Monday, December 22, 2008

Ask Bella: Update on "Changes in appearance"

There was a strong response from my blog readers on this Ask Bella post a few months ago, so I'm sure you'll be happy to hear this update:

Kerry Rose has left a new comment on your post "Ask Bella: Changes in appearance":

I just wanted to email an update about this particular post. I am the gal that sent in the question in the first place. Its now 12-14-08 which means I am almost 3 months post-op.

I have adjusted to my altered appearance and my initial terrified reaction at my transformation.

In fact, my post-surgery experience unfolded in ways I never expected.

After I sent this message, I started to experience great amounts of pain as a result of muscle spasms. For about a week, I couldn't sleep because the muscle spasms would wake me up every few minutes. Using a combo of prescribed sleeping pills and the pain medications, I was able to overcome it.

Then about 6-weeks post-op, I experienced an unanticipated break-up with a person with whom I had been dating for 5 1/2 years.

Ironically, I have met a lot of fellow ortho patients whose surgeries were the catalyst for numerous major changes in their life (including break-ups like mine).

I can honestly say that I am better than great!

I still think that my doctor should have been more clear about the physical transformation I would go through. I would even suggest that going to a therapist that deals with body issues (specifically one that relates to people undergoing surgeries) should be done ahead of surgery.

Thanks for all of the comments. It turned out to be so important for me to express what I was going through - especially because I had become somewhat of a prisoner of my home and my body. I needed reaffirmation that there was some action I could take to change my situation.

Thursday, December 11, 2008

10 months post-surgery

It's 10 months since my jaw surgery. WTF?

In good news, The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel has signed off on me, meaning that I don't have to go every week to get my jaw stretched anymore. My range of motion is somewhere between 42-46 mm now (depending on the day), which is well within normal range. Though he did mention that he expected that I would be a "long-term intermittent" patient of theirs.

I'm okay with the intermittentness, seeing that each appointment costs me $42 and doing that weekly for almost a year (on top of my many other appointments) has gotten pretty expensive.

Right now, my regular physiotherapist has me coming for TMJ classes, where I learn stretches for my jaw that I can do without her. She wants me to do them everyday for a period of time, with our sessions to evaluate whether I'm doing them correctly. Then, the responsibility will fall on my shoulders and I will only go to physio when the pain/tension gets really bad, due to stress, etc.

My braces are still on (having been taken off for three months and then put back on because my upper teeth relapsed), which causes some tenderness. Since they've been back on, I've noticed that my joint has been kind of crunchy and poppy when I open my mouth really wide. I hope that the joint is just settling and adapting to the new position of my teeth and that this isn't going to become a long-term problem.

In not-so-good news, I've been continuing to have problems with fatigue and depression. I haven't felt physically well since my surgery. I've tried to be upbeat and proactive about everything, but the stress of the long recovery and anemia seems to have taken its toll on my body and mental health.

It took a long time for my doctor and me to figure out that this is a depression, because there were so many other things going on with my body, and because the symptoms I was experiencing were very physical - headaches, aches and pains, fatigue, exhaustion, etc. I also have a family history of this kind of thing, so it's not too surprising that this is my body's reaction to something as intense as major jaw surgery.

So, I'm off work for awhile to rest and get this fatigue/depression taken care of. I'm optimistic that in the next few months, I'll get back to my old fabulous self, with a winning smile that I can't help but show off.

Wednesday, November 5, 2008

And the heavens opened and there was much rejoicing

Yesterday, I went on an epic quest in search of the elusive orthodontic wax.

I was positive that I had seen it on a particular shelf in a drug store the last time I was there. I went to a different location of the same chain, only to find they didn't carry it.

I then drove all the way across town to the original location where I'd seen the wax, expecting that it would be exactly where it was just a few days ago, but it wasn't there, either.

I begged the store clerks to help me find it, but they confirmed the fact that it wasn't there. I soon realized that I was so desperate for the stuff that I had actually been hallucinating it was at the store. They don't carry it, and hadn't carried it for years. It was all just a beautiful, beautiful dream created by my wax-deprived mind.

It's kind of sad, really.

I was almost in tears when I realized that you can't really buy this stuff in stores, at least not in my city. Also, my orthodontist doesn't have an office in town - he just comes in on weekends every few weeks, so it's not as though I could get some from him.

And then one of the clerks suggested I go to the dentist's office in the mall to see if they had any.

Good idea! I ran there and begged the clerk at the desk for some, conveniently not mentioning that I was not at all a patient at that office.

She wasn't sure if they had any, but after much searching in a back room, she came out with a plastic baggie with about a lifetime supply of the stuff. I almost kissed her, I was so relieved.

And then I mushed a whole bunch of that stuff into my wires and cried tears of joy.

Sigh.

Life is good.

Tuesday, November 4, 2008

Damn you, Four Months Ago Bella!

One of my new brackets is rubbing against the inside of my upper lip, creating a very raw bump that catches on the metal every time I talk, smile, eat and...do just about everything.

Last night, I tore apart my purse, bathroom, bedroom searching for that little magical box of orthodontic wax. The fact that I couldn't find it anywhere drove me absolutely nuts, because I'm the Queen of knowing exactly where all of my stuff is at any given time. It's my thing.

As I obsessed over where it could possibly be, I suddenly got a very distinct image in my mind of me tossing the box in the garbage four months ago and saying smugly to myself, "Hah! I'm never going to need that again!"

Right now, I would be quite happy to smack Four Months Ago Bella across her braceless face.

(In case you were wondering: Yup, braces + raw lip = cranky Bella.)

Monday, October 27, 2008

Ask Bella: Fuzzy teeth

Q: I have having trouble with oral health. Did your mouth feel nasty after your surgery??? My tongue is white and I am trying to drink water but my mouth feels gross. I had surgery on my top jaw and a huge metal splint put in my mouth that has to stay there for six weeks until the next surgery. I try to brush my teeth (the bottom anyway) but things still are not great. Is this to be expected? I want to know if its normal or if I am doing something wrong.

A: Oh, how I remember the grossness of my mouth post-surgery, and I was only wired shut for two weeks. The first week was alright, but by the second week, I could definitely feel a fuzz growing on the back of my lower teeth. When I got the wires off, my teeth were brown. It was absolutely disgusting.

