Final Post

One last posting to wrap up this blog. I am sleeping well now and have a pretty normal life. I rarely need a nap during the day - if I am sleeping during the day it is out of decadence - not a necessity!

My teeth work very well and I think look great. I will have to wear my retainers at night only. I asked Dr. Hatcher how long I would have to wear them, he said I only had to wear them as long as I wanted straight teeth. Oh well. Small price to pay for great-functioning, straight, healthy teeth.

The little bit of numbness that I have left isn't much to mention. I will have a little numbness on my lower lip that extends down to my chin. This hasn't changed much in the last year and a half so I imagine this will be permanent. My hard palate and upper incisors are still significantly numb. I know that I have scalded my hard palate on hot tea and food, but it is numb enough that it doesn't really bother me.

I do have one health concern that I need to have checked out. During a recent anesthesia workup for a minor surgical procedure I was told that I have a slight heart murmur. I wonder if this is a little collateral damage from having sleep apnea for 13+ years. I will have it checked out soon.

It took alot of adjustment to get used to the changed face that looks back at me everyday. I have come to terms with her and we are getting along just fine now. What do you think?

Settling In

I have had the retainers for a couple of weeks now and I must admit that they aren't too bad. Once I got over the initial soreness and "customized" them so that they didn't wear a hole in the underside of my tongue. I think that the best thing so far is being able to take them out for eating and cleaning my teeth. I can actually eat without worrying about food dropping out of my mouth or getting stuck in the braces. My mouth still feels clean when I am done eating. Beautiful!

Freedom Comes in Stages

I had my appointment with my Dr. H yesterday to get my retainers. The weekend without anything on my teeth was nice but short-lived. The retainers look much nicer that braces but they are so tight! I am thankful, though, that I can take them off to eat and clean my teeth. Any, by the way, cleaning my teeth rocks now! I can brush and floss my little toofies in less time than it took me to brush my braces. Fabulous!


I hope that Dr. H isn't reading this because I took my Dremel tool to my lower retainer today. The wire that hooks over one of my molars was sharp and scratchy and was therefore irritating the bottom of my tongue on the left side. I tried to just bend it over a little bit so that it would curve down onto the surface of my tooth but it didn't want to budge - so I did the next best thing - I sanded it down a bit. I rounded over the end of the wire so it wouldn't scratch my tongue. It is still plenty snug but now it hopefully won't bug me so much.

With any luck, in 3-6 months I will be able to go to using the retainers only at night - which will feel like real freedom. Right now my teeth are that familiar level of soreness that I got with any adjustments to the braces. I am sure that within a few days I will be over the soreness and the retainers will become just another part of my daily routine.







I took a picture with Dr. H and my tech yesterday and they had no problem with me posting them - so here are the folks that have spend so much time listening to me talk with their hands and pointy instruments in my mouth.

Free at last! Free at last!

So, last Thursday was quite a busy day for me.

I had decided that since my teeth had been pretty sensitive since surgery I would have my teeth numbed before brace removal. You don't get extra points for going through that procedure in pain, right? My first stop of the day was at my dentist's office to get everything numbed up. And, boy howdy, was I numb when I left their office! The anesthesia was so complete that I was numb ear to ear and up to my eyes! I couldn't swallow and my talking was very similar to post-MMA. Not a pretty site - but I couldn't feel a thing so I wasn't worried about the braces removal.

When I arrived at the orthodontist's office the receptionist asked me why I was there. What! She totally blindsided me - I guess my mind was a little numb too. She looked very serious and had me going there for a few seconds. I was thinking to myself, "Do I have the right day?" and "Did I go through my mouth numbing for nothing?!" Then she smiled to let me know that she was just kidding with me. Evil. Pure evil.

The tech that removes braces is very quick and efficient. I couldn't believe how fast that part of the procedure went. All of the molar bands and the brackets were on the tray and off my teeth in under 5 minutes. What seemed to take a while was the picking and grinding off of the cement. That alone was worth the numbing. Then Dr. H. came over and polished and shaped my teeth. They looked so huge to me! Do you remember the movie "Something About Mary"? If you do you will remember Matt Dillion's character with the huge teeth. That is how I felt that I looked. Pretty weird. The next activity in the chain of delights was making impressions for my retainers. It took a few tries to get a good impression of my upper and lower teeth. Fortunately, being numb kept this from being the gagging experience that it usually is.

Dr H. did tell me that he had been thinking about the day we would be removing my braces and was concerned how smoothly it would go, considering my tooth sensitivity. He told me that he though the numbing was a good move on my part and was glad that the experience wasn't so unpleasant for me.

On Thursday, their debracing day, Dr. H's office celebrates with the kids that are completing their braces treatment. When all of the debracing is done each client poses with Dr. H for a picture and then gets to get their snack on. They have a popcorn machine and a table set with sodas, chocolate, gummy bears, skittles, nuts, and other associated stuff that you aren't supposed to eat with braces. I opted for the m&m's and mixed nuts. I have really missed eating nuts for the last couple of years. I had to take my stuff with me because there was no way that I could have chewed and swallowed without making a serious mess.

And, by the way, because of the numbing we are postponing the picture with Dr. H until my retainer day. My smile was pretty crooked until the anesthesia wore off - which was probably 7 or 8 hours later. My cheeks and lips were still feeling a bit rubbery when I went to bed. Powerful stuff they used.

My kids were really psyched to see me without my braces, my daughter kept asking me to smile for her. Kissing my hubby is now much nicer and takes no strategic planning to keep from injuring either of us. Very nice.

More when I get my retainers.

Peace.

Parole Granted!

Finally! Finally! Finally! My 44 year old teeth have finally moved to their desired positions! Dr. H fussed a bit last time because I wasn't wearing my elastic bands consistently enough to get my teeth moving that last little 2 mm to straighten out my crossbite. I told him that I took them off to eat or clean and I usually didn't notice until I looked in the mirror that they weren't in place. I hated putting bands back on until I could clean my teeth after eating. Well - I had to get over that! I sent out an email to my friends and family asking them to please remind me to put my bands back on if they ever saw me without them. Well, let me tell you that I got reminded alot! And, it worked! I told Dr. H and Jen (my tech) that it takes a village to move my teeth!

So - I am now about 36 hours into wearing the finishing bands. The purpose of these bands is to pull my bite together and make my molars really set. I can tell you that I am mighty sore right now. My teeth woke me up a couple of times throbbing. I am sure that things will settle down in a couple of days, but right now chewing is a little tender.

Now that I have a debracing date I need to plan my "Ooey, Gooey, Crunchy, Chewy" party. This is where everyone comes and brings something that relates with the theme of the party - namely stuff that someone with braces isn't supposed to eat. I personally can't wait to dig into a big tub of popcorn! Hey, any excuse for a party, right?

Aaaaargh! Here is a picture of me and my first mate at our church's VBS this year. The theme was (anyone? anyone?) VeggieTales "The Pirates Who Don't Do Anything" - Discovery Bay. Ben and I did science experiments with about 100 kids relating them to different bible stories. It was alot of fun and exhausting. Glad it is over.

The next pics will be with bare, naked teeth!

Parole Postponed

I went to the orthodontist yesterday and it seems my teeth didn’t get parole. I will have to do another month or so of hard time before I can be considered for release. No time off for good behavior. So – the “Ooey, Gooey, Crunchy, Chewy” release party will have to be postponed until further notice. Bummer. I have got to make these teeth move! I have asked my friends and family to remind me to put my rubber bands back on if they see me without the lousy things pulling my teeth and impeding my speech. We will try again in late July to see if I am ready for my finishing bands. If not, I will once again be sent away with no hope of parole.

With the adjustments he made to my lower wire and the really strong bands that I am wearing I can hardly put me teeth together today. Sore again. Yea.

BTW, I finally replaced my old digital camera that had died a slow death. So, here's a recent pic. Not much has changed in the looks department.

Anne

Come on June!

I saw my orthodontist last Thursday and have some good news. I am finally, finally, finally coming to the end of my orthodontia experience. My front teeth are moving (slowly) to the desired positions. I have had a slight crossbite that Dr. H. has been trying to straighten. My back molars also still need a little more uprighting. He really spent some time slenderizing my lower incisors and it seems to be doing the trick with the crossbite. I need to call their office to see if I am still to wear the elastics now that it looks to me like the crossbite has "uncrossed".

My unofficial date (subject to change at my 6/12 appt.) is (drumroll, please) JUNE 19th! Yea, yea, yea! Happy dance!

My only question about the whole debracing appt is this - my lower teeth, in particular the incisors, are still pretty sensitive. I am wondering if I should stop by my dentist's office on the way to the orthodontist that day to have a little nerve block done for my lower jaw. I know that when they had to pop 3 of the lower brackets off at about 10 weeks after surgery to reposition them the sharp, shooting pain of the tooth movement was very severe, albiet shortlived. I will be almost 8 month post-op. Maybe I will post on the forum to see what the other MMA vetrans have to say.

BTW, today is DH and my 19th wedding anniversary. I guess I'll keep him.

The Sweet Smell of Success!

As I mentioned before, I had my third sleep study this last week. My first study confirmed my problem with sleep apnea with an RDI of 27 or 28. The second study followed my nasal septoplasty, turbinate trim, and UP3. The nasal procedures were very beneficial however the UP3 was torturous and worsened my apnea. My RDI with the second study was 46. Yikes!

Well after two years of braces and with 5 months post-op recovery from MMA and GA I have wonderful news to share. My third (and last) sleep study had an RDI of 8.3 with oxygen desaturation only dropping to 89% during a few of the apnea episodes! Yee Haw! I actually have a decent REM cycle and am sleeping well.

The only advise he could give me was to lose a few pounds. I knew that was coming and agree. Time to quit procrastinating.


Good news, huh?

As far as the MMA recovery is concerned, things are sort of moving at a snail's pace. Function is pretty good but the nerve damage is still bothersome. My lower lip continues to feel altered - some numbness yet hypersensitive. The roof of my mouth and upper incisors are also slow to return. Still have that mild brainfreeze when I breath in cool air. But, I say sincerely, if I get no more sensory return I would be happy. Once I get the bondage, er, braces off my teeth I will be at a level of wellness that I could live with happily. Looking forward to my day of freedom.

Back Up and Running

The last month or so I have come to realize just how dependent I have become on my computer to keep me on task and to communicate with the outside world. My old computer has been dying a slow and painful death over the last couple of months. It finally died and I now have a brand spanking new computer. Unfortunately, some information has been lost in the shift from the old, damaged computer to the new one. So - if you haven't heard from me in a while please drop me an email so that I can recover your email address. I promise that I will get back with you.

