5 + 6 Months Post-Op

Hello, Friends. I'm sorry for the delay in my posting! This summer has been unbelievably busy. But the good thing is that I am out living life again (and not sitting at home on my computer).

In the beginning, I must confess, because of having to wear my splint and ugly braces I cringed every time I had to go to a party. But, I had to get over it. There were way too many wonderful events to attend this summer, because... MY BABY BROTHER GOT MARRIED!!!!!

June 1, 2012
NEW SCHEDULE- 
SPLINT: 2 hours twice a day, and all night.
FOOD: Soft diet and one soft chew meal every other day.

In addition to my 6 Month checkup in St. Pete, this month I had a Bachelorette Party Weekend to attend, an island vacation to enjoy, and a week in Florida packed with parties, dinners, lunches, brunches, and a beautiful Rehearsal Dinner and gorgeous Wedding for my brother and his bride. I was honored to be a bridesmaid... b-r-a-c-e-s and all! 

Next up was celebrating our 6th Anniversary and a vacation to St. John, USVI. Dr. Piper said I couldn't snorkel because my right joint was still too fragile, so I just wore a mask and swam around the reefs. Swimming in the sea throughout the week was really very good for my neck muscles which always get really tight from traveling.

We also went deep sea fishing. At lunch time, I got some strange looks from the captain when I pulled my jello and mac-and-cheese from the cooler, but once he saw the splint in all its glory, he put it all together. He may have thought I was a weeny to begin with, but in the end, I caught the BIGGEST fish! This girl is back in the game.

After all of the traveling this summer I have become a pro at brushing my teeth and changing my splint in every place imaginable. I can do it at restaurants, in a car, on a plane, aboard a boat, in public restrooms, in a truckers lounge (don't ask), and pretty much every place in between. All this splint stuff really becomes second nature. You do what you have to do if you want to stay on schedule, and by now, you should know that I like my schedule. No matter where I was, I wanted to be sure to stick to my soft diet, so my magic bullet has also become very well traveled!  Okay, enough with the fun stuff, I just wanted you all to know I am doing well :).  Here's the latest with my joints...

Monday, June 18th

Dr. Piper- 6 Month Checkup

My appointment started off like my last with a new CT Scan. Next, measurements were taken of how wide I could open and move my jaw from side to side. Dr. Piper went over my measurements, answered my questions, asked how I was feeling, and we talked about my progress. He was again very pleased that I was meticulously sticking to my daily medicine/break schedule, and that each week I continue to take two private Stott Pilates lessons, run/walk at least 5 times, and perform daily neck + shoulder exercises from my PT and therabite + jiggle exercises for my jaw.

Finally, we reviewed my CT Scans together on his big screens. Here are the results...

My neck has regained curvature!

My neck is still not back to normal, and it may never be, but it is so much better. I still get some tightness and soreness at times, but using my heating pad works wonders. Being proactive and always doing my exercises, limiting my computer time, and going to bed with my spa wrap eases the strain of the day.

My fat grafts are healthy. 

Everything looked good with my fat grafts. I have no pain in my joints at all. Occasionally I hear noise on the left side, but other than that, I really cannot even tell I had joint surgery.

I still have a Class II Occlusion.

My bottom teeth are sitting behind where they should be, so my top and bottom teeth are stacked on top of each other rather than being altered. Braces will be necessary to move my bite back together.

I have condyle bone growth.

Some of you might remember that at my 3 month check-up Dr. Piper believed he saw new bone growth on my condyles. Well, he was right. My left condyle has grown a lot. It actually looks round! The bad news is that my right side is not growing. It still looks as flat as a pancake. Dr. Piper said that it is rare for one side to grow and not the other, because the exact same procedure was performed on both joints and they have been healing in the same environment. While the left side looks healthy and strong, my right side is still weak and fragile. Dr. Piper thinks it may take an extra 3 months beyond the normal 9 month calcification period for the calcification process to be complete.

That being said, I may not be able to be finished with the splint and surgical braces at the 9 month point. At my next appointment in September the results of the CT scans will dictate whether or not I move forward with having the surgical braces removed and discontinuing the splint schedule, or continuing with the splint for 3 more months. Dr. Piper again reiterated the importance of continuing to take all of my vitamins and supplements for bone health and to be very careful while eating so not to injure the right side.

A second surgery may be in my future.

If my left side continues to grow and my right side doesn't catch up, I will be lopsided again. They will try to correct this with orthodontics, but braces may not be enough. Thus, there is a likelihood that once all of the growing and calcification is complete, I will have to have a jaw lengthening surgery on my right side. 

For now I am trying not to think about it too much. All I can do is all I can do. I am continuing to do all in my power to promote health, keep a positive attitude, and pray that right side will G.R.O.W!!!!