Gee, thanks for taking me back to those oh-so-happy times :)

I actually think that was the worst part of the surgery for me. Not being able to get the crud off my teeth with all that metal in my mouth, so I do feel for you. The only advice I can give you is to keep doing what you're doing (brushing the bottom teeth), and also get a Water Pik to try and get some jet action around that splint (being careful to aim it away from any stitches, etc.) and do lots of mouth rinses with salt water and/or alcohol-free mouthwash.

And then accept the fact that probably no matter what you do, your mouth will be gross and fuzzy for a few weeks, because that's the way it goes. (I did all of these things and still had fuzzy, brown teeth after two weeks, but you gotta at least try, right?)

Once you're done doing what you gotta do, take some time to fantasize about the moment when you get to brush away all that fuzzy sludge with a toothbrush until you wear its bristles down to nubs.

Aaaaaahhhh. Better than porn.

(I bet it's even better than German orthodontic fetish porn. Just guessing.)

Seriously, good luck. This sucks, but it will all be worthwhile once it's all over.


*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Friday, October 24, 2008

Choo chooo

It's true: the train tracks, they are back on.

As my orthodontist was placing them back on, he commented, "I don't even remember the last time I've had to re-place brackets because I needed to fix something."

So, I've gone from the patient who had her braces off after surgery in record time, to the only one in recent memory who has had hers put back on.

Oh, how the mighty have fallen.

Wednesday, October 22, 2008

Ask Bella: Changes in appearance

Q: I had upper and lower jaw surgery (turbinates removal & genioplasty as well) about 2 1/2 weeks ago. Like most people, I did this surgery for purposes of function and not appearance. I loved my appearance - I loved how dainty I thought I looked.

While I don't think my reaction a week post-op is much indication of how I will feel forever...after most of the swelling had gone down and I could tell what I would look like, I was devastated. I didn't recognize myself. I had this dysmorphic type of reaction to the results of my surgery and I couldn't stop staring at what I saw as the destruction of my appearance. Even 2 1/2 weeks out, the steroids have worn off, I'm not on meds, I'm getting normal sleep, I'm not in much pain at all....yet my reaction to the alteration of my appearance still stays.

Have you received emails from other people that have had this reaction? Do you know how they overcame it?

A: I'm so sorry you're going through such a hard time. Your email made me want to reach out and hug you.

My surgery wasn't nearly as extensive as yours, so I can't speak to the dysmorphic reaction to your reflection from personal experience; however, I have read on message boards about other people who have had similar reactions to yours.

And, really, who can blame you? We all identify with our outer appearance - you've lived within this skull and skin your entire life and then one day, suddenly, you look in the mirror and don't recognize the person staring back at you? That is a huge shock to the senses, psyche, and identity. How are you supposed to just accept that you look completely different in just 2 1/2 weeks?

Let yourself mourn your old appearance. It's okay to feel sad because you have lost something that was a big part of who you are. But at the same time, try to find things that you like about your new appearance. Take a good look. Check out your profile. (I know I always hated mine because my weak chin made my nose look bigger. Now, it's more in proportion, which I like a lot.) Make a list of what you like and focus on that as much as you can. Because the reality is that this is what you look like now, so you need to find ways to look at yourself in the mirror and like what you see, after the surgery.

I think time will help, focusing on the positive will help, and then if you still feel that things aren't where you would like them to be, talking to a therapist would be the next step.

When I'm frustrated and upset about the fact that I still don't feel like myself these days (I'm struggling with a lot of fatigue, even after my post-surgery anemia has gotten better), my boyfriend always says to me, "You're pretty hard on yourself, you know." It makes me realize that I do put a lot of pressure on myself to be perfect, to be healthy, to be this super achiever and that sometimes, I just need to be good to myself and say, "It's okay if it's not happening as fast as I want. I'll get there" and just give myself a break for once.

Two and a half weeks is not that long. Even if everything seems to be going swimmingly, you've had major, major surgery where they took a bone saw to your face and rearranged your bones. That affects your body and your mind and your spirit in a big way. So, don't pressure yourself to be totally healed and accepting of everything just yet.

Just be good to yourself. I hope everything goes well for you.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Friday, October 17, 2008

An apple a day

Even though I have had my braces off since early July, it took me until this week to eat an apple without cutting it into sections first.

I think I avoided it for so long because I had a hard time believing my jaw would be strong enough to eat a whole apple out of my hand instead of sliced up on a plate.

When I finally got around to it, it was as though I had forgotten how to eat an apple. I bit in with my top teeth and tried to pull of a chunk with them, as I used to do with my overbite. It wasn't working. And then I discovered that I had to move my lower lip out of the way and my lower teeth could actually dig into the skin, too.

Then, the coolest thing happened - I got a full bite out of the juicy flesh! And it was awesome!

I have been gorging myself on sweet organic apples ever since, and every bite fills me with a sense of marvel.

It took me this long to figure it out...and guess what?

My upper braces are going back on tomorrow.

Saturday, October 11, 2008

8 months post-surgery

It's hard to believe eight months has gone by since my surgery. It feels like forever, making me wonder if it ever happened in the first place. But I need only look in the mirror to see my new chin and smile to remind myself that yes, it really did happen.

In good news, I went to my physiotherapist yesterday and we got up to 45 mm for the first time! I'm almost at the end of my range of motion, so that's incredibly exciting. I still have some work to do, though, because my muscle memory is interfering with my mouth opening properly.

When I open my mouth wide, my jaw swings to the right, because the muscles are remembering the way my jaw was positioned for 32 years (it was a bit asymmetric before). So, I have to start doing exercises using my hands to guide my jaw into the proper position while opening my mouth.

I've also noticed the muscle thing when I smile. My smile is still somewhat crooked because my muscles have been compensating for the asymmetric jaw. I have to start taking time each day to practice smiling in the mirror so my muscles can relearn what to do.

I have to spend hours in front of a mirror smiling at myself? How tragic.

In other good news, I have full feeling in my chin now - no more numbness! If I pay super close attention and use a very light touch across my chin and lower lip, I can tell that the feeling isn't 100% back yet, but it's barely noticeable (we're talking 99.999876%). There are still improvements every day and I am positive that I will get to 100% in the next few months.

In the not-so-good news department, I am one week away from getting my top braces back on to close a couple of gaps that opened up at the back.

