Surgery Date

I now, after four years of treatment, have a surgery date. March 29, 2011. It was originally scheduled March 22nd, but I received a call from the resident asking permission to move it back a week. He said they have two other cases scheduled and they only had 2 hours alloted for me, didn't want to rush, and think they needed at least six hours on me.

Last Thursday, I went to my Prostodontist and received my temporary partial lower denture. It was screwed into my lower four implants and is very comfortable. It looks really high right now; that will not be the case after my surgery. I had to buy a WaterPik to clean underneath it. The BIG BIG negative is that my jaws and bite are so messed up that there is a large space between my upper and lower molars and it renders basically unable to chew since my teeth don't meet. How frustrating! I told him about it, but I felt like he kind of shrugged me off.

That night I got home and was tired and hungry and frustrated. I felt like I had enough of all of this dental stuff. Enough!! I emailed my surgeon about it, and he emailed me back immediately, copying my prostodontist. Augh! The prostodontist called me the next day and asked me to come in on Monday. sigh. He made me a thick plastic 'wafer' that sits across my mouth and over my back teeth to make molar contact. The chewing is easier, but not what I would call "easy".

It seems like all I can think about is my surgery lately. I'm petrified and I HATE being out of commission.

I'm thinking about starting a new blog to chronicle my jaw surgery.

This morning

I went to the Prothodontist for the next step in my treatment. The appointment went like this.

I got two shots of novocaine, which were the easiest I've had, but it did not feel like my mouth was numb at all. Sometimes older dentists are more experienced with this stuff. Then he took this curved scalpel and cut/dug each implant out under the skin (this did not hurt, and the asst was good at sucking up all the blood so I didn't taste it). Then he unscrewed the implant caps (which felt weird, and my implants started throbbing and hurting). It felt like someone was unscrewing something down deep in your chin bone. Then I bit on two different wax bites, then a model thing was attached to my ears ( to articulate my bite). He screwed in these really long posts into each implant (I was in throbbing pain by then) and put this hard acyclic stent like thing that fit over the long posts. he kept trying it on and taking it off and drilling the holes to make it bigger, sometimes with it still in my mouth. Then he pushed red wax over each and every bracket (gosh all my teeth hurt). Then he took the longest impression I've ever had pushing down on the area the entire time. This was followed by two X-rays of the area. Then he unscrewed each long post (remember I have four), then screwed in each longer healing cap followed by several excruciating twists to tighten with an additional wrench.

I was in substantial throbbing pain by this time. His asst gave me three Advil. I started crying when I got in the car, the pain was so bad. When those took effect I was much better. My chin and cheeks are still sore from holding open for 1 hour 15 min. But I'm not really in as much pain anymore.

This surprisingly turned out to be an ordeal.

jaw update

Last Wednesday I went to the oral surgeon for my one month follow up from my third surgery. It went well. I saw the resident that I like (and let's be honest, think is cute, but is probably 8 years younger than me), the fellow that did my 2nd surgery (and is very nice, but not as cute), and my surgeon. I was surrounded by men. My teeth and jaw make me such a unique creature of interest. (Sorry for the sidenote).

Things looked very good, despite the incision opening up twice. They were forced to just let the edges of the tissue grow together, and it has done so, quite well. I have to see the Prostodontist that is making my partial denture (my $5000 partial denture so damn it better be good), and in 3-4 more months we can "load" the implants with it. I'M SO EXCITED! I will have teeth on the bottom like 99.9% of the rest of the population.

Then my 4th surgery (aka the BIG ONE) is going to only be a one jaw surgery, on my lower jaw. It will be a Bilateral Sagital Split Osteotomy (BSSO), where my lower jaw is cut into pieces and repositioned. They are going to do a bone graft for my upper teeth spaces (that show and make me look like a jack o lantern) at that time.
That will be the first week of March.

It went well

So yesterday I had my 3rd jaw surgery. This one was technically a repeat of the 2nd surgery from the beginning of July from which I had four dental implants placed and hardware removal. I lost 3 of the 4 implants afterwards, etc.

I emailed my surgeon over a week ago asking him if he was planning on removing the hardware that was protruding through my gums and informing him that I did indeed have the surgical stent in my possession. The stent was made by my prothodontist and cost me $420. They packed everything up after my 2nd surgery and told me to take it back to him, not imagining that we would need it again. It's been locked in the cabinet under my downstairs bathroom sink.