I am still looking at debracing in a couple of months. So, hopefully about the time the kids get out of school and we start our summer I will have a new smile. So, yea me!

I have an appointment for my post op sleep study tomorrow night. I am anxious to see what my post op numbers are now. I will be posting what I find out as soon as I know.

Wish me luck!

I'm Still Here!

I can't believe it has been so long since I posted. I guess not needing to post a bunch of complaints is a good sign. I am in a state of limbo until I can get these damn braces off my teeth! I am getting tired of the tooth bondage. I know, same old story, but this is my biggest complaint today.

Now, for an inventory of my post surgical concerns:

1. I still have more cheeks that I would like. I think that all of the swelling is probably gone and I am left with big ol' cheeks. They are the same size as pre-op, just further forward and slightly lower than before. I still am not used to the new face. Sometimes I like the outcome, but most of the time I feel that I have too much chin, that my face is "bottom heavy" - I hope that this is just a perception problem on my part. Jay Leno wasn't the look I was going for.

2. I do like the nose now, especially in profile. I seem to be breathing very well. I haven't had any perceptible sinus problems since surgery. I had a cold back around Christmas but even with the upper respiratory congestion I never was unable to breath through my nose. This is a vast improvement from before I began my sleep apnea treatment. Before when I had a cold I looked like my IQ had dropped about 30 points because my mouth had to be open all the time so that I could breathe! The mouth-breather look isn't so pretty.

3. My lips are pretty small now compared to pre-op. I hope that as the nerve problems resolve and the braces come off that they look a little better.

4. I have a new weird sensation. When I breathe in, especially when it is a little cool, I get the sensation of a cold hard palate and front teeth. Kind of like a mild brain freeze without the headache. Not a big deal. I figure that some feeling returning means that things are still healing with my nerves.

5. I still have the cold nerve sensation at the corners of my mouth down to my chin when I drink cold liquids.

6. I have been wearing my elastics to adjust my 2mm crossbite. I can't see that it is changing. We will see what my orthodontist says on 3/2/08.

7. My jaw movement seems to be improving slightly. I am gaining a little lateral jaw movement, more to the right than to the left. My right jaw pops fairly significantly when I try and move laterally to the left. Not to mention, the molar bands bite when I do too much lateral movement. Moving my jaw forward is also improving slightly. My right jaw pops when I move it more than about 1 cm.

8. Still have the bony ridges on either side of the back of my mandible. That doesn't seem to be smoothing out although it isn't really painful any longer. Still have the pocket between the ridges and my back molars that keeps me on my toes with cleaning. It requires a bit more that just a toothbrush to get things squeaky clean back there. Those little dental brushes that they sell for cleaning under bridgework and brackets come in really handy.

Sleep has been pretty good. I have had kids with minor illnesses over the last few weeks and there have been a few extra stressors in my life right now. I have had some afternoon sleepiness lately that has me a bit concerned. I am writing it off to maybe having a mild version of what the kids have had and stress getting me down a bit. I will be having my repeat sleep study in April and I am hopeful that all is improved.

I will post again next week after I have my orthodontist appt. Possibly a picture? Wait and see!

Jacking up the Bondage a Notch

Just when I thought the braces couldn't get any more fun I go visit the orthodontist. Today the wires were changed, I had some more slenderizing on my funny little fan-shaped lower incisors, and a power chain was stretched from one side of my lower teeth to the other. I again have the pleasure of wearing elastics, one diagonally from top to bottom on the left and another elastic diagonally from top to bottom right in the front. What this means is that there is no way to eat without removing the elastics. When I drink I have to make sure my lips are poked out enough to make a good seal. Having the rim of a glass bounce off the front elastic and dribble down one's shirt can make one look a little sloppy.

Dr. H. noticed that the bony ridges that I have on either side of my mandible are a little problematic. They form pockets against the back molars where food can get trapped and cleaning is difficult. It is too soon to say whether or not a revision procedure is necessary but things are going to have to improve significantly before cleaning is not a hassle.

On the good side, Dr. H. said that I should only have two or three more regular visits, then two weeks in heavy elastics to pull the bite together into it's final position, and then I get to DEBRACE! So, with any luck we are looking at late spring/early summer to be done with the braces.

Ah, to be slick-toothed again. I am starting to see the light at the end of the tunnel!

Just putting along...

I can't believe that 12/19 was the last time I posted! My family had a nice Christmas and New Year's holiday. The kids go back to school on Monday and things will get back to normal.

I am 10 1/2 weeks postop and nothing much is happening.

That is good, in that I am not having new problems popping up. Still eating like a toddler - but food falling out of my mouth is endearing, right? Still needing to "wax up" everyday so that I don't spend the day biting the back incisions.

It is bad in that nothing much seems to be improving. My mouth opening and jaw "limberness" doesn't seem to be making much improvement either. I have been advised that it is too early to start worrying that I need to see an OT for my TMJs. With normal use and gentle stretching exercises (exagerated facial expressions) I should see a slow improvement with my jaw function. I'll give it a month or two and then I start to worry about seeing an OT to help widen the pie hole.

The slight changes that I have noticed over the last couple of weeks is that the roof numbness is subsiding and my upper teeth are becoming more sensitive. More specifically, my upper right incisor aches a bit. My lower lip continues to improve. The scalding is all but gone now. When I place something cold to my lower lip I get the same cold sensation down my lower lip to my chin. It feels like I have dribbled my cold drink down to my chin. I have wiped my mouth many times for no reason.

My speech is pretty clear now. I rarely have to repeat myself because I slurred my words. (I have to repeat myself often to my children because I am a mother and they don't hear me.) I think that any remaining speech impediment will be resolved with the removal of my braces. I see my orthodontist on Jan. 23rd. Hopefully we will be talking about an estimated braces removal time.

I will update again when I have new pics or after I see my orthodontist in a couple of weeks.

Eight Weeks Postop

Life is starting to settle into the new routine. I am sleeping well, which is such a miracle. I am awake all day with only a little mild sleepiness in the afternoon. It doesn't require a nap, I can usually work through the dip in energy until it passes. Who knows, after the first of the year when I get more settled into a regular diet and exercise schedule I may discover that the afternoon dip is a drop in blood sugar or deconditioning .

The most significant problem I have now is that I bite the back incisions (the ones in front of my TMJs) and/or pinch them with the back molar brackets. Whatever the cause, it hurts! The numbness is gone back there and I wish it was back! With the fleshiness/bone protrusion of the BSSO site and the close proximity of everything back there I have no choice but to bite. There isn't alot of area on the side of my molars to help adhere ortho wax. Pretty much all of the space is taken up with the molar bands and brackets. I try to keep a wads of wax jammed into the space between my back molars and cheeks - upper and lower, both sides. Believe it or not, the medieval surgical hooks (that I hated so much) gave me something to push wax onto to secure it in place. I have lots of trouble keeping wax in place because it won't adhere to mucous membranes. I have swallowed more than one piece of wax while eating - it's there when I start, not when I am done. Given enough wax I guess I will tough out the next few months until these braces come off. Don't know that I have a choice.

The numbness on the roof of my mouth is starting to resolve. It tingles and itches alot. Slightly scalded feeling too. The teeth on top are completely numb. Can't feel flossing or brushing at all.

My lower lip that has been the worst area of nerve pain is really starting to change. The scalded feeling is fading significantly. Now I have a presistent itch on the right between my lip and chin. When I scratch it I get pain in my lower right central incisor. Weird. I am wired a little differently now.

It has been cold here lately and I have been wearing my jacket with a scarf. I really can't stand for the standup collar of my jacket to touch my face. It feels like I am being tickled with a feather duster.

The jaw rehab is going very slowly. I am doing what my surgeon told me to do two weeks ago. I am making no progress on increasing my jaw opening or movement forward or laterally. Also, I now have a crunchy sound in my jaw with the jaw exercises that I have been doing. Occassionally when I yawn I have a bit of a muscle cramp and a feeling that my TMJ is popping out of place slightly. I only lasts a few seconds but hurts enough to get my full attention. Dr. H. assured me that normal usage would allow me to return to as normal range of motion as possible. I am really start to doubt this. So - I have contacted an OT friend of mine to see what she thinks. If she thinks that I would benefit from some OT hopefully she will help me word her recommendations to my doctor.

The cheeks are still too puffy. The nurse at my family doctor's office today said that I look different but still have come "chipmunk cheeks". I know she didn't mean to be negative but I really didn't need to hear this today.

Wow, what a whiny post! I must be feeling sorry for myself. I guess I have officially arrived at the middle recovery period. Things are slowly settling in and I want to be done with all of this. What is settling in isn't perfect and I am frustrated. I know, marathon not a race, marathon not a race.

Off the Hook(s)

I saw my orthodontist today and had an uncomfortable but not as bad as I expected appointment. My ortho tech Jen (hi Jen!) popped off the brackets to be repositioned. The three bottom teeth that needed new brackets are very sensitive. She says that they are a bit loose also. A fun time was not had by all. The cleaning up of the bracket cement and placing the new brackets was a breeze. The upper and lower wires with all those nasty surgical hooks were changed out for new smaller gauge wires that were fitted much easier. And, thankfully, today the gates on the brackets opened without trouble. They have historically been very tight and difficult to open. They have been a significant source of my soreness following my orthodontist appointments.

This evening hasn't been too bad. I was prepared to be really sore but other than some mild discomfort managed with Tylenol I am fine. So, yea, I am done with doctor's appts until I see Dr. Hatcher's group the end of January.

One Doctor Down, Two To Go

Today I had my 6 weeks postop appt with my oral surgeon. He was pleased with my progress and decided to release me. He would like for me to follow up with him again in 6 or 8 months when my braces come off. We will talk again at that time as to whether or not I need a revision on my nasal spine or on the bony prominence on my lower jaw. Hopefully both of these areas will smooth over enough over the next 1/2 year that that won't be necessary. Time will tell.

He would also like me to contact my doctor that ordered my sleep study to set up my repeat sleep study for around 5-6 months postop. It is nice to think that I am cruising into actually completing my treatment for sleep apnea.

Birthday week

This week I turn the ripe old age of 44. Sleeping well is a great birthday gift. Once I get the remaining nerve pain settled down and get my jaw loosened up I will feel like I have reversed the clock a bit. I still feel that I would do this surgery again to sleep as well as I do right now!