Until then, I will be eating popcorn, corn on the cob, apples, and other crunchy "forbidden" foods to my heart's content!

Chow down!

Saturday, October 4, 2008

Ask Bella: Healing time

Q: I'm 20 years old, work and go to school full-time, and I'm having my upper jaw advanced, lower jaw set back, and maxi expansion. my case is pretty bad, to the point where my insurance is covering 100%! I will be ready to get my jaw surgery in April. My ortho's assistant told me that from what she's observed with other patients, I could do the surgery over Easter break (one week) and be back at school after that. I nodded politely, but in my head I was thinking, "Uh, no." From all the research I've done it seems like you need at least a few weeks. I was thinking about taking online courses next semester so I could get the surgery in April and not have to spend the summer healing. From your experience, how long would you say I should expect to be out of school/work?

A: When your ortho assistant told you that you'd be back at school in a week, did you happen to notice a crack pipe nearby? Or perhaps some telltale trail marks on her arms and a glazed look in her eyes? Because she had to have been on something to say that.

Seriously. That is nuts.

I only had my lower jaw done and I was off work for a month, and I wish I would have taken six weeks off. My surgeon had told me that I would be fine to go back to work after two weeks, but he might have been smoking the same thing that your ortho's assistant was, because there was no way I would have been able to go back in that time frame.

It wasn't so much the pain from the surgery, but the exhaustion of my body trying to heal and also not being able to get enough calories in that did it for me. Granted, I am 12 years older than you, so you could heal faster and have more energy, but for the first month after surgery, I had to take a two to three-hour nap after I did just about anything. Even something simple like tossing a load of laundry in the washer knocked me out for a few hours afterward. Ditto for when I had to put stuff in the dryer.

Because my surgeon had told me that two weeks off would be enough, I only asked for a month off work, and felt that I was being indulgent taking that. In reality, I needed more time to rest and going back to work that soon probably set my healing back awhile.

I think it's a great idea to take some online courses and then you can take things at your own pace and not worry about rushing yourself to get back to school/work before you're ready. Just listen to your body and do what's right for you.

Best of luck to you!

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Saturday, September 27, 2008

Before, during and after pictures

I finally got my "after" pictures taken at my last surgeon visit, so if you would so kindly ignore the bags under my eyes, here you go! (The order goes: before braces, before surgery (with braces), and after surgery and braces removal.) Enjoy!







And here are my teeth, pre-braces, pre-surgery and post-braces and surgery:












Friday, September 26, 2008

Brace yourself...again

So, I went to my orthodontist for a follow-up appointment and guess what?

I have to get my upper braces put back on.

I wish I were messing with you and there was a really awesome punch line to insert right here, but that's not the case.

There are some spaces between my upper molars that opened up these past few months. My ortho had closed some gaps a few weeks before the braces came off and I guess they didn't "set" in their new positions and even wearing the retainers as instructed (religiously, I swear!) did not keep them from moving back.

My teeth, to anyone around me, look perfect, because you can't see the gaps. But I can feel them, particularly because anytime I eat anything, it gets impacted in the spaces and drives me absolutely crazy.

If I were only doing this for aesthetic reasons, I suppose I could live with it. But the whole point of getting the braces and surgery was to have a functional bite. I'm not willing to compromise on that. And after everything I've been through this year, this is not that big of a deal in the grand scheme of things. I imagine it will only be a month or so and then I'll be done. Again.

So, here we go.

Bring on the tire tracks!

Sigh.

(On the plus side, I don't get them on until late next month, so there is lots of time for me to eat corn on the cob until then. Yay!)

Saturday, September 20, 2008

Ask Bella: Jaw Surgey Blogging 101

Q: How do I go about creating a blog? I was really thinking that writing about and sharing my experience could not only help others, but really help me to get through this as well. Not to mention, hopefully meet people going through the same thing. I have never done a blog before and I am not too sure how to get it set up so that it's on a site with other jaw surgery candidates/patients, etc. I really do not want to have the entire world be able to view it, just the people who are going through the same things.

A: Thanks for the email. I'm glad you're thinking about a blog - I know it really helped me make my decision to read about other people's experiences, so the more information that's out there for people, the better, I say.

There are two blog platforms that I'd recommend: Blogger http://blogger.com/ and Wordpress http://wordpress.com/. Both are user-friendly and straightforward and have templates for you to choose from for your blog layout, so there's no HTML coding or anything like that. And they're both free, which is important as well.

I've been thinking about your question about privacy and only having your blog open to other people in the jaw surgery community. That's difficult to do, because most people would find you from Google searches, so if you had your blog password protected, those people would likely not request the password - they would move on to another search result that wasn't protected. Blogger only allows you to password protect the entire blog while Wordpress lets you password protect specific posts, so that might be an option for you if you wanted to keep certain things private.

But the way I see it is this: don't put anything on the Internet that you don't want everyone reading. If it's truly private, don't put it out there. Only write about things you feel comfortable about. Use a pseudonym and an email address specific to the blog (i.e. Gmail, Hotmail, Yahoo, etc.) to protect your identity. If you're really concerned, don't post any pics of your whole face, either. Or you could always password protect your pictures. But again, I wouldn't post anything expecting that the password protect is totally secure (people could always give your password to other people, etc.)

To connect with other jaw surgery folks, start reading their blogs and commenting on them with your blog address. Link to the blogs you read and let them know you linked to them - they may link back, which would build your readership. Leave your blog address up on the jaw surgery message boards and link lists. You'll build a community around you quickly. I wouldn't worry too much about other people not in the jaw surgery community finding your blog (particularly if you're not using your real name or email, etc.), because people aren't going to be looking for your blog unless they're going through the same thing.

Yes, there are some freaks out there. I would make sure you have a stat counter on your site (http://www.statcounter.com/). This will allow you to see how many hits are on your blog each day and what search terms people are using to find it and the country/URL they are accessing your site from. It should be pretty straightforward to install it - it's just a code you paste into your template and you're set.

The stat counter is how I found out that 1,500 German orthodontic fetishists came to my blog in a three-day period. It was a little weird to know that, and there wasn't much I could do about it, unless I wanted to shut down the blog. Though, for the record, they never left any comments or emails. I think they just like to look at women with braces. And then they went away.