I told my husband on the drive there that I'll bet they were hunting EVERYWHERE for that splint. We got to the hospital and thankfully, I had a fellow that I really liked. He came in and told us that "they were going to take some impressions" because "I haven't had any since June". Hahahaha. I played along for a while, and then I pulled the box out of my bag and said, "Oh, did you need the surgical stent? I have it right here". You should have seen his face! We all laughed. He said he called everywhere looking for it and called me twice. I don't why he didn't leave a message. My surgeon also doesn't read his email either. He admitted that he has over 1000 unread.

The start was slllooowww. They were training a new older male nurse (that was annoying and clueless) along with the nurse I like. The assistant brought in trays and trays of equipment. The fellow put in the IV with no problem. I sat for a looonnggg time while everyone ran around. I remember them giving me a little bit of meds (probably Fentayl and Versed) and then the room started to spin. Later, I remember trying to talk and them shushing me. I don't remember waking up at all or them taking out the IV or anything.

I didn't wake up in pain like last time and feel about 1000% better than the last surgery. I've had more oozing of blood and more swelling and a LOT more stitches. I can hardly open my mouth. Of course I'm on massive doses of Clindamycin (again) for 10 days. I only took one Norco before bed last night and am managing pain with Tylenol. They wrote me off for all week but I may go back tomorrow. Trying to conserve sick time.

I'm feeling.... I don't know, hopeful again?? :)

the Good, the Bad, and the Ugly

I'm not even sure what to say. this is going to be rambly-esque post.

It's been busy.

The crap:
P was in Philly for work. He got home. He experienced a bad cold. He was crabby and feeling crappy to boot.
It was stiflingly hot and humid.
I lost yet another implant. I'm 1 for 4 right now.
My BSSO surgery was delayed by two months to January (okay, this is both good and bad as January is better than November)
Don't know if I want to invest more $$ in my teeth.
V has been laying on the floor an awful lot in protest. This is very hard on the parents' backs.
P's back is bad from lifting laundry as he had major problems for a week (see above).
V picked up P's glasses and broke the earpiece clean off with a snap. She wasn't the least bit sorry either.
Horrible hair days
Got my period after five days late. Was starting to play "what if" which is can be a heartbreaking game for infertiles. I was sure is was going to be a boy too.
Having dilemnna whether to sell all the baby stuff or not. Letting it go will be difficult to let go of V's babyhood and accept that she will be my only baby. However, maybe I'll have one of those haha moments where I got rid of stuff and now I'm pregnant!
2nd molars trying to erupt. Enough said.

The fun stuff:
I'm finished with my 3rd course of antibiotics! Yeah!
I took V to a new playstructure with swings twice this week after work. We had so much fun! She swang and swang and I had to basically drag her home. We need a swingset of our very own. I have spent so much time looking for a decent swingset for under $300. Craigslist, (don't want to dissassemble and carry away), ToysRus, Amazon, Walmart, etc. We haven't wanted to shell out $500 for the same ones in all the yards, but I really think she would use it. P and I finally agreed that he would get her one next spring FOR SURE.
What Halloween costume to get for V? This is fun part of parenting. She is still at the age where she has no say in what she gets to wear, and I get to indulge in whatever I can find a good deal on and that is cute! I am leaning towards Abby Cadabby from Sesame Street. I would like to try and make it but I am so sewing challenged.
The oral surgeon is not charging me for my 2nd "corrective" surgery!!!
P booked a 10th Anniversary Trip for us in December.
Labor Day is coming up - going to visit family up North (V and I are) for a long weekend.
Gymboree coupon for 20% off + gift card = :)
Been eating some great Gluten Free Bread this week from Celiac Specialities. texture is weird, but taste is great!

The jaw saga continues

On Sunday, P had a work picnic. On the drive there, my tongue found a swollen spot over one of my implants which I examined in the mirror. It was a swollen bump obscuring the implant. The implant also was flopping around in the socket. Uh, oh I thought. That is what happened with the last one prior to coming out. On Monday I called the Oral surgery resident and he never got back with me. I convinced myself it was getting better on Tuesday. On Wednesday, I stopped by the clinic, but they couldn't see me. Thursday I called again and recieved an appointment for 3:30 pm. They took me in late which could be a problem since with traffic and exiting the parking garage I am an hour's drive from picking up V. Of course, the took me in late. My surgeon was in surgery and I saw yet another new fellow, completely new to my case.