I asked on the sleepnet forum a few months ago if anyone had significant changes in their voices after surgery. I have sung all my life, currently in a church band, and was concerned that I might have tone control problems with the change in my airway architecture. I am glad to report that I started singing with my band this last week and sound fine. Rehearsal, which goes on for an hour and a half or so, is exhausting. Breath control is a little weak right now. I am sure that this will improve as my energy improves and I continue to practice. Any worries I had before surgery about singing have now been aleviated.

Eating continues to improve. In fact, given enough time I dare say I could eat just about anything. Sharp things like tortilla chips are a bit of a concern right now. I sometimes lose track of them in my partially numb mouth and I have swallowed a piece or two that could have benefitted from a little more chewing. I also have to be careful that I don't put in anything that is too hot in my mouth. I took a bite of pizza where the crust felt fine but the cheese was too hot. I think that I scalded the roof of my mouth - it doesn't hurt because of the numbness but I will be babying it for a while so I don't injure it further.

This afternoon I yawned really big. I have been letting yawns happen figuring that the gentle stretch will help with jaw rehab. This backfired this afternoon. During a yawn I had sharp pain in my right jaw and couldn't close my mouth completely for a few seconds. This was muscle pain, but it definitely got my attention. I will be a little more cautious in the near future.

I continue to adjust to the person in the mirror. I rather like my profile. I feel that my nose is much more balanced with the new face. The front view is still a little concerning. My nose is still rather crooked (but not a big deal), my cheeks are still a little puffy and my lips are uneven and thin. I have been doing some soft tissue rehab on my own. By saying my vowels with very exaggerated facial expressions I do feel that my lips and cheeks are loosening up a bit. I don't know for sure whether this is doing anything of value, but hey, it seems to me like it is helping.

All for now. If you are reading this and have a question or see that I haven't addressed something, please met me know and I will see what I can do.



By the way, here's a reminder of how I looked in profile before the surgery - actually this was taken in 2005 before my UP3, nasal septoplasty. I like having a chin now and I think my nose looks much more in balance.

5 weeks postop

I seem to have passed another milestone. My energy level is good. I met friends for b'fast and lunch today (I'm so popular - ha!) and ran several errands. I was out from 7:30 until around 2:30 with no problems. I was bushed when I got home but I had a chance to sit and rest for a little while before kids got home. Didn't need to nap, just rest. I have been fine the rest of the evening. I will be going to bed within the hour hopefully. I am sleeping well through the night, still using Sonata but I will be trying to go without soon.

I have been released to eat anything I wish - so I have started a little jaw rehab. The eating variety and the passive tension variety. Just trying to relax my jaw while I use a few fingers to hold my mouth open just to the point of tension, not pain. The lateral movement of my jaw is pretty much non-existent right now. With the total 20mm advancement (12mm BSSO + 8mm GA) my TMJs are very tight. The discomfort with chewing is decreasing daily. I was able to eat salad with grape tomatoes, cucumber, and peppers on it. It was so nice to crunch the veggies. The lettuce has a tendency to get a little lost in my mouth because of all the numb spots, but I happily managed. I am sick to death of soft cooked veggies. My lips seem, well, too small. It's like they are thinner than they were before surgery. I guess some of this came about from the addition of the chin. I am hoping that when the braces and those awful surgical hooks are gone that maybe my lips will appear a little more normal. I am scheduled to have my lower front brackets repositioned on 12/11. At that time the surgical hooks will be removed. That will be worth the discomfort of the appointment.

Speaking of lips, the numbness on the left lower lip to chin is fading. Maybe slightly more numbness on the right. Cheeks are still pretty numb on the inside of my mouth.

I have a bony prominence (don't know how else to describe it) on the left lower jaw - it comes up beside my back molar. It creates a bit of a pocket that is just big enough to hide a little food and make it difficult to brush the back molar. I asked my orthodontist about what he thought. He said that the body really doesn't like sharp edges and to give it 6 months or so to see if it smoothes itself out. If not I might have to consider having a little revision done back there eventually. Also, where my nasal spine was cut is pretty sharp. Ditto for a revision in at least 6 months if it doesn't smooth over and settle down on it's own. Right now it makes it fairly uncomfortable to blow my nose.

The weight has stabilized at 17 pounds down. This has been the count and amount since about two weeks postop.

All for now. I am ready to hit the hay. I am really sleeping well. What a blessing!

No Such Luck

I was hoping that my orthodontist would change out my wire and remove the god-forsaken surgical hooks. No such luck. He wanted to make sure that everything looked okay and to adjust the elastics placement. I will have to wait another two weeks until after my surgeon releases me before he will change out the wire and remove the hooks. He also plans to reposition the brackets of my lower front teeth. Sounds like fun, huh? Actually sounds like I will have pretty sore teeth for a few days after that appt. Changing out my wire requires alot of pushing and tugging with the type of braces I have, not to mention the removal of the old brackets will be a little unpleasant also.

Left the office today with a double handful of wax packets. To cover all the hooks that bite takes a whole pack per application. Multiply that by two cleanings per day equals alot of wax.

On the upside, I met my friend for lunch today and had a nice chile relleno and beef enchilada before what I thought was going to be my last comfortable meal for a while. Good lunch with a good friend - never a bad thing.

Big Weekend

I thought I would give a report on Thanksgiving weekend. Energy-wise this has been a pretty tiring weekend but I am sort of pleased that I handled it as well as I did. Between the preparations for Thanksgiving on Wednesday, the long Thanksgiving day at my folks (not too physically taxing, just long) and then a family reunion about an hour away on Friday and Saturday, this was a long weekend. When the reunion plans were being made months ago, hubby and I decided not to stay at the lodge but to drive over for shorter visits so that we could come and go as my energy level warranted. We stayed for several hours each day - lots of talking and a fair amount of eating. I took quite a bit of Tylenol this weekend but otherwise I think I did okay. The food available wasn't exactly what I would have chosen to chew, but a girl has to adapt, right?

Thanksgiving dinner was really good. I was able to manage everything - even the turkey. I just made sure I chose dark meat and cut it up small so I didn't have to chew too much. It took a long time to eat but actually that made me feel full before I had eaten my whole plate of food. I had to wait a while before I had a lucious piece of pumpkin pie - but since I wasn't so full it was much more enjoyable.

Off to the orthodontist this afternoon. I am hopeful that he will change out my braces wire so that I can drop most (if not all) of the torturous hooks from hell. These things continue to eat up my cheeks/lips if I don't have a large amount of wax covering them up. I will be taking Tylenol before the appt. because I am expecting that this will be an uncomfortable visit. Wish me luck!

Happy Thanksgiving

Well, actually Happy Thanksgiving Eve. I saw Dr. Hudson today for my 4 week post op visit. He seemed pleased with my progress except that he wants for me to start wearing a couple of elastics again to keep my mandible from slipping back. He also, yes boys and girls, released me to eat anything that is comfortable enough to manage - and just in time for Thanksgiving! I am looking forward to tomorrow. My brother and nephew are coming in from Killeen, TX for the weekend. My sister-in-law, niece, other nephew, and my niece's husband are staying in Killeen. My niece's husband is shipping out for his second tour in Iraq on Saturday. Please pray for his safety.

I am pretty tired tonight. My mom isn't up to doing the preparations for Thanksgiving without some help. That's me. I am feeling pretty good, albiet tired. I will sleep like a log tonight! I am glad that sleeping like a log is becoming the rule rather than the exception! I am so blessed to be living in a time when repair of anatomical problems that cause life-shortening apnea is possible. Not to mention, I am beginning to like the new chin more and more as the cheeks slowly resolve their puffiness.

The nerve pain seems pretty much the same as before. The numbness of my hard palate and upper teeth is still profoundly numb. The cheeks are thankfully still numb - the hooks on my braces are eating up my cheeks. I am keeping a veritable wax museum in my mouth just to keep the irritation under control. The big problem with nerve pain continues to be my lower lip extending to my chin. Still very numb, yet scalded feeling. When I am tired or after eating is when it seems worst. The smile is still crooked and my lower lip is in hiding for the time being. Time will tell how much this situation resolves.

Peaches, our spoiled rotten, high energy Bassett Hound, was sitting so quietly while my son took the pictures that we had to snap a quick pic of her too. Isn't she cute?

I think this is all for now. One month (the worst month) is now behind me! Yea me!

Full Disclosure

Okay, if you have read this blog you know that I began it as not only a place to whine but also as a place to journal my experience. I wish for it to benefit others what will have this apnea treatment journey in the future. For that reason I must let you know that even though I am sleeping better, I am still a LONG way from being recovered. I am improving everyday but in inches, not yards. Although I did do a little retail therapy on Friday (a few hours at most), and went to a friend's house for a couple of hours yesterday, I paid for my outings. By the time I got home yesterday I was so nauseous and wrung out. I laid down for an afternoon nap for 2 1/2 hours (longest nap needed since the first week post op), spent the evening in my chair, and then slept for 9 1/2 hours last night. Today I am over the nausea but I am sore. I haven't needed Tylenol since the beginning of the week but I am taking it now! Eating is really a chore - to the point that I think I will be returning to a liquid diet for a day or two, just to lessen the effort to eat. I am not the most patient person, and when I get good sleep Iwant to go. Getting out and being (even minimally) productive does wonders for my mood but I am physically not ready for it.

On the sleepnet forum it has been stated over and over that it takes so much energy to heal the extensive bone changes that effort put elsewhere will knock you down. Not one to do anything the easy way, I am learning that this is very true.

I will wait a few days to give an inventory on my numbness/discomfort until things calm back down. If I did it now it wouldn't give an accurate report.

Best Day So Far!

After two nights of fitful sleep, I got some Sonata sleeping med from my family doctor. This stuff is fabulous! I managed to fall asleep peacefully and woke up on my own a few minutes before my alarm sounded. Wonderful! I managed to Christmas shop with my mom for several hours today. This was the best thing I could have done for my mental health. Being stuck in the house for the last three weeks has been tough - I have been going a little stir crazy.

Three weeks and one day

Well, here I am at the point where I start counting in weeks instead of days. Progress measured in weeks, not days. This is good because if I look at the last few days I am a little down because I have had trouble sleeping. I have had a cough with some heartburn that may be sinus related but I don't know for sure because I don't know how my sinuses feel when they drain now. With my hard palate being so profoundly numb right now I might not be able to feel sinus pressure right now. I took some OTC that I had used before surgery and it is keeping me up at night. Not good. I need sleep! (Sleep ,good -awake, sweaty, jittery Anne, bad.) Thanks to some good advice from a friend (thanks Bill) I have kicked the OTC med and got some sleeping meds from my doctor to tide me over until the nerve pain in my chin quits bothering me. I am really hoping for a good night's sleep tonight. Hubby says that when I am asleep I am quiet as a lamb. No sounds, no apnea. Yea me!