Dr. Jackson- Orthodontist
12:30 PM
After my appointment with Dr. Piper, I went upstairs to consult with the wonderful Dr. Jackson, as it was time to start planning for my next set of braces. Since Dr. Piper recommends him, I have chosen to continue traveling to St. Pete and doing my orthodontic work with Dr. Jackson. I don't want to risk anything at this point, so I am sticking with The Man.

Dr. J looked at my latest scans, examined me, and took more measurements. He informed me that he can easily get a bite completely back together with braces when the open bite is 2-3cm. However, my bite needs to move 5cm :(. Thus, he thinks that I will need to wear the next set of braces for at least 18 months and after that it still might not be enough. After 9 months of wearing the braces, we should know if the orthodontics can complete the job or not. If they cannot,  I'll have to move forward with the right side jaw lengthening surgery. But we're going to give it our best shot!

When I started this process, I thought I would only have to wear the second set of braces for around 9 months. So, when I heard it would be at least 18 months, I was a little bummed. Then, Dr. Jackson made my day by showing me the latest and greatest INCOGNITO BRACES! I would like to kiss whoever invented these little golden jewels. If you haven't heard about them, they're placed on the back side of your teeth, so they are completely hidden from view.

Incognito braces are made one patient at a time, one tooth at a time. They are 100% customized to follow the contours of your teeth for comfort and performance. The wires are bent to a precise shape with robotic technology to ensure the desired results. This allows teeth to be moved in the most efficient manner possible. Dr. J said that the only problem is the braces can cause a bit of a speech impediment while you're getting used to them. Heck, that is no problem for me... I've learned to speak pretty clearly wearing a giant splint.

FYI- Once I get the braces on, I will only have to visit Dr. J every three months for checkups.

OTHER UPDATES

The GOOD

All of the physical signs of my surgery are pretty much gone. I no longer have to wear any bandages over my stomach scar, because it really isn't sensitive anymore. My ear scars are totally faded and my sideburns are finally long enough to tuck behind my ears.

I have no headaches and very little pain, with none being in the joints. Over the last few months, I have experienced some deep aching in my ramus bone or masseter muscle (I cannot really tell which it is), but it hasn't ever been there for more than a few hours for a couple of days.  A few times it was on the right side when I awoke, but mostly it has been on the left. Lots of talking and smiling can also make my masseters sore, but this is so much better than it used to be. I usually just take Aleve and it makes it feel fine again. But, around 10 times I've taken 1/4 tab of Klonopin to treat the ache/soreness.

The BAD

Brownish teeth are not attractive. I panicked a little as I thought my bottom teeth were starting to rot, but Dr. J told me that it was just the braces' glue, that got in between my bottom teeth, which has started to turn brown. I brush all of the time, but he said that there really isn't anything that can be done until I get the braces off and have my teeth cleaned. Luckily, I don't think it's really noticeable to anyone but me, when I'm staring at my teeth one inch away from the mirror, but still. EWWW!

The UGLY

My chin has receded. After surgery, my profile was almost back to normal, but not anymore. This was to be expected. Dr. Piper let me know that I would have some compression of the fat grafts during the healing process. I was hoping that it wouldn't be noticeable, but it has become visibly apparent. People say they don't notice, but it bothers me. So, if I want my old profile back, I will have to have the Genioplasy surgery to move my chin forward in order to make up for the pre-surgery condyle bone loss. If I plan to move forward with it, Dr. Piper will do the surgery. I'll keep you posted.

July 1, 2012
NEW SCHEDULE-
SPLINT: 1 hour twice a day, and all night.
FOOD: Soft diet and one soft chew meal each day.

July was almost as busy as June. We've gone to two friend's out of town weddings, celebrated our nephew's big 5th Birthday, attended a concert in St. Louis, and hosted an Engagement Party. I love life, and now that I am feeling better, I don't have to miss any of it. HOORAY FOR HEALING.

W-O-W
The most amazing and unexpected part of this whole journey has been receiving emails from people who have read this blog. In the beginning, I was just hoping that a couple of people would have a resource that I wish so badly would have been there for me. To each of you who have written to thank me, I want to THANK YOU. Your kind words and genuine expressions of gratitude have given me a sense of purpose, restored my faith in my belief that everything happens for a reason, and blessed me in more ways than I could ever express.

The Zen of Zebras

I LOVE ANIMALS! I took this zebra photo, blew it up, and hung it in my home, to remind myself to BREATHE...

Feeling stressed about your jaw issues? It's not just in your head. The rest of your body feels it, too. My  step-mom is a physician and she sent me the great article below. Dealing with TMJ and other jaw problems is really hard. And while you may think you're handling it fine, your body might have other ideas... 

Believe it or not, the same physiological mechanisms that made the zebra run away after being attacked by a lion are at play when you have psychological stress. Lance Luria, MD, vice president and medical director of Mercy Health and Wellness, noted,“When you're under stress, it causes real biochemical changes to take place in your body. Stress is a survival response that was geared to get us out of harm's way. We weren't designed to live with it for years on end."

