I went to the Orthodontist today to be "fitted" for a prosthetic tooth, but my gap isn't large enough. On measuring this morning, I've cranked 6mm, but the gap is only 3.5mm. Dr. White shaved down the left side of the expander so that my teeth would match on the other side. Due to teeth movement, my right side was suspended in air which was a little weird. I'm hopeful that this will help with eating. Dr. White intimated that the expander will probably be in for 6-7 months. Even though the palate bone will be strong enough to move teeth about 2 months after the expansion stops, he likes to keep the expander in so that he can move around the lower teeth to better positions without having the top teeth get in the way (and also to avoid a really awkward bite if teeth are in strange positions). He thinks that I may be ready for the 2nd jaw surgery in about May-June of 2009 (wow!)... Right now the prosthetic tooth will be installed on 8/18 (pictures to follow)...

I'm Starving!

Today I hit an all-time low with the food... I have not really chewed anything in over 2 weeks. My son turned 5 today, and at his party with his friends we had pizza which I love, but now can't eat. As soon as everyone left, I took a fork and scraped off the top layer of several pieces of pizza and devoured (in miniscule bites) a pile of cheese/soft crust sludge, and it was fantastic... :) Ice cream cake also goes down beautifully...

For the record, my jaw does NOT hurt from the surgery. At this point my problem is with my expander and with my teeth. Yesterday I had the sensation that the right side of my expander was a little loose. I could hook my finger on the edge if it and wiggle it a tiny bit. I didn't think much else of it at the time. This morning, though, when my husband cranked I experienced excruciating tooth pain on the right side. All three of the teeth covered by the bonding plus my incisor were very sore to the touch. I couldn't even squash a soft noodle on the right side because of the pain. The interesting thing, though, is that the expander is no longer loose. I wonder if the cranking has put strange pressure on the teeth? For now, no smushing will be happening on the right... I can't wait to get the expander out!!

I have cranked for 11 days...22 turns... 5.5mm. The gap as measured today is about 3mm (good). I'm still pretty drooly and lispy, but it's getting better every day.

2nd Oral Surgery Visit

Today's visit was quick and easy. The healing seems to be going well, the sutures are mostly intact, and my jaw is obviously expanding. It's still a strange sensation to crank, because you can feel the base of your nasal passages expanding. Luckily the outer portion of your nose doesn't appear to spread, though in some of my pictures I do feel like my nostrils are more prominent (i.e, more pig-like). At the conclusion of my visit, Dr. Alexander mentioned that he wanted to go over my CT scan from last week with me at next week's visit because my deviated septum is impressive. There's a point in my nose he said where I "move no air". Personally, I've always been a mouth-breather (which probably has led to some of my jaw problems) and haven't felt comfortable breathing solely through my nose, so maybe it's the septum which is the problem. He suggested that at the conclusion of all of my orthodontia I might consider getting it fixed, and that my "nasal tip" could be fixed at the same time. Of course, driving home, I'm looking at my nose at every stoplight thinking "What's wrong with my nasal tip?" I guess I'll find out next week...

Having jaw surgery is a not-so-great weight loss plan... In almost 2 weeks I've lost about 10 pounds. When you're drinking your calories, or smushing mushy foods (which takes awhile), I find that I'm bored and frustrated before I've actually eaten very much. I'm not a cook, but I've got to figure something out because I'm bored to tears with yogurt.

First Day Back at Work/9 Cranks

Today was my first day back at the Pediatric Center. My office was nice enough to block some of the office visits in my schedule so I could get back in the swing of things. I'm now Post-Op Day #11 and overall am doing fine. Everyone was so sweet at work and thought that I looked pretty good compared to how I looked in some of the earlier posts. At this point, the swelling is mainly in my lower cheeks and upper lip. The unfortunate part of my job is that I talk to patients ALL DAY LONG! I tried to very masterfully slurp my spit while babies were crying, so as not to gross out the parents, and worked hard to not use words that had "ir" or "er" in the middle, because I can't get those sounds out intelligibly! By the end of the day, my jaw was definitely tired and I needed some Motrin.

I've now cranked 9 times and have expanded 2.25mm -- the gap is getting larger but isn't too bad so far. I have my 2nd oral surgery follow-up tomorrow, so we'll see how things are going!