So, if you're putting your information out there, you do have to prepare yourself for the fact that there may be people using it in ways that you didn't intend. Someone may leave a rude comment, too, which could be very hurtful. (And...delete! The comment, not the blog!)

From all the emails and comments I've gotten these past few months I've had the jaw surgery blog, I really have helped a lot of people by telling my story and sharing details about my recovery. Other people helped me, and now I'm helping people. It's karma. And if a few people are freaks, so be it. I'm not going to let them get in the way of what I feel is important.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Wednesday, September 17, 2008

Ask Bella: Ya gotta sing, sing

Q: I had jaw surgery six weeks ago and my jaw muscles feel terribly weak. It's hard to enunciate. I have this brand new speech impediment. It makes singing incredibly frustrating and discouraging. Have you been able to resume singing yet? Are you happy with your voice? Any changes?

A: I know what you mean about the speech impediment. For the first while, it hurt to touch my teeth together, so I started avoiding it; after awhile, it became a habit, so my enunciation wasn't so hot. Everyone seemed to think I was saying something naughty when I wasn't!

It was something I had to work on. It is weird to have your teeth in a different place after decades of them being in another position. It takes time to adjust. Now, I would say that my enunciation is better than it was before!

I auditioned for a musical revue at the end of August (six and a half months post-surgery) and have been rehearsing this month. I'm amazed at how much easier it is to sing now. Instead of having to thrust my jaw forward and do all kinds of jawnastics to enunciate properly as well as create enough space in my mouth for my voice, I am now able to just open my mouth and let my voice come out.

Is this really how normal people sing? Is it that easy?

I also really like the placement of my voice now. Before, I would struggle to ensue my voice was placed at the front of my mouth; now, it's just there. And I don't get headaches after singing, because it doesn't put a strain on my jaw to do it.

It feels really, really good. I can't wait to start really singing again and see what else is in store.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Saturday, September 6, 2008

Audio clip of blog post on the radio

Below is the audio clip of my blog being read by host Kelley Jo Burke on the CBC Radio Saskatchewan program, SoundXChange. I actually figured out how to embed it on this site, which is no small feat! Enjoy! [You do need to have Real Player installed to hear the file, which you can download for free here.]

Thursday, September 4, 2008

Blogging killed the radio star?

No, it most definitely did not. In fact, while there was some tension between them at first, after a few belts of scotch, they ended up telling each other their life stories, eventually collapsing in a drooling heap of exclamations of "I love you, man."

"What are you getting at, Bella?" you're all thinking. Yeah, I get that a lot.

Well, guess what? A monologue I wrote based on my post about German orthodontic fetishists finding my blog is going to air on the CBC Radio One (102.5 FM in Saskatchewan) show SoundXchange this Saturday, September 6, 5 to 6 p.m. Saskatchewan time.

The monologue will be read by the host and will appear later on in the show, about 5:45 p.m. CBC is also going to link to this blog on the SoundXchange website.

For those of you not in Saskatchewan, there will be a live stream of the program on the show's website.

Please tune in if you get a chance!

Monday, September 1, 2008

Reader experience: Chronic pain and arthritis

A few weeks ago, I got a comment on a post from someone who had lower mandibular advancement surgery 15 years ago in the same city I had mine, and is now having problems with pain and arthritis. I'm posting the comment here, so everyone can read it, as it's important to show all sides of this surgery, not just the positive results.

[I am not sure if this person had the BSSO surgery or the older version of it, and I don't know how much surgical procedures have changed in the past 15 years. I'm hoping there are less problems with newer procedures. Does anyone have information on this?]


Working From Home Today has left a new comment on your post "Three weeks ago, something cool happened":

Hi Smiling Bella,

I had jaw advancement surgery back in 1993 in SK. I wish I could say differently, but my story is not positive. Keep in mind that I don't think it's this way for everyone.

I did experience nerve damage from the surgery, I still can't feel the half of my lower lip. But that's a minor discomfort and if it were the only side effect, I wouldn't sweat it much.

The bad part for me is that over the last 15 years, my jaw has experienced severe deterioration. It's cost me thousands of dollars to be diagnosed and treated. I recently got to see Toronto's best expert on the subject. She was so amazing, so knowledgeable. After lots of testing, the diagnosis is that I will experience severe arthritis for the rest of my life. I have one more bone scan to see if it will get worse as I age. Fingers crossed, it won't. The kicker is, of course, the associated pain.

I've been prescribed industrial-strength pain relievers but I don't like the side effects. I take them only on the very bad days, about once a week and no more. The rest of the time I rely on my hard mouth splint, Shiatsu and exercise. It all helps immensely. I owe so much to the experts I've found.

I am guessing it's not like this for everyone. But I honestly don't know what I would say to people contemplating this surgery. I'm still so angry about it. I can't wait to go back to SK, where I fully intend to take my scans and MRIs into the office of the oral surgeon who conducted my original surgery. It's a conversation we need to have.

Of course, I can't prove the damage is related to the initial surgery because, as I'm told repeated by the country's best experts, adequate long term studies have never been done.

My firm belief now is that this one of the most complex joints in the human body. It should not be handled by orthodontists.

Meanwhile, I look forward to reading your blog. I suspect I'll find some excellent advice. Congrats on your braces!

Wednesday, August 27, 2008

Reality check

I have been feeling cruddy this past while, exhausted and weak, generally run down. When I start to feel sick, my jaw pain tends to act up as well. I didn't really pay much attention to it in the past, but thinking back on it, this has been happening for the past few years.

I feel tired and run down, my jaw tenses up, I get a debilitating headache and can't go to work and do my job. More unpaid sick leave for Bella. Hooray.

Today, I got high on codeine to take the edge off the jaw migraines triggered by the overall cruddiness, spent the day in bed and went to see my physiotherapist late afternoon for my weekly appointment.

She asked how I was doing, so I told her, mentioning that I felt like some allergies were being aggravated or that I was coming down with a cold and that my jaw acted up whenever I felt this way.

She told me that when an area of your body is in pain for a long period of time and the condition becomes chronic, as my jaw likely has, the area grows extra nerve endings and becomes sensitive to histamines. So, if you do have allergies or are coming down with a cold, the pain in that area will flare up.

The news hit me kind of hard. I realized that I have been in pain for the past three years, and, as a result, this is something that I will probably have to deal with for the rest of my life, surgery or not.