If I look at my progress in weeks I am doing much better than last Thursday. I had just gotten my surgical bands removed. My jaw was aching and food felt sharp in my mouth. Now I am able to eat food that doesn't really require chewing without problems. I am fun to watch eat - sort of like watching a toddler feed themself. With my hard palate, cheeks, and lips numb I lose track of the food that is in my mouth. I can't feel if I have food on the outside of my mouth. I occassionally dribble liquids. At home I have a kitchen towel that I use to keep my clothes clean - I won't call it a bib though. Bibs are for babies, right.

Where the heck did my lips go! I will be glad when the swelling, numbness, braces, and wax are gone. Maybe then my lips will return.

Two steps forward, one step back

Things in the food department have been improving - I am managing to get enough to eat now that I am not hungery all the time.

The step back today is that I developed a rash. I was getting itchy before my shower this morning and just thought that it is dry skin. The heater has been coming on some now and I just though that I needed to slather on some lotion. By mid morning I had a red, raised, itchy rash all over. Not as bad as the allergic reaction in the hospital, but concerning nonetheless. I called my pharmacist to see if I might be developing Stevens Johnson syndrome (long shot) or maybe having some reaction to coming off the Oxycontin (another stab in the dark). She said that the Ancef should be all out of my system now and didn't think that I should be developing a rash from stopping the narcotic. I started taking Benadryl which pretty much wiped me out and depressed me the rest of the day. Bummer.

The good news is that the rash does seem to be dissipating and I am off of my narcotics. Tomorrow will be a better day. Mom and I plan to try a little retail therapy. We will see how long I last.

Official Count and Amount

When I was at my Oral Surgeon's office on Thursday I picked up a copy of the operative report for my surgery.

During my surgery he was able to move my maxilla forward 4mm. My mandible was moved forward 12mm and my genioglossus advancement was 7-8mm.

That's alot of movement! No wonder my chin doesn't dissapear inside my turtleneck when I look down anymore! I am anxious to see how my face will look when all the swelling is gone. Time will tell.

2 week postop appointments

Dr. Hudson promised me that this week he would be removing the surgical bands and he kept his promise. His assistant took off the bands and I waited a few minutes for him to join us. Having no bands holding my jaw closed was a really weird sensation. My quivery jaw muscles were obviously not ready to have my jaw dangle. My jaw only opens a little bit but it felt like my mouth was standing open. I was actually glad to get training bands put back on. I liked the secure feeling.

The good news is that I can eat food! Nothing that requires me to chew, but I have so many more options now. I had some mushed up pork chop, rice with gravy and soft english peas. I was so hungry but was only able to eat a small amount. My mouth is still very tender. Hopefully this will improve over the next weeks.

I finally was able to clean my teeth really well. They feel all slick inside - I love it! Two weeks without a proper brushing is not very pleasant.

Off to bed. Two doctors appts. in one day is about all I can handle in one day right now.

Recovery Timeline

Almost daily for the last month or so someone has asked me how long it will take to get over this surgery. When I tell them 6 months their eyes get huge and their mouths drop open. I have told them that the worst will only last a few weeks but it takes a while to get everything working again. Well, I remembered that my personal MMA hero - Seattlebill from Sleepnet.com posted a timeline after getting many requests from folks preparing for surgery. I have this printed out and posted on my refrigerator to remind me to be patient with the process. Since I am sure that most of my friends and family that will read this blog won't venturue over to sleepnet, here 'tis:

A general timeline for recovery post-MMA happens in these phases.

1) Initial Peri-op Phase: 1-5 days. The initial peri-op hospital phase (the "glad I'm alive", OMG- what have I done, oh boy- now what) involves intense recovery. Though it is much feared, it passes quickly and leaves indelible memories particularly if this is your first surgical experience.

2) Early Post-op Adaptation Phase: 3-14 days post-op. This is typically where most of us learn to confront and adapt to the typical post-op lifestyle changes. (ie, a swollen face, closed mouth, altered caloric intake, +/- pain , pain meds, fatigue, etc...). This is where advice, ingenuity, and mutual support pays off.

3)"Doldrum" phase : 2-4 weeks post-op. In this stalled phase of early recovery, it is common to be bored, look for any sign of progression (wanting "real" food,arch bars off, etc...), be mildly depressed (common with anything involving a slow recovery), and be persistently fatigued. Distractions, reassurance, and activity help in this period.

4) Turning the corner phase: 4-6 weeks post-op. Lots of positive things happen during this period. Arch bars get removed, braces get adjusted, diet improves, we feel more energetic and feel better rested. Physiologically, as with any major procedure, this is about the time where the healing body stops sucking energy stores and allows you to function more normally. Most of us really start to feel "normal" around this time.

5) "MIDDLE" Recovery Phase: 2-4 months post-op. Gradual restoration of normal eating (soft-semi chew, minced, full chew), normal mouth opening, restoration of facial and oral sensation, return to active life and work, etc... But, this is just the "middle" phase ! We're still not done yet !

6) LATE Recovery phase: 4-8 months post-op. Complete return of normal eating, restoration of most of facial sensation (though full restoration in some areas can be delayed up to 12-18 months), and finally a time frame where we can really judge how effective the OSA improvement can be ! This is the time for a repeat sleep study. Sleep architecture patterns will have equilibrated and we can really fairly judge our improvement without physiologic impairment from surgery clouding the results.

7) RESIDUAL PHASE : 8+ months post-op. By now, we have generally recovered and are dealing with residual effects of the surgery. Sleep studies will either demonstrate cure, improvement, or need for further procedures. Residual sensation may need more time to recover, or may not improve at all. Dental alignment may need to be addressed, etc...Basically, at this stage, we are what we are...and must move forward from there.

Bottomline: It really does take about 6 months for a full recovery, even though there are definite stages of notable improvement. An MMA recovery is truly a marathon, and NOT a sprint.

Cool Realization

Today is postop day 13. I have been sleeping well since surgery and have been able to keep my own schedule up till today. My husband had an early morning meeting this morning and was going to have to leave the house before the kids needed to be up for school. He needed for me to get the kids up and ready so that the neighbors could drive them into school. So I woke to an alarm clock this morning. Rising was much easier but I yawned a few times. Stiffling a yawn right now HURTS! And then it occurred to me - this was the first time I had yawned since surgery! Wow. I used to yawn dozens of times a day because I slept so poorly. In almost two weeks I don't remember yawning until this morning. Yea me!

numbness

I realized that in all of the story so far I haven't talked about the numbness that I have. My bottom lip and chin is the most profoundly numb. This extends slightly up my right cheek. The numbness, though more diffuse, extends up my left cheek to my temple. My lower teeth are numb, which is a blessing because with my jaws banded I would be very sensitive to cold liquids otherwise. The roof of my mouth feels like I am wearing a plastic retainer. I am already gaining back some feeling to my lip - I get tingling, prickly feelng in them. Also, when I am getting close to needing pain med my lower lip feels like it is swelling and scalded. Weird and changing everyday.

Day Seven, Eight, and Nine - 10/30-31/07, 11/1/07

I decided to stop taking the Penicillin Tuesday morning. I am not one to stop antibiotics early but I couldn’t tolerate one more day of feeling so poorly. I figured that if Hudson was upset about my lack of antibiotic coverage he could fuss at me and give me a shot in the butt on Thursday when I saw him for my first post-op visit. Patsy brought me some Activia yogurt that I thinned out enough to drink. It was an amazing day! Within 12 hours or so I was feeling 70% better! The cramps and diaphoresis stopped. I realized that when all I had to deal with was my surgical pain it was manageable! I was going to make it! Wednesday was even better. As my stomach continued to improve I was able to improve my nutrition. All I had to do now was rest, take my pain med and eat. Piece of cake.

Thursday rolled around and it was time to see Dr. Hudson. After having new xrays made it was time to see the man. He was very pleased with the way things were looking. He said that if things continue to improve when I see him on 11/8 the surgical bands will be removed and training bands will be placed.

After seeing Dr. Hudson I had an appt. with Dr. Hatcher, my orthodontist. He was also pleased with the results so far. He said that my teeth are lining up nicely so hopefully it won’t take too long to fine tune my teeth after I am all healed up.

Good day. I felt better and both of my doctors are pleased with their work.

Day Four, Five, and Six - 10/27-29/07

The next morning Bruce called Dr. Hudson and explained that I needed something stronger for pain control. To his credit, Dr. Hudson came back into town (he was about 45 minutes away) to give Bruce a written prescription for pain medicine. He told Bruce that Oxycontin was the strongest narcotic he could prescribe for home. If this didn’t cover my pain I would have to be readmitted to the hospital. Fortunately, this medicine helped much better. I wasn’t pain free but my 8/10 pain was a manageable 4/10 with the med.

The antibiotic gave me cramps. I began to feel generally lousy –abdominal pain/cramps, nausea, diarrhea, diaphoretic/clammy, and a headache. This problem paired up with the surgical pain and I was a mess! I couldn’t drink anything that didn’t fire up my stomach. I was having trouble even trying to sip on Boost supplements. And four times a day I had to take more antibiotic and every four hours I had to take pain med. I couldn’t get on top of the GI symptoms. I had black diarrhea for a week after returning home (sorry - TMI, I know). I know that some of this was from blood from surgery but I think that the allergic reaction caused me to develop a gastritis for which everything irritated my digestive system. The small blessing in all of this is that I wasn’t nauseous. To give you an idea of how upset my stomach was- the first 48 hours home I lost 7 pounds! I continued to lose a total of 13 pounds in 5 days. I felt bad.

Day Three - 10/26/07

Day Three and more of the same. Dr. Hudson comes in and tells me that I am doing well and can go home today if I feel up to it or I can stay and go home tomorrow. The problem with the unit I am on is that it closes down for the weekend. What? If I stay the night at the hospital I have to change rooms. So much for patient satisfaction/continuity of care – when the hospital might lose a buck or two keeping a unit open for patients that have been there for three days. Okay, I am finished bitching. The nurse kept coming in and asking me if I planned to stay or go home. She needed to have me moved or have me gone before 3pm. I really felt that I was getting the bum’s rush. I was so exhausted that the thought of moving to another hospital room for the night and then being discharged the next day didn’t sound good. I decided to go home. In hindsight, not a good idea. The nurse came in and discontinued my PCA pump and then thirty minutes later came in with liquid Lortab 5. I fell asleep again and the next thing I knew (actually about 30 minutes later) the nurse came in and asked if I was ready to go. Let me tell you, this is no way to stop a PCA pump. There is no way that I could know if my pain was under control. There needs to be at least 12 hours between discontinuing the PCA and deciding if one’s pain is controlled.