Sore Tongue/Post-Op Day #9

Overall, the swelling is better every day and my yellow cheeks are much improved. I can drink liquids comfortably (especially mango margaritas), but really can't chew yet, so it's all liquids and yogurt for now. For whatever reason, I woke up this morning with a sore tongue! I looked in the mirror and the papillae on my tongue were unusually prominent and I had 2 or 3 tiny little cuts from rubbing against the metal expander. I'm sure everyone reading this has at one time or another had a small "bump" on their tongue that ended up being excruciating every time it touched their teeth -- now multiply this by 20. Talking is very awkward when you're trying not to move your tongue. Luckily, I remember reading in Brandy's blog about a similar issue and went out and bought "Active Flex" band-aids to wrap around the expander to cushion the tongue. I put one on and it made a huge difference, though it was a little hard to maneuver. I'm hoping that tomorrow everything just calms down. I also started swishing frequently throughout the day with Peroxyl (hydrogen peroxide mouth wash) in hopes that it would help. We'll see...

Surgery Follow-up Day/Post-Op Day #7

My headache is 75% better today...my vote is for sinusitis! This should convince me to finish all of the antibiotics.

Today I went to Dr. Alexander's (OS) office for my first official post-op! Overall, everything seems to be going fine. He was actually surprised at the extent of my swelling, because he felt that the surgery couldn't have gone smoother. I also received some clarification that he had performed a Lefort I, which essentially detaches your upper jaw all the way around, splits it in the middle, and then just lets it hang inside the sutured gums. This "hanging" is why I was having all the disturbing sensations with swallowing early on. When he does a Lefort I, but actually moves the upper jaw forward, the jaw is re-anchored with plates which makes things more stable and comfortable. This actually gives me hope for the 2nd surgery in a year or so... While I was in the office, cranking began. He turned the expander 2 cranks equaling 1/2mm. Immediately after the turns, my two front teeth had a tiny space between them. The cranking wasn't painful, but you had the sensation that your sinuses were opwning up a little!

Post-Op Day #6

I was too tired to post yesterday -- I don't know what's wrong with me but I have had the worst headache! Starting yesterday I began with a splitting headache -- at first I attributed it to lack of eating and drinking/caffeine, but then I started to think that I might have sinus infection. Touching anywhere on my head or sinuses was excruciating -- it was like a sandbag was resting on top of my head and face. If this is what a sinus infection REALLY feels like, I have never had one before in my life! Since I'd finished the Keflex that I was prescribed, I fished some old Augmentin out of the linen closet (I know, bad doctor not finishing all of her antibiotics) and figured it couldn't hurt to take "just in case it helped". The alternative is that there was something really wrong in my brain. I've just finished the 3rd dose and have essentially slept (Vicodin helped) for the last 36 hours. I'm hoping that I'll wake up tomorrow feeling better...

My swelling is getting better every day, and talking is happening more, though it's still very garbled. In my head, my speech sounds very nasally and I sound like I have a pretty serious speech impediment. Hopefully this is not my new voice. Swallowing is not as painful now which makes getting in calories much easier.

On a good note, I took my almost 9 year old daughter, Lauren, to the orthodontist today for a "checkup". These days it's recommended that kids be seen around the age of 7 because there are lots of things that they can do early to help prevent trouble in the teenage years or later. According to Dr. White, Lauren will need a little expansion on the top and bottom, but none of her problems are serious enough to warrant doing anything now, and that she'll just need one phase of treatment around age 11-12. This is good news on the financial front. :)

Post-Op Day #4

As expected, everyday the swelling gets a little better and I can move my mouth a little more. Two interesting turns of events -- both lower cheeks are a sickly shade of yellow and my upper teeth are loose. Up until this point, I literally thought I had no bruising. All of a sudden, both lower cheeks are bright yellow which is a normal color several days into bruising. It's almost like the blood has finally settled to the lowest point -- I also seem to have gained a double chin (check out the picture once I post it). Since I'm feeling more in my mouth I also noticed that my upper teeth are loose -- all of them! At first I thought it was just my jaw shifting around, which I think is part of it, but the teeth themselves wiggle around like I'm 8 years old! Even the sheer act of walking causes them to move. I finally had to stop touching them SO THAT MY TEETH DON'T FALL OUT! :) I made my husband call the OS and he confirmed that this was normal. Swallowing is also a little easier today -- less bone shifting overall. I tried to eat some soft meat at dinner and again it was a disaster. Knowingly swallowing your food whole is just too weird (sort of like a snake). I instead went to Ukrops and bought some 500 calorie smoothies with 30g of protein.