In the spring when the snow melts and the mold underneath the banks starts swirling around, during cold and flu season, on windy days...I'm going to feel sucky. My jaw is going to act up. I am going to get horrible headaches, and I probably won't be able to go to work.

While I don't regret the surgery, and I believe that it has improved my quality of life (chewing, talking and singing) and saved my jaw from more damage in the future, the damage was already done before I went under the bone saw. And I'm going to have to live with that. And figure out how to deal with it.

Anyone have any thoughts on how to handle this situation going forward? (That don't involve allergy drugs, because those aggravate other health conditions I have.)

Tuesday, August 26, 2008

Ask Bella: Always wear protection

Q: I broke my jaw in three places by falling and landing jaw first on a concrete step. I had surgery immediately after the accident, which resulted in two titanium rods being inserted either side of my chin. I also broke some of my teeth in the fall. I had my mouth wired during the surgery and shut with elastics. I went to see my specialist and he removed the elastics after only 12 days. I still, however, have all the wires in for another four weeks.

The main problem is that my bite is miles from being where it should be. At the moment, only my teeth at the back touch. I am hoping that the jaw will loosen over the next few weeks and may improve my bite, however I'm not very optimistic that it will improve very much.

Would you have any advice here? It looks like I will need the help of a dentist/orthodontist to sort me out!


A: I cringed when I read your story - that must have been so painful.

I'm no expert, but I'm guessing you'll need some orthodontic help to get your bite in order. I was wired with wires and elastics over top for two weeks as well. My surgeon told me that the elastics were there to help level the bite while the jaw was healing, so there would be less work for my orthodontist to do.

Your elastics were likely there to do the same, so if your teeth aren't touching at the front, that means more would need to be done. I hope that everything works out for you.

A friend of mine was telling me about a guy he knew who fell off his bike and broke his jaw. After everything I've been through with my surgery, I'm considering getting one of those full-face bike helmets (here's an example of what they look like: http://www.mec.ca/Products/product_detail.jsp?PRODUCT%3C%3Eprd_id=845524442621427&FOLDER%3C%3Efolder_id=2534374302693161&bmUID=1215389828047) so that if I fall, my jaw, as well as my brain will be protected. Hey, a gal can never be too careful.

Good luck with everything - I hope the rest of your recovery is a smooth one.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Wednesday, August 20, 2008

Brace-free and fabulous

I promised brace-free pictures, and I like to keep my promises, so here you go:

I am now officially at six months post-surgery, though I had my braces taken off at the five month mark (a record for my orthodontist, who says he's never had a surgical patient's braces taken off that quickly.)

I still have to have some dental work done, though. There are large spaces between some of my top teeth, common after this kind of surgery, that I have to get filled in by my dentist next month.

So, we're getting there. By the end of this year, I figure everything - jaw opening, chin numbness, tooth spaces - will be taken care of, and I can finally move past this phase of my life.

Tuesday, August 19, 2008

High...um...I mean "hi"

The last time I went to see The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel, he put me through so much pain that I was gasping for air, crying, and doing Lamaze breathing to get through the appointment.

I wanted to hate him and swear I would never go back, but the dude's effective - he got my mouth opening from 30 mm to 36 mm in one session.

So, I just swore. A lot.

It takes months to get in with him, which gave me time to psych myself up for round number two. I decided that there was no way I was going into my next session sober. I was going to get very, very high on painkillers first. Fortunately, it doesn't take much to impair my brain function, which made me wonder a bit about the stability of my brain function, a thought that quickly disappeared with two T3s (codeine) taken in the waiting room before my appointment.

By the time they called me in, I was flying. An intern was the first one to see me.

Intern: The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel is running a bit late, so I'm here to get you started. How are you doing today?
Bella: I'm doing GREAT!!
Intern: You certainly are chipper today.
Bella: I'm high. He's mean, so I had to get high so I wouldn't have to breathe like I'm giving birth, not that I know what it's like to give birth or anything, but yeah.
Intern: Uh...okay.
Bella: He makes me cry when he uses his Thumbs of Steel.
Intern: I have heard that before, actually. Though I don't know anyone else who had to get high before they saw him.
Bella: I'm special.
Intern: Yes, I can see that.
Bella: Codeine is goooooood.

By the time The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel came in, I was even more far gone.

Bella: German orthodontic fetishists like me, you know.
Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel: [puts Thumbs of Steel in Bella's mouth and pries her jaw open]
Bella: You're mean. Codeine sucks!!
Jaw Master Grant Pouba of Physiotherapy with Thumbs of Steel: [cranks Bella's mouth even farther] Feel that? That's the end of your range of motion. Your mouth won't ever open farther than this because this is how far the bones will let me go. Let's just hold it here for a bit and measure it so we can see where we're at.
Bella: Aaaaaaaaaaaaaaaaaaaghhhhhhhhhhhhhhhh!

Then I said a bunch of other weird incoherent stuff I don't really remember and accused him of various human rights abuses. All I know is that they were pretty amused by my altered state.

However, in the end, I discovered that the end of my range of motion is about 47 mm, and in our session, he was able to get me from 42 mm to 44 mm, so I'm pretty much there. By the end of the year, my jaw physiotherapy torture sessions will be a distant, painful memory.

The next time I see him is in December. Hmmm...I'm pretty sure I have some liquid hydromorphone left over from my surgery...

Saturday, August 16, 2008

Ask Bella: Nausea and eating post-surgery

Q: I just had upper and lower jaw surgery and some genioplasty. I'm so relieved I found your website. It has truly been helpful in answering some of my questions and it's good to know that there is someone else out there that has had the same problems as me. I do have a question for you though. What was the easiest way for you to eat anything the first couple days? It's frustrating. Also, did you have nausea and, if so, what helped?

A: I didn't have nausea right after the surgery, but I did purchase some children's liquid Gravol just in case. It came in handy a bit later on when some of the drugs made me a little nauseated. I just took some by syringe and it also helped me sleep, which was really handy, too.

The easiest way to eat anything the first few days was by syringe/tube. In the hospital, I got quite good at loading the syringe up with liquid food and shooting it into the side of my mouth. If you're eating soups or other things like that, make sure you strain it or it will get stuck in your wires. I had problems with that but for some reason stubbornly refused to strain my soups, even though that would have solved everything. I blame the drugs.