By 3:30 on Friday we were home. I had been discharged with Lortab 7.5 and Penicillin VK. I took the Lortab as often as I could and it was not managing my pain. I even bumped the Lortab to every three hours through the night with no pain relief. Horrible night.

Day Two - 10/25/07

The first night of sleeping was not bad at all. My friend Patsy told me that during the couple of 2-3 hour periods between nurse interruptions I actually looked like I was sleeping peacefully. I had one short period (less than 5 minutes) where my O2 sats dropped to the high 80’s but I didn’t stop breathing during this time. The next morning I actually felt that I slept – not the fitful apnea stuff that has been the norm for the last 12-13 years – but actual restful sleep. Now don’t misunderstand me – the fatigue from being through my surgery was still with me, but the been-run-over-by-a-truck-hangover feeling wasn’t! I had a long way to go with recovery but it was the first positive sign I had seen that maybe this surgery wasn’t a mistake.

My day continued to cruise along with a few visitors stopping by to see me. The swelling in my face was continuing to increase. Dr. Hudson stopped by to check on me and told me that he was pleased with the surgical outcome. He was able to get 4 mm advancement on my maxilla, at least 12 mm advancement on my mandible and an additional 3-4mm genioglossus advancement with my chin osteotomy. He told me that the swelling would peak at around 48 hours. After that it would be the slow descent back down to my new face. Pain was always present, but manageable with the PCA boluses. I was tolerating clear liquids fine, actually able to use a cup even though my bottom lip is totally numb. Yea! I was stoked that I was going to be able to manage nutrition without having to use a syringe. Later that afternoon I started feeling itchy and flushed. I thought that maybe I had gotten too warm. Then within minutes it seemed that I was itching everywhere! I looked in the mirror and my face and neck were breaking out in a rash. I got a throbbing nasty headache on top of the surgical pain I was feeling. We called the nurse immediately. As it turns out Ancef, the IV antibiotic that I had gotten in surgery and three more doses since surgery, I was allergic too. I questioned the nurse about the Ancef – reminding her that I am allergic to Cephalexin. She said she saw the allergy and had called the pharmacist about it. The pharmacist had also questioned the order knowing that that both Cephalexin and Ancef are both in the same cephalosporin family of antibiotics. The pharmacist had been told (by my doctor? the anesthesiologist? I don’t know who) that I had been given Ancef in surgery and did okay. So, since I didn’t have an allergic reaction no one saw a problem giving me a medication that I am allergic to! This really ticked me off! For every damn piece of paper that I had signed for the hospital, in the pre-admission interview, the anesthesia interview and on my chart it was noted that I am allergic to Cephalexin yet I was given a cephalosporin anyway! So much for fail-safe policies and procedures to prevent medication errors! I was started on IV Benadryl immediately. My antibiotic was changed to Cleocin that afternoon.

After school my kids came by the hospital to see me. They took the way I looked pretty well. They came right up to me and gave me a very delicate hug, being careful not to bump my face. I was so glad to see them. As much worrying as Allison had been doing preop I was concerned that she might be upset seeing me. She seemed to actually be okay with the whole situation once she knew that I was done with surgery and wasn’t going to die. Ben has been fairly trusting that I would be fine all along. After a short visit, Mom took them home to get homework and dinner done.

Following the allergic reaction and with the addition of Benadryl to my medicine regime I started having my O2 level drop when I fell asleep – which happened often because Benadryl + Dilaudid = sleepy Anne. O2 by nasal cannula was added. I was already wearing a humidifier mask to humidify room air to keep my nasal passages moist. During night shift my nose was really starting to get sore because the nasal cannula was rubbing against the newly-trimmed nasal spine. The respiratory therapist switched the humidifier mask over to O2. Well, to get 2L/hr flow of O2 through a humidifier mask you have to turn the flow up really high. I found myself with uncomfortably cool air blowing in my face. The evening continued to be less than optimal with the nurse I had been assigned that night. I wound up with a slow Eyore-like LPN in charge of caring for me. I have nothing against LPNs. I have worked with LPNs in the past that could work circles around anyone else, but this chick wasn’t great. My PCA ran out of med and it took one hour to get it back up and running. Being an LPN she couldn’t do anything with my PCA so I had to wait for the RN on the floor to become available to reset it. I am a fresh surgical patient who would have been in ICU had it not been for Patsy and I am assigned the LPN with one speed – slow. Not a stellar night.

Post-surgery - 10/24/07

***Warning - this posting is a bit graphic***
I was supposed to spend a night or two in ICU but they didn’t have an open bed when I needed it. Dr. Hudson’s decision at this point was whether to send me to ICU at the main hospital down the street (accessible from my hospital by shuttle) or to send me to a regular room with the understanding that one of my RN friends would be staying the night with me. Fortunately, the regular room with the nurse friend was chosen. My husband and mother and another of my nurse friends, Amy, were waiting in the room when I arrived from recovery. It was nice to get settled into the surprisingly comfortable bed. I pushed the PCA button as often as I could trying to get comfortable. Unfortunately I don’t think there was enough medication that I could get, short of having to reintubate me, that was going to get me comfortable initially. I was just going to have to hurt. In my room I had an IV (for hydration and IV access), a PCA pump (for pain control), leg compression machine (uses inflating/deflating knee-high boots to massage my legs to help prevent blood blots), and an O2 saturation monitor (measures my blood oxygen level. A good oxygen blood level is 95-100%). I felt kind of queasy and wobbly but stable enough to get up to the bathroom with some help. At this point of my surgical experience I was thinking, “What the hell have I done to myself! I have let someone saw the front of my face off! What was I thinking!” The logical side of my brain was still asleep.

Over the next couple of hours I continued to feel queasy until I vomited on return from the bathroom. I really was worried about how dangerous vomiting with a banded mouth would be, but honestly it wasn’t that bad. Since my stomach contents were liquid everything just ran out through my teeth. I had a stomach full of blood that I had ingested during surgery and it was making me nauseous. I instantly felt better. My routine over the next few hours was to rest, push that PCA button to keep my medication boluses coming, and to irrigate my mouth every couple of hours. I have incisions inside my mouth where my gums meet my upper lip and my lower lip and then more incisions in the back near my TMJ joints. For the first 24 hours or so they continued to ooze and my mouth needed irrigating so that I didn’t swallow any more blood. The routine doesn’t sound too taxing but I was profoundly exhausted. I couldn’t believe how much effort every thing I did took.

Along with the circus tent hospital gown, the compressions boots, two IV pumps and the O2 sat monitor, I had this elastic fishnet stockinette stuff that covered my head except for my face. Inside the stockinette were two large balls of gauze to cover the tiniest of incisions on each jaw. The only thing left to complete the look was the jaw sling ice pack. I looked ridiculous with the ice pack, but it was my buddy. The cool packs were very soothing to my throbbing jaws.

Surgery and Recovery - 10/24/07

After a reasonably good night sleep Bruce and I arrived at hospital admissions at 6am. Shortly thereafter I was taken to a pre-op room where I was left to change into a gown that I am sure was a circus tent in a previous life. I am not a small woman, but I could have wrapped this thing around me three times! I also was asked to don TED (antiembolism) hose. So here I am in this gigantic hospital gown, TED hose, and my decorative socks. In comes the nurse to hook up the compression boots and start my IV. Three sticks later I finally have a patent IV.

The anesthesiologist comes in to do his little talk. He covered my anesthesia/intubation/allergy history. We spoke about post-op pain control also. I can’t take Morphine so I am limited to what I can have in my PCA pump. I told him that Fentanyl worked well for me in the past. He told me that although they can use Fentanyl in surgery, it has a very short range between good pain control and depressing respirations. Since the goal here is to keep my breathing while trying to control my pain, Dilaudid was going to be the drug of choice in my PCA pump. [FYI – PCA is a patient-controlled analgesic pump. The pump is set to give a set dosage through an IV while allowing the patient to give additional small doses (boluses) to supplement pain control if needed.]

Dr. Hudson came by also to see if I was ready. I asked him if he had gotten a good night’s sleep and had eaten his Wheaties. He said that he did sleep well but that he was a coffee-for-breakfast kind of guy. Good enough.

Bruce was in the holding room with me after the IV was started, and then it was time to go to surgery. Bruce and I smooched a few times – this, after all, was the last time he was going to be able to kiss my old mouth. His joke was that when all of this is over he was going to be able to have a midlife crisis with a new kisser and not have to cheat. Our minister joined us for a quick prayer and I was off. I remember about 30 seconds in the OR, they got me off to sleep quickly.

The next thing I remember is waking up in the recovery room in excrutiating pain. My face was throbbing and I couldn’t get the RN to help me. I kept saying “I hurt” and “PCA not helping” but she told me that I was getting as much medication as I could. I finally realized that my O2 sats were not great so they were hesitant to give me more med. Ok – I understand that. Lots of pain but nothing I could do about it at that point. What really angered me about this nurse, though, is that she kept telling me to open my jaws a little bit so that she could give me ice chips. WHAT! She wanted me to work against the banding and pry my jaws open. What an idiot!!!! This one still flabbergasts me. I had just had my maxilla and mandible CUT LOOSE FROM MY SKULL. I had a bunch of plates and screws holding them in place until the bone regrows. I won’t even be able to chew scrambled eggs for months and she wants me to strain against the bands so that she can drop some ice in my mouth. I kept saying that I couldn’t do it and she was getting a little impatient with me. I didn’t catch her name but, man, she needs to pay attention to the procedures that her patients have done.

Hallelujah!!!

I just heard from my OS insurance clerk - All of my surgical procedures are covered! One more worry to cross off my list. Thank you Lord!

Got my teeth cleaned this morning. I will take some photos later this evening to post some before surgery pics.

Calm before the storm

Two days away from surgery and I am suprisingly calm. I guess that I know I have done EVERYTHING I can to prepare for this - whatever happens now is out of my hands. Not trying to sound fatalistic, just realistic.

I have gotten some terrific advice and encouragement from my friends on the nonCPAP forum on sleepnet.com. If you are considering this surgery and haven't yet discovered the wealth of practical information and encouragement from folks that have been there/done then you must go to that website! This is information that the medical community can't provide because it comes directly from folks that have had their MMA or UPPP or a host of other procedures for sleep apnea. Sandman does a wonderful job of hosting that website.