Post-Op Day #3

Today the swelling in my face has decreased dramatically (thank goodness). I can open my mouth a little bit more and was able to swallow some liquids without pain as my facial bones shifted around. I'm still continuing to ice and have switched to Motrin as the main painkiller. I've had a constant headache for a few days now, but am attributing that to mild dehydration and caffeine withdrawal. I used to drink two Starbucks coffees a day and then went cold turkey to nothing! Not a good plan... Do you like how I got my nose to ooze on command? :)

I see my oral surgeon this week and am interested to see where I fall on the spectrum of surgical patients. From what I understood going into surgery, I would be eating soft foods in no time at all, and that a liquid diet wasn't really necessary! At this point I can't imagine being able to mash food anytime soon! I tried to put a small piece of lasagna in my mouth tonight and I couldn't figure out what to do with it...I couldn't mash the food in between my molars because I have a splint-like expander in, and when I tried to swallow it I couldn't put my lips together, so in the end I just cleaned it out with the WaterPik! :) Pure liquids are much easier...

Post-Op Day #2

The swelling is actually worse today, which I think is to be expected. I'm very happy that I have my WaterPik and mouth cleaning sponges because they are a life-saver. Because your mouth is slightly open due to all of the swelling, everything just dries on your tongue and on the roof of your mouth. The sponges very gently and efficiently clean out all of the gook. My nose is still bleeding off and on, but nothing that won't stop with a tissue. It seems to be worse after I swallow, because the palate and nose shift some, probably opening up small capillaries. I'm still on a liquid diet. I recommend looking for smoothies, etc. that have lots of calories and protein. You may not be eating very much so you want to get the most bang for your buck.

On a professional note, thank you Carolyn for doing my hospital rounds and call tomorrow -- I would have scared away the patients!! :)

Post-Op Day #1

What beautiful swelling... My cheeks are so tight today that I can't move my lips (which feel like swollen sausages). In the picture I look like a deer in the headlights, but it's just that my face is so swollen, there's no room for any expression. I've tried to swallow some sips of water, but I can feel the bones in my face moving which is not comfortable. I tried to explain to my husband that my face feels "springloaded" like a mousetrap. With every swallow, I can feel my nose, teeth, and palate move. I have to "gear up" for every swallow, which pretty much takes the enjoyment out of it. Also, because my lips won't close, I can't swallow my spit (which seems to be in overdrive), so it just sort of drools out and I catch it in a rag. I'm trying to at least get some Motrin in and take my Keflex (the antibiotic prescribed by my OS). The good part of it is that the pain really isn't too bad! I'm pretty much writing everything on a pad of paper because I can't speak at all. Hopefully this is all normal stuff...

July 10, 2008 SURGERY DAY (SARPE)

Today I got to the hospital at 6am for my rapid palatal expansion surgery. After having an I.V. put in, and meeting with 3 anesthesiologists, I was taken into surgery around 8am. I literally remember nothing about the surgery -- I remember climbing onto the surgery table as they gave me some Versed and then waking up in recovery. According to my surgeon, Dr. John Alexander, the surgery went very well and they were done in 1 1/2 hours. I was in recovery for about 3 hours getting periodic doses of Fentanyl for the pain. When I left I was still a little groggy and slightly nauseous, but was otherwise o.k. I realized pretty quickly, however, that the PILLS that I had picked up at the pharmacy were not going to work and that I needed the liquid form. I basically spent the rest of the afternoon on the couch holding ice packs to may face and wiping spit/blood from my mouth and nose.