After a few days, I graduated to the Zip 'n' Squeeze bags, which made eating go a bit faster because you can fit more in the bags than you can in a syringe.

It is so frustrating to eat, because it takes so long - I feel you there. Try to cram as many calories into your food as possible. Use whole milk with extra skim milk powder in it, put whipped cream in your hot chocolate, that kind of thing, so that whatever you manage to get past your wires packs a good punch.

Best of luck to you. I know exactly how you feel. Just hang in there and keep telling yourself, "This will all be over soon."

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Thursday, August 14, 2008

Bad vibrations

I'm a big fan of live music and shows, when I'm feeling well enough to go, that is. Since my surgery, I've only had the chance to go to two performances (a burlesque show and an outdoor folk festival), and I'm beginning to see a pattern emerge that concerns me a little. It's only a hypothesis at this point, but I'm curious to know if anyone else has had a similar experience.

When I go to live shows, I carry a pair of ear plugs in my purse. That way, if the sound system is too loud, I can take the edge off instead of getting a nasty headache from the noise. (You know you're getting old when...)

Anyway, I had my earplugs at the ready but was surprised when it wasn't the noise that bothered me this time; it was the bass.

I was enjoying myself at first, but as each of the shows went on, it felt as though the vibrations of the heavy bass guitar were reverberating through the speakers and straight into my jaw. They then travelled up the sides of my face, causing me to get a splitting headache and leave early.

My hypothesis is that the heavy bass is vibrating the screws left in my jaw from the jaw surgery, which irritates the healing bone and gives me a headache. The area where the screws are located seems to be the focus of the initial discomfort, before it spreads into a full-blown headache.

Has anyone else experienced this? I wonder if it goes away once the bone is totally healed, or if this is what I can expect anytime I go to a show for the rest of my life?

I really hope not. Because earplugs are a simple solution to loud music that hurts your ears. But what's the solution to music that vibrates your jaw screws?

Saturday, August 9, 2008

Three weeks ago, something cool happened

It's hard to believe that it's been three weeks already and I haven't written about this. But that was part of the plan. Not to write about it. To have something that was just mine, that wasn't a status update on Facebook, that wasn't Twittered, that wasn't mentioned on one of my blogs. Something special. Something that could actually be a surprise.

And man, was it a hard secret to keep. I have a big mouth, and this is something that has to do with my mouth, so it was even more difficult to shut up about, so to speak.

Three weeks ago today, I went to see my orthodontist for a ten-minute check-up. He just wanted to see how my teeth were progressing so we could talk about the potential of getting my braces off in the next month or so.

He looked at my teeth and said, "They're perfect. Take them off!"

I looked at him, puzzled. "So, I should make an appointment to get the braces taken off, then?"

He said, "No. Take them off now."

"You mean, right now?" I asked, incredulously.

"Yes."

"But I don't even have my camera with me!" I cried.

I am such a blogger, jeez.

Next thing you know, they're coming at me with pliers and a drill. Two hours later, I was brace-free and grinning ear to ear. I'm sure the grinning had nothing to do with all the painkillers I downed before I'd let them come at me with the pliers and drill.

So, what was the first thing I did with my new metalless mouth? Well, I didn't eat corn on the cob, like I had originally planned, because the lady with the pliers told me that I should wait for my teeth to settle into the bone more - she was worried that eating anything too hard would pull them out of alignment. I couldn't argue with her on that one, because once you've gone through everything that I have, you don't want to take any chances.

I don't remember what I ate, but I do know how awesome it was to brush my teeth for the first time without all that metal in my mouth. It was so...easy. Brushing your teeth is awesome! The brush feels so good against your teeth and gums. I don't know why we don't do it all the time, like for fun:

Imaginary friend in alternate universe where teeth brushing is uber cool: Hey Bella, what do you want to do this weekend? Live music, hanging at the pub, going to a movie?
Bella: Why don't we all get together and brush our teeth?
Imaginary friend: Why didn't I think of that? That's the Best Idea Ever!
Bella: And get this, after we brush, we are totally going to floss!
Imaginary friend: Hooray!!

And flossing! Oh, my, flossing! Why did I ever not floss before? It's practically effortless. Just glide that string between my nicely spaced teeth and I'm done in a few seconds. People who have never had braces don't understand how awesome flossing is. Once you have to maneuver around wires and brackets for a few years, you want to do it all the time when it's easy again.

After all the gratuitous oral hygiene, I did something that I've wanted to do for the past year and a half. I told my boyfriend that I had something important to show him and that he had to come over right away.

Once he walked in the door, I kissed him.

You see, the entire time we've been together, I've had braces, so I didn't know what it was like to kiss him without them. A year and a half is a long time to wait for that kind of thing.

And I must say it was worth the wait. The boyfriend is a very good kisser, even better when he doesn't have to worry about my wires digging into my lips.

As for my other friends, I didn't post my news online because I wanted to show them myself. I thought they would just notice right away, but none of them did. I had to resort to staring at them and grinning like a maniac until their fight or flight instinct kicked their brains into high gear and they exclaimed, "Oh, you got your braces off!"

Yes, yes I did. Thanks for noticing.

Saturday, August 2, 2008

Ask Bella: Nerve damage and chin numbness

Q: It's such a scary thing to anticipate putting oneself through such a major procedure, and I must say I also find the prospect of permanent nerve damage terrifying. Thanks for sharing your experiences with acupuncture, as that gives me some hope that things can be done afterwards to help! I just wanted to ask: Are you still having improvements in recovering sensation in your lower face?

A: With the chin/lip numbness, I notice an improvement every single day. It's amazing, really. After the surgery, I noticed the numbness starting to go away alongside the swelling. At the two week post-op point, I would say I had about 85% of my feeling back. The return of feeling each day was very noticeable at that point.

Now that I'm at about 99% of feeling back, the return is more subtle. Instead of getting back 5% a day, it's .05% a day (or some other microscopic amount. I'm into words, not numbers, so please excuse my lack of accurate mathematical estimates.) But I notice it everyday, particularly after acupuncture or one of those home microdermabrasion facials. What a great excuse for a facial!! Anyway, I'm fully confident that I'll have total feeling back by the end of this year at the latest. I'll keep everyone posted on my blog, but I know it will happen.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Wednesday, July 30, 2008

Ask Bella: Acupuncture

Q: I've never had accupuncture before and am scared of the little needles. But I am tempted to try it, after having read your website. Would you strongly recommend it for the numbness? I also had a genioplasty (where they take your chin bone and slide it out forward to create more of a chin), and I can't even remotely feel ANY sensation in my chin. Which is, apparently, normal. But if I can speed up the process of the numbness going away, I'd love to do it. I'm just a little scared.