I am off to my regular dentist this morning for routine cleaning before surgery. Figured it was a good idea to start the surgery as squeaky clean as possible.

A special thank you to Toni, Bill, and Brandy - my forum friends - for taking the time to make sure I have thought of everything and have been adequately encouraged. They are great!

Pre-op OS visit

I had my pre-op visit with my oral surgeon this afternoon. He seemed pleased when he looked at the xrays, cephalogram, and the molds. He plans to move my maxilla 4mm and my mandible 12mm and also the genioglossus advancement. We talked about the plan for pain management and course of post-op recovery. I felt much better about the whole process by the end of my visit.

I also took my nurse friends to breakfast this morning. Just to make sure everyone had all the relevant phone numbers and a basic game plan. It turns out that the ICU I will be in after surgery is a small, 4 bed unit. I like the idea of not being in a huge ICU.

5 more days until surgery. Yikes!

Hooks, hooks, and more hooks

I went to the orthodontist for my last visit with them before surgery. I had new xrays, pictures, and molds made. The other fun event for the day was to have hooks installed for the banding to immobilize my jaws after surgery. Eight hooks above, eight hooks below. If Pinhead from the Hellraiser movies were to have braces they would look like mine do now. When I get copies of today's pics I will post them. The overbite looks really impressive on xray.

All for now. Time to wax up the hooks and go to bed.
Anne

Things going too smoothly - time for more insurance screwups!

After returning from a wonderful week in Williamsburg, Jamestown, and Yorktown, Virginia with my family I checked our home phone messages. There was a message from my OS's office saying that they had gotten a letter from BC/BS of Mass. The MMA had been officially approved but the GA had been denied because it was cosmetic. Cosmetic? Are you kidding me? Having one's chin tip sliced off in order to pull the tongue forward is sexy, no?

This morning I called my OS office and spoke with the insurance clerk. She read the insurance denial letter to me (I have yet to receive anything official directly from BC/BS.) She told me that the Lefort I osteotomy and the BSSO are both approved but they were denying the genioplasty tongue advancement. I asked if the "genioplasty" term made it seem like a cosmetic rather than medically necessary procedure. She assured me that it was the appropriate term and told me that all of the physician's notes, cephalograph info, xrays, etc. had been filed. She told me it was now in my court to take this up with BC/BS. She gave me the name of the UR nurse that had been handling my case. Before calling her I decided to call the head of HR for my husband's company. She was familiar with me and helped trememdously with the insurance problems I had before. She was helping me think through all of what I would need to ask/tell the insurance folks. Before I could call BC/BS I got a call back from the OS office. The new, on-the-ball clerk checked what had been filed to make sure it looked alright. She double-checked the codes that were filed. Turns out that the old insurance clerk (the one that was involved with the previous problems and has since been freed up to find new employment) filed the right procedure terms but with the wrong codes! The code that she used was for a genioplasty (the cosmetic kind) and not the genioglossus advancement! Dr. Hudson has dictated an amended letter and the new clerk has been on the phone with the UR nurse with BC/BS. The UR nurse will be expediting this to see if they will now cover the procedure. So - push comes to shove I will be writing out at check for $3K next Wednesday that hopefully I will get reimbursed after the surgery. If all goes well (I am not holding my breath) the GA will be approved and this will be nothing more that another angry, stressed-out day dealing with insurance problems. Unfortunately I won't know if the re-filing works until late this week.

Just an aside - I keep mistyping insurance as unsurance. I think I like the typo better.

Through all of this mayhem Toni (Learian) and Bill (SeattleBill) from the sleepnet forum have been wonderful, supportive friends.

On another note, daughter told me that she had a stomach ache all day today. She is doing some preemptive worrying. I have some more comforting and reassuring to do.

Peace,
Anne

26 days to MMA

Okay, no one ever mentioned that there could be weight loss before surgery because of having a nervous stomach for weeks on end! I didn't expect that the pre-surgery nerves would kick in so early, a week or so before but not 6 weeks before. Trying not to think about it so much, but let's be real, it is hard to think of anything else.

I am whittling down my lists of things to get done. Lois, a very good friend, is coming over Monday to help chop and cook so that I can get some more things in the freezer. My goal is that my family won't order pizza more than once a week while I am out of commission. My kids would eat pizza every night but they need a bit more balance in their diet. I am still working on a christening gown for my new niece - need to finish this up this week. A few other little niggly bits to cross of my list but I have the big ones done.

Reading back through some of the posts I realize that I didn't give an update on my dad after writing about his diagnosis of metastatic melanoma. He had his surgery for his tumor removal the end of June and has spent the summer recovering. The pathology reports came back as good as could be expected. In fact his oncologist told him that he is an enigma - he has no evidence of cancer therefore nothing to radiate. There is no chemical treatment for him. He will be PET scanned fairly frequently over the next couple of years to make sure that if something crops up it is caught early. Great news for our family.

44 days and counting

I saw my orthodontist today. More of the usual (powerchain change, wire change, more slenderizing) and then it occured to me - this is my last regular appt. until after surgery. I have an appointment at their office on Oct. 16th, but to have molds, xrays, and pictures made. Then two days later I see my OS to have more of the same. Then surgery the next week after that. Wow. The reality is really starting to dawn on me.

I am still making my list of things to get done before surgery and am slowly getting them marked off. Everything from getting my annual physical done to getting the car tuned up. I have a christening gown for my new niece that I need to finish. My dining room needs another coat of paint before I can get it put back together. Lists have been made of the grocery items and non-grocery items that I need to get. I will be ready, it just have to keep plugging away at getting stuff done.

Boo!

I realized recently that with an Oct. 24th surgery date I will have one heck of a Halloween mask! Admit it, you are a little jealous, huh?
Anne

Lists, lists, and more lists

It is dawning on me just how much I have to do to get ready for this surgery. I am now down to 8 weeks until surgery and am starting to feel nervous about all that I need to get done. Seven weeks really, we will be on vacation for a week in early October.

The list keeps growing:
-the list for what to get (liquid vitamins, baby spoons, white board, lots of chap stick, etc),
-what to get done before surgery (finish painting the dining room, finish renovating daughter's room)
-what groceries to have on hand (supplements, liquid vitamins, yogurt, blendable stuff)
-what to get prepared and in the freezer for my family (regular groceries, prepared and ready to bake - DH doesn't cook, but he orders a mean pizza. I really don't want the kids to just eat pizza for three months!)
-questions to ask my OS on my next visit (Should bank autologous blood? remember to tell him that I can't take morphine.)
-lining up a housekeeper to start before surgery and go for probably 4-6 months (because I won't be able to relax if the house is a dump)
-setting up the email notification list for updates on how I am doing - figuring one email sent en masse to friends/family will be much more manageable than lots of phone calls or individual emails, especially in the beginning while DH and Mom are handling the communication. (If you wish to be on this list, please drop me an email or call and let me know.)

I start meeting with my friend/personal trainer this Friday. She will be helping me improve my strength and stamina before surgery. I like the idea of having a personal trainer who is also a friend - she will have no problem holding me accountable for exercising. Thank you Lisa!

I am also starting vitamins to boost my immunity before surgery. I saw my family practice doc/friend who had no problem with what I plan to take. He also changed out my HTN med due to it being somewhat ineffective to control my blood pressure - and I think it may be thinning out my hair. I am getting thin hair quickly enough!

Maybe I can catch a few quick winks before I need to get the kids up for school. I have been up since about 3:30am mulling all this stuff over.

I will definitely be taking a long nap today.

SleeplessinSeattle from the Sleepnet forum said this: "Your family and friends may think you're crazy, but they don't have sleep apnea. They don't know how it can drain away your life like some sort of invisible vampire." Couldn't have said it better myself.

Annie, you got some 'splaining to do!

I was a church this morning attending the contemporary service with my husband and children. During the "Joys and Concerns" time before the prayers of the people I mentioned that I finally had a surgery date. In my mind this was a joy - I have been waiting a long time for my mouth to finally arrive at the appropriate misalignment. Next thing I know, my 1o year old daughter raises her hand and expresses her concern that I am finally going to have surgery. We have been talking about my impending surgery for so long that I just assumed that my kids were okay with everything. Today I realized that I need to spend some real time focusing on what they need to be okay with all of this. We started the discussion in the car this afternoon. Lots more talks and hugs to come.

Yaaaa hoooo!

I haven't posted over the last two orthodontic appts. because there just hasn't been that much to report. More lower tooth slenderizing, back in rubber bands to help tighten up those lower teeth as much as possible. But with my last appt. he told me that it was time to see the oral surgeon again.

I saw Dr. H today and he agrees that I have enough overjet to proceed! My surgery date is October 24, 2007! So I am T minus 78 days, 11 hours, and 37 minutes. (Sorry for the geek talk, I live in the Rocket City).

Dr. H wants to proceed with the MMA along with a elliptical osteotomy version of GA. He explained that for the GA he will cut a diagonal "chunk" of my chin loose and shift it forward. He explained that this procedure would help the vertical aspect of my profile more so than a regular GA. I will go back to him a week or so before surgery to have a final set of pre-op xrays done and then will be ready to go! I am excited about getting ready to proceed but I don't think the actual reality of all of this will hit me until much closer to time.

More info when I have it.
Anne

No Pain, No Gain?

I saw the orthodontist again yesterday. The upper and lower wires were changed to the final wire gauge for surgery. The lower incisors were "slenderized" - meaning that they have this sanding gizmo that sands down the sides of my teeth. Imagine your teeth being sanded with an emory board. Unfortunately with the stiffer wire trying to fit into the brackets there was lots of pushing and tugging going on. The ortho and my tech, Jen were trying to be careful but the wire really didn't want to go into the bracket.

Anyway, lots of pain last evening and today. Difficult sleeping with my teeth throbbing. I will be glad when things settle down again.

The surgery date still looks like it will be late October. My ortho advised me to make contact with the oral surgeon and let them know that I am 4 month out from surgery. I can't believe that we are actually closing in on a date.