He limped in on crutches, took a tweezer like instrument out, and plucked the implant out of my gum. It was fairly painless, but I heard the crunch of bone as it came out. While the last implant failure was painless and bloodless, this was bloody.Very bloody. I bit down on gauze to reduce the bleeding. THe fellow announced that he was going to irrigate the wound. Last time this was simple. This time, he found so much infection and necrotic tissue that he had to debride it. He scraped out the area right down to the bone. That too was relatively painless. But it smelled. And it tasted bad. And I could feel the tool scraping against the bone. THen I got dry heaves and starting vomiting.

The fellow felt that he should page my surgeon. That was in surgery. That was a bit worrisome. I was the lucky recipient of YET another course of antibiotics this time a double - Flagyl and Clindamycin. Then I went home.

I was devastated. I don't know what is going to happen next.

dental implant woes

Last night after four doses of Flagyl, I thought my implants and jaw looked better and less swollen. It turns out, the implant started to migrate upwards out of the socket drilled in pure bone and protrude through my gums. I phoned the fellow on call and on the way to the ER, it fell out. He irrigated the hole in the bone and sent me home. I searched the literature and I cannot find one SINGLE case of this happening. There are many cases of implants failing (about 10%), usually they become loose and and have to be removed. Never have I heard of the implant working its way out of the bone in this manner. Two of the three remaining implants are loose, and we are watching them carefully. The crazy thing is that this was completely painless.


I'm just so disappointed.

the infected one

It's no secret I've been having issues with my last jaw surgery.
I started having increased swelling on Friday. The skin around my implants had formed into blood bubbles and pussy yellow bubbles. I called the clinic AGAIN around 9:30 am and the resident on call was supposed to call me back. It got be almost 11:30 with no return call and and I called back and told the receptionist that I needed to be seen TODAY because I had an infection. THey told me to come at 12:30 pm. Ha! Success.

My surgeon was on vacation. The fellow handling my case was at a conference. The 1st year residents did agree that I have an infection Whether it was superficial or in the bone was yet to be determined. Since I have a bunch of metal in my face, that means that the chin plate and hardware from my previous surgery could also be causing the infection. They took another X-ray and just weren't sure. At least there were two cute younger guys fawning over me, right? Another fellow came in and said definitely an infection and diagnosed Peri-implantitis. If you have read anything about this on the internet, it is isn't pretty.

They were going to re-cut the flap and irrigate the area, then re-sew it. Great. Instead, since it was draining, they decided to try and pull off some of the pus (with a syringe) to culture. Thankfully, he put numbing cream on the area, and I didn't feel a thing. He wasn't able to pull off any pus. I got sent home on antibiotic mouth rinse (burns like crazy) and massive doses of Clindamycin - 4 pills a day. Clindamycin also kills off the good bacteria in your gut, so I've been trying to pop some probiotics whenever I get the chance. Strangely, the pain isn't bad at all.

Wednesday I see the oral surgeon and they are going to decide if they want to remove everything. Pray, pray that I heal. I really cannot shell out another $4300 to get these implants replaced. I paid out of pocket last time. All I want is some teeth on the bottom so I can bite into things, like say, normal people?

Post Surgery Update

Friday evening I had a repeat of the previous evenings. My pain was not controlled, I wasn't sleeping, and I felt horrible. I "hit the wall" so to speak. I called the junior resident on call at the hospital (what is the difference between the chief resident, junior resident, fellow, etc?) and he was very nice. He said that while pain is minimal for this type of surgery, people heal at different rates. He would gladly call something else in for me, but since the Ibuprofen seemed to be working, take 400 mg every four hours. That is what I have been doing. I cried and cried. I was exhausted and pain is really wearing on you. It's not like I got to rest much either.

Saturday night I was fed up. I took my Ibuprofen at 10:00 PM. I decided after further thought and research to take Klonopin (i hadn't taken Norco for almost 24 hours). I took half a dose. I slept from 11:30 to 9:45 am! P let me sleep in. That was great! My pain was better on Sunday. It was about a 25% improvement. I'll take it!

I tried the same thing last night. I woke up at 4:30 am in pain. I'm going to go into work early. Wish me luck on working today. The business might distract me from pain, but it's a lot for ne talk and be there all day when I don't feel well.

Surviving Post Surgery

I am hanging in there. Much less swelling, but much, much more pain. Lots of pain. Think about gettng kicked in the teeth and super sore cheek muscles. Don't forget the pulsing itchy (weird I know) pain in my lower jaw.