A: The first time I had acupuncture, I was scared, too. But it doesn't hurt that much, if at all. I mean, think about everything you've been through so far - do you really think acupuncture with its teensy little needles will ever compare to having a bone saw taken to your face? After what you've been through, you can handle anything!!

Also, some naturopaths or physiotherapists do it, which means you might be able to find someone who can help you with all of your post-surgery recovery needs. It's important to find an acupuncturist you can communicate well with. I've had some excellent acupuncturists who could barely speak English. They were great at what they did, but it was difficult to understand them, so if you had any questions or wanted them to explain what they're doing to you, you were out of luck. If you haven't had it done before, keep that in mind!

I did notice a big change in the numbness after I started going to acupuncture. Everyone's different, but it really helped me.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Monday, July 28, 2008

Ask Bella: Lymph drainage massage

Q: I was considering a lymph drainage massage, but my oral surgeon said, "I have no idea what that is, so I don't know if it's a good idea." But you did have one, and you said you noticed a difference, correct? Was it at all uncomfortable? And would you recommend it?

A: Lymph drainage is very gentle - like a butterfly touch - and it drains the swelling like crazy. I couldn't believe how effective it is, particularly because the guy "massaging" my face barely touched me. It made such a huge difference.

The only regret I had was that I should have gone the day after the surgery instead of waiting two weeks. I was very swollen and lopsided from the swelling, and after one session I noticed a huge difference. The homeopathic remedy Arnica is great for helping to reduce swelling, too, and you can find it at most health food stores.

It sounds like your surgeon is pretty traditional. Some doctors are strictly medicine/surgery, while others are more open to complementary medicine and alternatives.

Just so you know, all of the remedies and treatments I have used post-surgery are things that have been used by many other people who have gone through the same surgery - just check the online jaw surgery support groups found in my sidebar for examples of others who have done the same. (That being said, please consult with your surgeon or doctor before taking any supplements or natural remedies.)

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Wednesday, July 23, 2008

Willkommen, Ich bin Bella

As you know, in February, I started this blog to chronicle my jaw surgery. My vision was that it would be a site for people seeking out information about what to expect when they went under the bone saw. I also saw it as a good way for my co-workers, family and friends to see how I was doing while I was at home recovering.

It's a specialized site that I've promoted on the jaw surgery forums I frequent, so it has a small, specific audience. When it began, the blog got an average of 15-30 hits per day. So, when I went to my stats page one day and saw that my site had gotten 599 hits in one day, I was more than a little surprised.

I did some digging to see where all of these new readers were coming from, and the same website popped up for all of them. It appeared to be a forum for people with braces. When I tried to click on the link, it wouldn't let me in without a user name and password. So, I created one, expecting admission to the site would be immediate.

Not so much.

My membership had to be approved by the site administrator first.

Umm...okay.

As I waited for the approval, I watched my stat counter reach more than 500 hits again the next day. What on earth was going on?

When I finally received my Willkommen email (that should have been my first hint), I began clicking around to see what the site was about and why I was suddenly so popular. While nothing on the site is overtly stated, it quickly became clear to me that it isn't a support group for people with braces, as I had assumed by its name.

It is...

what I can only presume to be...

wait for it...

a German orthodontic fetish website.

If you are choking on a retainer or a loose wire right now, I'll give you a moment to regain your composure.

[pause]

Alright then.

The page where my URL is posted is titled, "erwachsene frauen" or "adult women" and all it contains are links and links and links to pictures of women with braces. The pictures aren't dirty or provocative, just photos of unsuspecting women smiling with braces on their teeth, likely lifted from websites, forums and blogs like mine.

If this isn't a fetish site, I don't know what else it could be. Because otherwise, what's the point?

I imagine that part of the thrill is the fact that the women don't know their pictures are being used in this way; they are unknowing participants or even victims of this fetish.

And while part of me is a little disturbed by this development, I do have to note that after my URL were not one, but two exclamation points.

Yup, braces or not, I've still got it.

The funny thing is, the 1,500 alleged German orthodontic fetishists who flooded my site for three days in April actually did me a big favour. After the Germans came, my site traffic jumped from 15-30 hits per day to 75-100 hits per day, and it has stayed that way. My stats tell me these new visitors are the result of legitimate searches for jaw surgery-related terms, not more hits from the same site.

From what I understand, because of the huge spike in hits, Google's crawlers took note of my website and prioritized it in their searches. Now, when people who are looking for information on jaw surgery and recovery, they find my site. So in a weird way, the fetishists helped me help other people going through the same thing.

How thoughtful of them! How am I ever to repay their kindness or thank them for what they have contributed to the jaw surgery community?

I considered taking some pictures of sauerkraut stuck in my arch wires, or maybe a big German sausage against my brackets. But that was too much work. The post-surgery anemia makes me tired, don't you know.

In the end, I decided to devote my final braces colours to my legions of German fans. The bracket ties are bands of black, red and gold - the colours of the German flag. See?


Genießen Sie, meine Freunde.

Sunday, July 20, 2008

Smiling Bella

I googled the name of my blog for kicks the other night, and the third entry that popped up was this:

It's the "Smiling Bella" Female Latex Mask!

According to the website: "No matter what you intend to do with this mask, one thing is certain: you are going to have lots of fun, guaranteed!"

Only if your guaranteed fun includes being totally creeped out by yourself and your ghoulish smile.

All I can say is, my face better not look like this once my recovery is complete, or I want my money back!!

Friday, July 18, 2008

Ask Bella: Supplements and nerve regrowth

Q: I was just reading your post from Mar. 30 where you mentioned the odds of nerve damage following BSSO increasing with one's age. My surgeon brought up B12 as something he might want me to take. He said there's some research going on to see if it will help. Do you have references that support the use of B12?

A: B12 supplement is a very good thing to take before/after the surgery. My naturopath recommended it for me to take as well because it's very good for nerve repair. I found a really cool B12 product that's perfect for when your jaw is wired shut: B12 dissolving strips that are like those Listerine Pocket Packs. They're even minty!