Dad is still waiting for a surgery date. All of his diagnostic tests since the original biopsy have come back clear. We are grateful for good news but anxious to get the cancerous lymph node GONE!

wild roller coaster ride

The last couple of weeks have been insanely stressful. My father found a lump in his groin that was biopsied to be metastatic malignant melanoma. Further testing shows that it seems to be confined to the one lymph node - no trace so far of a primary site. More testing will be done to rule out a GI or GU origin. Who knew that melanoma could develop on parts of the body that have never seen the sun! My entire family is off to the beach this next week to celebrate my parent's 50th wedding anniversary. When we return my Dad will begin to attack this cancer problem. He is facing a pretty meticulous surgery to remove the involved lymph node. So far there is no obvious need to chemo or radiation. Anyway, the diagnosis and then waiting to further diagnostic testing to see if this was a death sentence or something treatable has been very nerve wracking.

This week has been so much better! The kids are finishing up school so there has been no homework hassle. I saw my orthodontist on Monday and I actually left fairly happy. This is the first time I have seen him in six months that he hasn't bumped my surgery date. He was pleased with the tooth movement and changed my lower wire to the next to the heaviest wire needed for surgery.

The plan is to bring me back in a few weeks and "slenderize" a couple of lower teeth to facilitate that last little bit of overbite. Then on my next regular appointment the plan it to change out both my upper and lower wires to the wire needed for surgery. He still thinks that I am on track to have my surgery in late fall.

A Little Good News

Thursday I dropped by my orthodontist's office because I had a toothbrush bristle caught in my molar band that was poking my tongue. I also needed to get my lower wire clipped as the gap in my teeth where my lower left pre-molar was pulled had FINALLY closed. (After waiting a year for it to close ir really moved closed quickly after the last wire change.) The tech called Dr. H over to look at the lack of gap and he decided to go ahead and change my lower wire to a heavier wire. He also removed the wire spring over the gap area and told me to stop wearing the elastic over that spot also. So, yea!, I am actually ahead for my next appointment. If I hadn't had the bristle problem then it would have been May 21st before I went back in and therefore gotten my wire changed. He seemed pleased with the progress - not enough to move my surgery date up yet, but progress nonetheless.

I also saw my regular dentist earlier this week. Everything, dentally speaking, looks great.

Urrrgggggghhhh!!!!!

I had my regularly scheduled appt. with my orthodontists today and just knew he was going to be pleased with the movement of my teeth. I have gone in two or three times since my last appt. to have my wire trimmed because my teeth have moved so much - or so I thought. He told me that I have at least 6 months to go before being ready for surgery. I reminded him that he said I would be ready in 6 months three months ago! After some discussion that involved my hands at his throat, I got wired back up and left. So here I am - disgusted with my slow moving teeth, a little mad at my orthodontist that he doesn't seem that concerned that I have a least another 6 months of crappy sleep, and sore from having my teeth jerked around. Bad day. Things will get better, right?

Pictures!

Well, I can't believe that it has been almost 2 months since I posted. Time flies (not!) when you are waiting for teeth to move. I was thinking that since my bite has changed so much that maybe I take some amateur, up-the-nose pics of me and my ever-worsening bite. It would seem that all I am able to chew these days is my cheeks. Enough whining, on with the pics.

First , a review of where I started. Not great, but I could chew my food!

If you think this looks like I am pointing a camera at my face and snapping pictures, you would be right. Not an obvious change from the front, except for some serious tooth bling and tea-stained bracket cement.

The profile is changing significantly. It seems like my little chin is disappearing. When I am not smiling for the camera, my lower lip is also disappearing. With no lower teeth to help hold it in place it is starting to look like I am sucking my lip in.

If you look carefully up the nose you can see a tiny nativity scene! This pic is taken with my teeth together in the most natural position. Needless to say, I can't bite a damn thing! Surely this is getting close enough to being bad enough! I will know more in a couple of weeks.

A sssthar is born!! That reminds me of the other thing I was going to mention. I have started to talk with a little lisp/whistle thing. Temporary, right?

Well, I think I have posted enough for now.

new friend

Just when I seem to be getting rather depressed with all of the waiting, waiting, waiting that goes along with preop braces, I meet someone who gives me a little hope. I was at a school meeting on Sunday and sat next to a very pretty woman named Cindy. After a little while she asked me how long I had left with my braces. She explained that she had recently gotten her braces off. When I explained that I had them in preparation for surgery we began a deeper conversation. It turns out that she also had braces in preparation for surgery - the same surgery as I will have, by the same doctor, at the same hospital! I was very pleased to know that she was very pleased with the whole process and had a wonderful outcome. I took a really good look at her then and admired Dr. Hudson's esthetic judgement for her profile. Her facial proportions are perfect. One of my concerns with the MMA is that my jaw will be brought too far forward and I will have a bulldog profile. I know this isn't realistic, but it is a concern anyway.

She also told me that to this day she can't stomach milkshakes or smoothies after having so many of them while banded shut. They are so fattening, it is probably a good thing.

My sleep apnea journey

Delays, delays

The beginning of December I had my orthodontist appointment. New hardware - I got a horizontal spring on each lower side to close the gap where my bicuspids were extracted before I got braces. I also got rubber bands to pull my lower front teeth back to increase the overbite. All this adds up to sore teeth again. Yea.

I also asked him when he thought my overbite will be large enough to proceed with the MMA. Expecting him to say spring (like he projected when we first started this process) - he really suprised me by saying probably late August. Sheesh! So, add an extra half year to the journey.

Adjustment #2

Two days ago I had my lower jaw wire changed for the next heavier gauge wire. Dr. H says that my teeth are moving along nicely. The next adjustment is scheduled for Dec. 4th at which time they will be adding springs to my lower teeth to really pull my teeth back. I am getting a pretty nasty overbite but nothing like what is to come. Yea. The sooner my overbite is sufficient, the sooner I can proceed with the surgery.

Soreness is a manageable, frequent companion.

Insurance Update

I have an update to my insurance saga. After hearing from my surgeon's insurance clerk that there were problems with my insurance getting on board with me, I had an idea. I called the head of the Human Resources for my husband's company - not the local person, but the head of the food chain - and explained my situation. She agreed that what I had heard from the insurance, by way of the insurance clerk at my surgeon's office, wasn't plausible and needed to be handled directly. Five minutes later I was in a three-way conference call with the HR director and the group manager for my insurance. I once again got to explain my situation. The insurance group manager wasn't even able to pull my case file up on the insurance computer! Since things weren't coming close to making sense, she said that she would call my surgeon's office the next day and talk with the insurance clerk. She would get the clerk to fax the reports to her and she would walk them through to those that needed to see them. The next business day after that (so fast after 7 months of waiting) I got a call from the HR director with great news! She told me that no predetermination is needed for my MMA. Medical necessity was determined by the diagnosis code, and yes, sleep apnea is an approved diagnosis code for MMA. It turns out that the insurance clerk was trying to file a predetermined cost estimate (or something like this) and this isn't something that BCBS does. It is more of a dental insurance thing. So, I don't know why noone at BCBS mentioned that she was trying to file something erroneous or why she didn't ask BCBS what she was doing wrong. At this point I don't care. I am just over the moon that my surgery is covered by insurance! Our HR director made sure that I had her number and encouraged me to call her directly with any future problems. I love it when a plan finally comes together.

Frustration abounds

I am so FRUSTRATED! I finally heard back from the insurance person at my oral surgeon's office. They heard from my insurance company - BC/BS of Massachusetts. After many requests for additional records and test results, the medical director for BC/BS has decided that the decision to approve or not approve the MMA will be delayed until AFTER my orthodonic treatment is completed.

This is so frustrating for so many reasons:

-Delaying the surgery until after my teeth are completely finished doesn't make sense. I need the braces in place for wiring my teeth during the postop period and for fine tuning my tooth position after the bone healing is done.

-This decision makes me wonder if the insurance medical director has a clue about this procedure that he/she is making a ruling on. Is the decision-maker a dermatologist who doesn't have a clue about current treatments for sleep apnea?

-My bite is getting worse everyday thanks to the braces doing exactly what they are intended to do - to give me a terrible overbite in preparation for my maxilla and mandible movement with the surgery.

-Chewing is getting really difficult - the thought of the surgery being postponed for another period of time is very discouraging.

-The thought of not being able to have this surgery scares the hell out of me. My weight, high blood pressure, arrhythmias, rock-bottom energy level. I have been trying to keep from getting depressed about the whole situation. The long-term damage of sleep apnea
are well documented and quite permanent.

I have a few calls into the human resources rep from my husband's work. Hopefully she will find out something that I don't know already.

I find this all exhausting and it makes me want to crawl in the bed and never come out. Maybe my next post will be some good news.

Frustrating Arrythmias

Well, I continue to have a dozen or more arrythmia episodes per week. I saw my doctor on Friday and was sent to the cardiology center to be fitted with a 72 hour holter monitor. Well, frustratingly, who knew that the mere act of hooking up a holter monitor could cure erratic heartbeats? I have had the quietest couple of days in months! It is like taking a feverish, vomiting child to the pediatrician. They arrive afebrile and smiling - and then vomit in the car on the way home.

I have a call into the doctor's office to see if we can try a 30 day monitor. I will let you know how things shake out.

Arcing and Sparking

It has been a few weeks since I changed the dosage on my Toporal XL. No real change noted on the arrhythmias. I see my doctor again next week.

I have also started back on the CPAP machine. It doesn't really make me feel any different, but it makes my husband feel better. Glad one of us is getting some benefit.

Secondary problem

Another problem with my health that I don't seem to be able to get under control is my high blood pressure and cardiac arrhythmias. In the last several years I have been on 5 different medications, trying several dosages of each until it is deemed uneffective or I develop an uncomfortable side effect. I remember coughing night and day for a couple of months until I realized that my Altace was causing the cough. I stopped taking it and within 36 hours my cough was gone!

Starting today I am on a higher dosage of Toporal - my third dosage increase. I am keeping my fingers crossed to see if this works.

Adjustment #1

Well, I have had the braces for almost three months now. Things have been clicking along okay - getting used to having everything I eat get stuck in my braces. I find it much easier to floss these days - heck, I could even floss with kite strings in most places.

Today I saw my orthodontist for my first scheduled adustment. Got the wires changed to a heavier gauge to get things moving along more. I asked him how things were looking and he said that my teeth are moving along on schedule. I was hoping that since the front teeth are looking so different and my bite seems different everyday that he would say that things are ahead of schedule. Well, that was wishful thinking - I am still looking at next spring as my target time for surgery.

By the way, I still don't have final approval for my surgery. My case is in "review" with the insurance company. They have requested more information from the orthodontist and it is just taking forever. I will be able to relax a bit once I know that I am not responsible for the $60K that this surgery will cost. Also, once I have surgery approval I can get started with my quest to get insurance to pay for the braces.