I had four screw implants placed in my lower center jaw. The three screws sticking up through my skin were removed. Also apparently the bone ridge (which was augmentened at my last surgery), was too high, so that had to be lowered by grinding it away with a drill burr. Everything was stitched up neatly with black thread instead of white thread.

Other than the pain, things went much smoother than the last time. We woke up V early and dropped her off at school at 7:10, about an hour earlier than usual. She was surprisingly good natured, but cried to stay with us when we dropped her off. We got there and P was able to come back with me for a bit. The resident started the IV, went over the procedure, and had me sign consent. The nurse set up the EKG and oxygen. They are all ready to get started and the resident says, "oh you aren't pregnant, aren't you? When was your last period?" Uhmm try 25 days ago. I was hoping that I was pregnant. So I had to go pee in a cup. Of course it was negative.

I don't remember that much, but I do remember waking up during the surgery. That can happen with conscious sedation, but despite having it 8 times in the past, that has never happened. I remember them telling me to open my mouth, and that is the extent of it. When I woke up of course they tried to rush me out (are you seeing a pattern here?). I kept telling them I was thirsty and they ignored me. I told them I was having pain and they told me to take Ibuprofen when I got home. Gee, thanks. I made Paul stop at the hospital coffee kiosk and buy me a Diet Coke which I started sipping right away. We ended up getting home around 12:00. He dropped my med prescriptions off and picked me some soup and mashed potatoes form the coney island. I took some of Norco (it was stronger) from my earlier surgery and fell fitfully asleep for a few hours.

The pain came back with a vengence around 4:30 so I took Ibuprofen then. At 6:30 I was still in a lot of pain so I took a dose of the liquid Norco. At 9:30 it is really bad again, so I took one of the oral Norcos. It's dulled somewhat, but not gone. The weirdest things hurt after surgery, like my cheeks (apparently they told my husband I have such a small mouth that they really had to streeeecchhh it open. I feel it now. My upper teeth (which were not touched) are THROBBING. Everything got jarred around.

I am going to sleep in bed tonight instead of in the recliner. That's a plus!

Heavy Metal

Here is the X-ray of my jaw and what it looks like on the inside. You can tell I am missing a lot of teeth; not due to decay, but due to the AXIN2 mutation. They just never formed. There are a lot of screws ($150 screws!) and plates and do-dads holding my chin onto my jaw and the bone graft down. You can see the bone graft on the lower bottom because the bone line is much higher to the gums.


It doesn't hurt at all anymore. My chin feels a tiny bit numb and is hard to the touch. I'm starting to become very excited about all of this. I wish I would have had the opportunity to do this 20 years ago, but I had no money and my parents weren't supportive at all (my mom mostly-she is not supportive of a lot of things, but that is a post for another day). My mother told me to have of them pulled like she did and "why did I want to go through all of that?". I did have braces in Junior High because our family dentist insisted on it; otherwise he couldn't make partials for the missing teeth. Most of the orthodontics were covered by insurance, but my mother still likes to remind me (20 years later) that they had to pay out of pocket for it. The Orthodontist that did give me braces in Junior High was unkind and bordering on verbally abusive. I could not help it my teeth were so crummy. Jaw surgery would have been out of the question. We were also a 3 hour drive each way away from an oral surgeon. Did I mention that I love, love my orthodontist now? He treats me like a celebrity :)

It's obvious this process has brought up some resentment towards my mother - like "why didn't they help me? My teeth and jaw were such a mess"? I don't think my parents were capable of it. My father was sick and we lived pretty frugally in a town without many resources. She still doesn't understand why I am going through these expensive, and painful procedure and withholds verbal support. It makes me feel like I am not worth the trouble and am trying to be a "snob" because I am having work done. Her teeth were good enough for her right? So they should be good enough for me. But my husband is supportive and I'm so glad. Because I'm totally worth it. :)

Day 4 post surgery

And I am happy to say I"m improving!!!

My main challenges are feeling crummy from the Norco (pain meds) and getting enough to eat. Because I can open my mouth a few mm's, I have to eat using a tube attached to a syringe that I put in the side of my cheek by my mouth. The hardest part is getting the food pureed enough so that it will suck up into the syringe and be discharged easily. Sucking the food up into the syringe is a herculean effort. It hurts the muscles in my chin and neck so much. The best thing I had was mashed potatoes pureed with whole milk. Plus, it needs to be done frequently, because the syringe only holds 2 oz. Needless to say, having an 8 oz cup of soup takes 30 minutes. I've been drinking Boost too for a calorie bang, but I find that a little big too sweet on its own. I bought some Stage 2 sweet potatoes in the baby food aisle yesterday, going to try them later as they are fairly watery.