Because our bodies are a network of interconnecting systems, stress can have an effect on all of them. Over time, it can cause, or aggravate, all kinds of physical and mental issues – including heart disease, depression, sleep disturbances, weight and metabolic disorders, and stomach issues, to name a few. While we may consider ourselves superior to animals in some ways, they have a definite health advantage over us when it comes to their response to stress. 

“Humans have the ability to imagine, react and relive stress. Because we're able to think abstractly (anticipating a problem at work or health issue), we're susceptible to a chronic stress response – which may have serious health consequences,” Dr. Luria stated. “The zebra doesn‟t do that. When the zebra is being attacked by a lion, its stress response is activated. If it survives, the stress response resolves.”

Dr. Luria's reference to the zebra is a nod to the work of Robert M. Sapolsky, professor of biology and neurology at Stanford University and a research associate with the Institute of Primate Research at the National Museum of Kenya. In his book, Why Zebras Don’t Get Ulcers, Sapolsky explained: 

“For the vast majority of beasts on this planet, stress is about a short-term crisis, after which it's either over with or you're over with. When we sit around and worry about stressful things, we turn on the same physiological responses – but they are potentially a disaster when provoked chronically. A large body of evidence suggests that stress-related disease emerges, predominately, out of the fact that we so often activate a physiological system that has evolved for responding to acute physical emergencies, but we turn it on for months on end, worrying about mortgages, relationships, and promotions.”

In Constant Fight/Flight Mode
So what turns on a stress response? Your brain. If it perceives danger, whether real or imagined,it sends out signals releasing chemical messengers and hormones (including glucocorticoids). These signals instantly activate our body's fight, flight or freeze response. But if the stress doesn't end (the lion isn't vanquished or you still have to face family or financial issues), your body doesn‟t return to normal. Can't we just tell our brains to turn it off? Not exactly. Our conscious brain isn't in complete control. The unconscious and primitive part of our brain runs the stress response and we may not be able to control it.

Here's why: Our nervous system is divided into a voluntary (conscious) system, and an autonomic (unconscious) system. The autonomic system kicks into high gear when there's a perceived danger – whether physical or emotional in nature.

This autonomic system also has two parts. When we're under stress, one part (the sympathetic nervous system) is activated, and the other (the parasympathetic nervous system) slows down. The sympathetic system releases chemicals like epinephrine (adrenaline) as part of the emergency stress response. It increases heart rate, blood pressure and blood sugar, for example, maximizing resources that can save your life.

At the same time, the parasympathetic system (the alter ego of the sympathetic system), which normally promotes digestion, energy storage and relaxation, slows or shuts down completely so your body can use all available resources to survive the emergency. In the modern-day world, this may simply be a traffic jam.

“For instance, if you're being chased by a wild beast, your stomach automatically says, "I don't have to process food; I'm more worried about becoming food." So your stomach stops digesting,” Dr. Luria explained. “Your brain directs blood away from some regions, sending it to other areas needed to help you stay alive.”

Warning: Danger Ahead
Although a stress response may be lifesaving in the short term, it can be very detrimental if it becomes chronic. Although stress impacts each of us differently, it's important to know how to recognize signs of stress in ourselves and those around us. In addition to more serious medical issues, stress can also cause:

Cognitive: Memory problems, poor concentration and judgment, increased negative thinking.

Emotional: Moodiness, short temper, irritability, agitation, complaints of feeling overwhelmed, general unhappiness and isolative behavior.
Physical: Frequent colds, increased physical complaints such as feeling worn out and headaches.
Behavioral: Procrastination, neglecting responsibilities and taking unscheduled days off.

Go to Your Happy Place
While we can't all be like zebras, letting go of our stress response as soon as the predator disappears, there are lots of simple things you can do to reclaim your cool when you're feeling frazzled. Here are a few:

Exercise. It helps reduce stress, improves your health and even promotes the growth of new neurons in your brain. 

Try a Relaxation Technique like yoga, meditation, visualization or tai chi – and practice it often. 

Eat a Healthy Diet high in antioxidant-rich foods such as fruits and vegetables. These may help neutralize toxic free radicals that form in the brain under stress.

Get Enough Rest.

Work at Being an Optimist. People who handle stress well tend to have an optimistic attitude. Try exchanging negative thought patterns and self-talk for a more positive outlook.

Spend Time with People You Enjoy.

Embrace Challenges, have a good sense of humor and believe in a higher purpose. 

Nurture Others: helping those in need can make you feel better about life.

Strive for Control in Your Life: set goals for the things you have control over and follow through with them.

Don't Over-Schedule Yourself. You need unstructured time, too. 

With everything I've been through with my jaw issues, I know I've earned my stripes. Each morning I remind myself to channel my inner zebra ;).