After reading the sleep net forum I have begun to collect the items that I will need after my MMA. I have a good blender and an immersion blender. I am making plans to have a recliner at home during my recovery time. I am really benefitting from the other postings out there. Thank you Westernjoe, SeattleBill, Cupertinojoe, and all of the others back at the sleep forum.

Anne

Feeling better

My teeth have settled out from the new wires now. I can actually stand to chew a little bit. Glad to be able to eat a sandwich without a knife and fork. Daughter if feeling fine also. She healed from her tonsil surgery without any complications. Yea! School is out so I don't have to get up so early - another yea! Things are coasting along nicely right now so I won't post again until I have a significant update.

new wires

The night before leaving for Boston last Thursday I flossed the wire out of my back molar band. Yea. I tried to manipulate it back into the little hole in the bracket but I couldn't manage. So, a little snip with my wire cutters and I was free of that poking wire end. It was 10pm before going out of town for a week - it seemed like the right thing to do.

After getting back from Boston (G'vanni's in the north end - best italian food EVER!) I made an appt. with the orthodontist folks. It turns out that a couple of the molar bands didn't have their wires attached! Due to the angle the wire needs to make to reach those back brackets and the softness of the starting wire, this is a problem that was likely to repeat itself. The solution - a heavier wire. Sounds easy enough. It felt a little tighter in the office. Well, now things are pretty sore again. The pull is significant enough to make all my teeth painful. Means things are moving, right? I sure hope so.

My daughter Allison had her tonsils and adenoids removed on Friday. She is having trouble swallowing and I have painful chewing. We are quite a pair right now. She has been a real trooper through her surgery and recovery. She didn't even flinch when they started her IV preop. She got to come home six hours after surgery. Now she just has to put in her time to heal.

All for now.

Changes?

I have been comparing my teeth to the plaster casting that the orthodontist gave me - I am seeing a difference but wondered if it was just wishful thinking. Well - today Gina, my occupational therapist said that she can tell a difference in my teeth. I didn't bring it up, she did! So, yea(!), maybe things are moving along. Had my first hamburger A.B. (after braces) today at lunch. It was a really good one too, not one of those little kiddie burgers from McD's. I had to eat it with a knife and fork but it was well worth it!

By the way, physical therapy is progressing. After 9 months of OT, my elbow is finally approaching where it was pre-injury. I don't think it is physically possible for it to regain fully-normal motion, but it is sooo much better than it has been. Gina's the bomb. I think she enjoys torturing me, but she gets results. I keep coming back.

Things settling down

Today is day #10 with the molar bands in place. The previous week has been fairly miserable. I went down to the Gulf this weekend to attend a conference. Eating conference food is bad enough, but having to paint the sides of my tongue and the insides of by cheeks with Orajel before eating just put the cherry on it. Although I was with friends and was at the beach, I was ready to come home because my mouth hurt so bad. You know, when you feel bad you want to be at home.

I saw the orthodontist yesterday to get things smoothed out. Much improved! I ate dinner tonight without numbing anything and it wasn't too bad. Maybe these braces aren't going to be too bad. It does force me to slow down my eating which is actually a really good effect of the braces. Hey! I am already noticing a difference in my teeth! I compared my plaster casting to my lower teeth and can see a difference! My friend Kerry told me that she would be praying for my teeth to move swiftly and as comfortably as possible. Keep it up Kerry!

I have been following the Non-CPAP sleep forum on Sleepnet. Great info on that site for anyone dealing with sleep apnea.

molar bands stink!

Okay, I got my molar bands on today. It took an hour of cramming those things on to find the right ones. Once they had them all on and I thought, "whew, I'm glad that's over", they jerk them all back off! They smoothed them down (sort of) and then cemented (crammed) them on. Then the wires were installed. Dr. H. and his staff are really sweet but I was pretty sore when I got out of the office. Chewing is no fun at all. My back molars don't touch and it feels like I have metal making contact with one of my molars. I have to offset my jaw a bit to be able to bite down. It will be a while before before I can chew. Mashed potatoes again.

question to ponder

I was thinking while I was singing in church today. I was wondering what my voice will sound like when my airway is altered. I have always sung - since I was a little girl. I wonder what impact the surgeries will have on my voice. I will post this question on the sleep forum website to see what input I can gather.

The braces aren't bothering me anymore. Biting and chewing are a bit tedious but not painful. I go in to have my molar bands applied on Tuesday. Looking forward to that - not!

More when I have something to say.

Molar Spacers

Well, I got the thicker molar spacers yesterday. It was a quick visit - maybe 10 minutes total. The orthodontist tech snapped out the eight spacers and popped the new ones in place very quickly. Not very comfortable but at least it was over in a hurry. I think I left fingernail marks in the chair armrest.

I am not as sore as I thought I would be. That is a suprise to me. I was able to slowly eat some chicken salad this afternoon. Everything was going well until I popped a grape tomato into my mouth and tried to bite down. Couldn't manage and I had to remove it.

The unexpected sensation that I have right now is a slight pressure feeling on either side of my nose. I guess the thicker spacers have disturbed the nerve roots of my molars. Not painful, just a little weird.

Still haven't been able to tolerate the CPAP with the braces. I really don't notice that my sleepiness is any worse without the CPAP therefore I am not sure I will restart it. One less hassle.

Metal Mouth

Even though the last post was dated 4/15/06, it was written a couple of weeks before just waiting for me to get my blog set up. So, even though the date on this new entry is one day after the last one, a couple of weeks have actually passed.

As of last Thursday, I can officially be called "metal mouth". Pretty much hate them at this point. My teeth are so sore that I can't chew and the insides of my lips and cheeks are raw. In the overall scheme of things, this is merely an inconvenience though. On the pain scale, this is a distant third to the UPPP recovery and the elbow fracture - actually I don't think it is even on the same scale. I go back to the orthodontist on Tuesday to replace the molar spacers with thicker molar spacers - yea. The molar bands will be placed the week after that. I will be glad when I get adjusted to them. Right now soft food is the order of the day.

Now about the metal vs. invisalign braces. First of all, the orthodontist recommended the metal braces because they will get the job done quicker. The invisalign braces are more expensive plus they won't accomplish the same outcome. Go figure, the less expensive (a relative term) option is also the best option. The out of pocket cost of the braces is $5800. Ouch.

In going through this journey, I have to remember that this is a long drawn out process that will hopefully end with my apnea resolved, hypertension and cardiac arrhythmias resolved or controlled, more energy from restful sleep, a better profile, and straight teeth. The latter two a nice secondary outcome of the process.

The other change since getting braces is that I can't wear my CPAP at night. The mask pushes on my upper lip and pinches my lip between the braces and the lower rim of the mask. It is nice to be able to go to bed without the CPAP but I am especially tired the next day. Maybe I will be able to get back on the CPAP soon. Never thought I'd be saying that!

Time to throw my hat in the ring

After reading other folks apnea blogs, I decided that I needed to throw my hat into the ring. If my words help someone else as much as the other blogs that I have read have helped me, then this will be a worthwhile effort. Well, here goes…

I don't think that I have had a good night's sleep in eleven years. This coincides with starting my family so I just always assumed that this is how tired moms are supposed to be. It wasn't until 8 or 9 years later when my blood pressure started inching up along with my weight that I had to consider that this wasn't just normal "mommy fatigue". Of course the first thing you are supposed to do for low energy is exercise and lose weight. Unfortunately, exercise just wiped me out and ruined me for the rest of the day. I didn't get that "energy boost" that I had heard about from my friends that regularly exercise. My doctor decided to send me to the sleep lab after I complained of excessive daytime sleepiness and hypertension not easily treated with medication and cardiac arrhythmias. During my appointment with the sleep disorder specialist I expressed my desire to avoid the CPAP if possible. If I had a problem that was surgically correctable, I preferred to fix the problem than sleeping with a CPAP for the rest of my life.

What an experience the night in the sleep lab was. After changing into my jammies, my lab technician took me into the set-up room and transformed me into Swamp Thing with all of the wires and electrodes glued to my face and scalp. Back to the room for the chest bands and body electrodes. Nasal and oral breath sensors were attached. When all of the wires were attached to the monitor I was told to relax and go to sleep. Yea, right. But eventually I did fall alseep and thought that I had gotten a reasonable night's sleep. I was suprised to learn that I had awakened 27 times an hour during the night. The sleep disorder doctor referred me to an ENT to discuss surgery.

The ENT that I met with said that I had a badly deviated septum (which I knew about) and an enlarged soft palate. He told me that this would most likely cure my snoring but he didn't think it would completely fix my apnea, if at all. A few weeks later I had a uvulopalatophryngoplasty and nasal septoplasty. What a treat that was! I had never experienced anything so painful in my life. It was a full week of excruciating pain, with the worst pain starting on the third day! I never noticed any discomfort from the nasal septoplasty because my soft palate was so incredibly sore that it hurt to breathe! Ouch! Unfortunately, two weeks postop as I was beginning to feel human again I slipped and badly fractured my elbow! Talk about a pity party! I was still sore from the surgery and then I wind up in a heap in the garage with my elbow messed up badly! Tough time.

Three months later I was finally ready to have a repeat sleep study. I didn't feel any more rested but my husband told me that I no longer snored. I was hopeful that my numbers were going to be better. Unfortunately my new numbers were worse! I woke up 46 times an hour during my second sleep test. I was expecting the "the UPPP can only help so much, you have to lose 50 pounds and your sleep apnea will be under control" lecture. Instead I got the "you have an anatomical problem that needs to be fixed - get thee to an oral surgeon" talk.

Soooo, next came the appointment with the oral surgeon. He was impressed with my xrays and facial anatomy. I was expecting to talk about having a jaw advancement. The doctor showed me my xrays and pointed out the small airway that is the origin of my sleep apnea problem. He says that in order to advance my mandible far enough forward to open my airway, he will also have to advance my maxilla. We aren’t talking just a little bit of movement either – the plan is to move my maxilla out about 7 mm and my mandible out 15 mm! Wow!

If this surgery was done today none of my teeth would touch. So I will be wearing braces for at least a year to move my teeth out of their current alignment so that when my maxilla and mandible are moved forward they will be aligned. Fun huh? The insurance won’t be paying for the braces either – they are considered cosmetic. Ain’t that a joke! I am a 42 year old woman with hypertension and cardiac arrhythmias trying to fix the sleep apnea that is causing my troubles and they are considering that my braces are so I will look pretty! Needless to say I will be fighting this insurance denial. It may not work but I won’t go out without a fight.

I think that this first entry brings us up to date so far. I will be adding entries as I have new stuff to say.