In retrospect, I would recommend getting the following items prior to surgery:

1) Lots of cheap washcloths/rags to wipe the spit from your mouth and soft tissues for your bloody nose
2) Disposable oral cleaners (these are little green sponges attached to a stick that you can wipe on your palate) to clean the slime from your mouth
3) Liquid Ibuprofen (kids kind)
4) High calorie smooth liquids -- I had lots of yogurt smoothies but they only have 100 calories/apiece!
5) Portable WaterPik (I got mine on http://www.drugstore.com/) -- you want to avoid squirting the incisions but it makes it easy to get the "crud" out of the rest of your mouth.

Braces and Expander ON!

Today I had my expander put in and lower braces placed on the bottom teeth in anticipation of SARPE surgery in 2 days. My ortho, Dr. Paul White, has designed his own type of expander that acts as a splint (to help establish your natural bite) and an expander all-in-one. Rather than using spaces to make room between your molars, he molds a plastic expander that is glued to your back 3 teeth -- I'll show some pictures at some point. It feels very bulky in your mouth, but hopefully it will only be in there for 5-8 months. The hard part today was learning how to eat, talk, and swallow spit! I figured out that you have to slurp your spit or it will literally run out of your mouth. I tried to eat some mac and cheese (thinking that it would be soft if my teeth were sore), but the noodles got caught on top of the expander which was a big pain. I'm sticking to liquids for now. I'm also keeping my fingers crossed that the lisp will go away soon. My 3 and 5 year old were trying to get me to say words and would laugh when they came out all garbled!! :)

Before it all began...

I just wanted to comment a little on my past orthodontic history because it seems like there are many of us out there that are undergoing major orthodontia for the second time!

When I was around 9 (1980 or so), I got my first set of braces. Because my mouth was so crowded, the orthodontist removed 4 baby teeth (premolars I believe) and 4 permanent teeth to make more room. When I first got braces on, I remember having very old-fashioned looped wires on the top and bottom which were really painful and unattractive (and of course got embedded in my gums). I remember feeling lucky though that I didn't have bands around ALL of my teeth, which was very in vogue at the time. I wore braces for almost 4 years, and then had a nighttime mouth guard that I wore for 3-4 years. When I was 15, my wisdom teeth were impacted and coming in at the wrong angle, causing lower crowding, so I had all 4 surgically removed at that time. It wasn't until I was in my 20's that I realized that I had a crossbite and that my midlines were "off".

When I was about 28, I visited several orthodontists to see what would be involved in fixing my bite, and predictably got four different answers. Because I was in medical school and pregnant with my first child, I figured it probably wasn't the best time to embark on this journey.

Fast forward nine years and three kids later, my life has reached a calmer point, so I decided to look into orthodontics again. When I first met with Dr. Paul White, it was the first time that I felt like an orthodontist really had a handle on my jaw issues. With my mouth closed, my teeth were pretty straight, but I had a crossbite on the right, and my mid-line was off by about 2/3 of a tooth. I was also wearing one side of my teeth unevenly due to off-kilter shearing forces (left untreated this probably would have meant lots of caps in the future). It turns out that when my bite was "relaxed", I had only two teeth that would touch, and the rest were out of alignment. When I would close my mouth purposely, my lower jaw would shift to the right, and my jaw would be essentially out-of-socket (unbeknownst to me). This explains the years of "facial achiness" that I've had. On a panorex face film, he also pointed out that I had a vertical jaw growth pattern (not the ideal) and that the two sides were uneven. This congenital jaw asymmetry is what led to the crossbite. He confirmed that my bite may have been ok when I had my braces taken off, but that over time, everything follows the path of least resistance, hence the crossbite.

The next step was meeting with the oral surgeon, Dr. John Alexander, and getting his opinion on the need for orthognathic surgery. He agreed that the first step was having the upper palate surgically opened (SARPE or LeFort I) and expanded, and then following that up with a lower jaw realignment 12-18 months down the line. Without a second surgery, there would be a chance that the jaws would never fit together properly. I figured that if I'm going to go through all the trouble to fix my jaws and teeth, I might as well do it right! No pain, no gain...

Luckily, Anthem approved the oral surgery and I'm scheduled to get my expander and braces on on July 8th, and then have the SARPE surgery on July 10th! I'll try to keep the pictures coming so that others might know what to expect!