On the painkiller front I took 1/2 the Norco yesterday at 4:00 a.m., 2:00 p.m., and 9:00 p.m. Today I've just taken liquid ibuprofen so far. The Norco makes me so sleepy and lethargic. I hate it so much. Hopefully I will be off it by Tuesday, and then I can drive. Although turning my neck when it is so swollen is a barrier to that as well.

My mom is here and she is taking care of Vi. Vi woke up early today with a terrible cough and soaked to the skin with pee pee. I tried these 12 hour overnight Pampers last night and there were a big fail.

My ordeal

Monday I was to report to the hospital at 5:45 a.m. for a 7:30 a.m. surgery time. P had to wake up V, put her in the carseat with a blanket and drive me 25 minutes away. He dropped me off because we had no one to take care of Vi and I was then on my own. Bad idea. I was in a open surgery area which frankly, was a violation of HIPPA policy because I knew everyone's business being prepped for surgery. Everyone else had people with them and I began to cry. I could tell the other people waiting felt sorry for me too. All the other patients waiting had their IV's and stuff and I had no nurse or nothing. Finally, the Anesthesiologist Fellow came over and was super duper nice. The the Anesthesiologist showed up - this little Indian man, and he was a total jerk!! He tried to start my IV and wouldn't listen to my info about my IV's and gave me a huge hematoma on the 1st try. Then a nurse, and the fellow, and the OR nurse, and the Oral surgery Fellow all showed up as he was trying again. I got hot and cold and started majorly dry heaving. He just get on putting the IV in and someone stuck a alcohol swab under my nose and kept yelling at me to sniff it while I was busy dry heaving. I felt so alone and I was so damn scared. I never saw my surgeon at all and it would have helped, because I really like himn. The Anesthesiology Fellow came back and said he would give me something for nausea and to relax and I remember nothing after that.

WHen I woke up like at 1:30 I immediately felt very drugged and dizzy and my head felt thick and nauseous. It was a very different feeling than when I underwent twilight anesthesia all those times. The nurse started in saying "I kept waiting for you to wake up, I've been waiting a long time". I immediately grunted for my husband and she said no. I asked again and she said no, not in my condition. Everyone else had family back there. I conked out again and she kept trying to get me to sit up. I was so dizzy and sick and I asked her to please help me. She became all snotty and said "I just gave you medication in your IV. I am helping you> THe medication makes you dizzier. Aren't you ready to go home?" Finally P came back and agreed that this nurse was totally whacko!! She basically sat me up while I was dry heaving and could not stand up, pushed my clothes on me, and pushed me out the door. I was dizzy the entire way home and needed pain meds bad. P left me in the chair while he ran to Rite Aid and then made me a smoothie so I had something on my stomach. All last night, I've fought nausea off and on. I know it is the pain med Norco. I called the nurse today and she said she would talk to the fellow and have him call me in some liquid Tylenol with Codeine. I called the Pharmacy and they had nothing. I ended up taking half a dose which helped the pain and didn't make me as nauseous.

Great clinical care, don't you think? This happens to be the same institution where I work and I am mentally composing some letters.

I'm home.

I'm alive. Im home. It has been a very traumatic day. I'm settling in the recliner for the night. Hospitals, general anesthesia, mean nurses, and nausea are now officially banned from my life

The upcoming surgery

Today I went to Meijer's and bought things for the liquid diet that has been foisted upon me. I bought Boost, protein powder, yogurt, soy milk, bananas & peanut butter (for smoothies), frozen mango, frozen cherries and blueberries, pudding, refried beans, soup, chicken broth, and low sugar juice. I plan to have a lot of smoothies and soup.

My surgeon called me the other night. He is young (and good looking). He has four children (wouldn't you have four children with him? Trust me, you would). The important thing of course is that he is very well regarded and kind. There are no straws because it pulls on the incisional area, and no chewing anything for two weeks and only very pureed foods for six weeks. No chewing + no wheat makes for an eating challenge, don't you think? Anyway, the clinic is supposed to give me a big syringe with a tube to suck my food up in. That will be fun, I'm sure.

I've went from extreme anxiety in the last few weeks to a little bit of excitement. And I so hope everything goes well. THis is not the biggest surgery I will have, so this is the test. This goes badly = no more surgeries for me!