If you have the opportunity to go to a naturopath, I'd recommend it. There are some homeopathic remedies can help with nerve pain/regrowth, such as Hypericum Perforatum. It's worth looking into.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Wednesday, July 16, 2008

Ask Bella: Post-surgical depression

Q: I discovered you blog via a google search of "orthognathic surgery recovery depression." My son had surgical advancement of both lower and upper jaws on June 6. My question is regarding depression. He does not want to see any of his friends, which I am attributing to mild post surgical depression. He said it's because they make him smile and laugh which still hurts. Do you think I should insist that he he allow his friends to visit? How important were/are visits from friends during your recovery time?

A: I can really relate to what your son is going through. And it sounds like his surgery was far more extensive than mine, so his recovery will likely be more difficult.

Depression post-surgery is quite common, from what I've read, and what I've experienced first-hand. During the surgery, they pump you full of steroids to keep the swelling down. The steroids stay in your system for a week and during that time, you're feeling pretty good. Then, after a week, you go into steroid withdrawal and crash into depression.

It was very severe for me and I was absolutely miserable. Fortunately, it passed quite quickly - three or four days at the bottom and then things got better, particularly after I talked online with other people who had had the surgery and been through the same kind of thing. (I also went through a bout of depression at the three-month mark, which you can read about here.)

I can also relate to his problem of being in pain after having fun. I have had jaw problems for a number of years and have often felt torn between doing what's going to be healthy for me psychologically (i.e. going out and having fun with friends) or what was best for my jaw. Because going out, having fun, and laughing and smiling with my friends meant that I would have migraines for four days afterward and pretty much not be able to do anything. So, was it worth it? Or to what extent could I do it? Could I try not to have too much fun?

I wouldn't push him too hard, but I might suggest limited activities, such as going out for ice cream for just 1/2 an hour, or going to a movie so there wouldn't be too much talking/laughing but he'd still be out and around other people, which is important. Maybe his friends could bring over some DVDs or video games?

I think it's important not to isolate yourself when you're recovering, but at the same time, I get where he's coming from. I found that for a month after my surgery, I was very exhausted and had to have a two-hour nap after I did just about anything, even laundry. So, don't push him too hard, but make sure he doesn't totally cut himself off from the rest of the world while he's still listening to his body's need for rest.

Best of luck to you both!

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Sunday, July 13, 2008

Into the home stretch

I had my first post-surgery teeth cleaning on Friday. My gums were so sore from the baking soda tooth-blasting tool they used, but man, my teeth feel so clean! The dental hygienist marvelled at the difference the surgery made to my smile and asked me the changes I noticed.

I told her that just that morning, I was eating my organic shreddie-esque cereal and marvelling at how my teeth fit together. As I chewed the cereal using all of my teeth - front, sides, back, every possible surface an option, it dawned on me that this is how "normal" people eat.

They don't have to do strange jawnastics, using their tongues to make all the food go to the back of their mouths and to the right side, and then chew sideways to make their teeth meet correctly. They just chew. Up and down. What a concept.

Being able to chew without effort is something most people take for granted, but I think it will always fill me with a bit of wonder. I can't imagine taking it for granted after all this.

I went to my orthodontist last week as well, and he said that I can get my braces off anytime - I just have to coordinate with my dentist to have my gaps filled in before they can make my retainers.

When they did the surgery, they moved my upper teeth forward to make space for my lower jaw to advance. After this surgery, it is quite common that the upper teeth don't end up fitting together perfectly, leaving a few gaps that will need to be filled in with white composite fillings.

The earliest I can see my dentist to do this is September 3, so I may be stuck with the braces until then. I'll meet with my orthodontist next week to find out the plan for sure. But after everything I've been through so far, waiting an extra month for everything to come together is totally worth it.

Plus, I'm going to get my dentist to fill in the little chips in my two front teeth that I've had since I was a little kid. And I'm going to get my teeth whitened while I'm at it.

I can barely wipe the grin off my face already!

Friday, July 11, 2008

The soup recipe to end all soup recipes

My friend Krista sent me this very versatile soup recipe just before my jaw surgery. If you're creative, you can use it for just about any flavour combination you can think of. Let me know how your experiments go, and I'll post any recipe ideas that result!

Cream of anything soup

Onion, diced
Potato, peeled, diced
2 cups of any vegetable
Vegetable or chicken stock
Spices and/or fresh herbs
Cream, if desired

Saute an onion. Add potato, vegetables and spices. Cover with broth/stock. Simmer until all veggies are soft.

Puree. Top with cream and fresh herbs, if desired.


Note: If you're making the soup with sweet potato or similar starchy veggie, you won't need the extra potato for creaminess. And if you want high-fat cream of anything, skip the potato and just use cream.

And of course, if you're trying to up your protein content post-surgery, you'll want to put extra skim milk powder or other high-protein additions into the final product.

Enjoy!

Tuesday, July 8, 2008

Ask Bella: Advice

Q: I'm 15 and my lower jaw stopped growing in the first grade. I live in a small community and go to a small high school. Everyone except my best friends make fun of me and this has been going on for such a long time...fifth grade. I'm a sophomore now. I don't get my surgery until next summer. Will they have to remove my wisdom teeth before that? And do you have any advice you could give me? Most of the time, I dread everyday at school.

A: My heart just goes out to you. This sounds like such a horrible situation. I mean, elementary and high school are hard enough to get through without major jaw problems and people teasing you about it.

I'm glad you have best friends who are good to you, and at least you have a problem that is fixable, you know? Think about all of those people who get teased for things that they could never change, even if they wanted to.

One year seems like a lifetime right now, but in one year, no one is going to be able to tease you about your jaw or teeth again. If your problem is that noticeable right now, imagine what a dramatic difference the surgery is going to make! You are going to look fantastic. I bet people who've known you for years won't even recognize you! It's really exciting, when you think about it.

Try to concentrate on the end results. Make a calendar counting down the days/weeks/months until your surgery. You probably don't have a date yet, but estimate one and outline it in glitter and bright colours. When people tease you, just say to yourself, "Wow, they're pretty stupid to be teasing me about something so superficial. Just xxx more days and this will all be over."

Of course, if they're really nasty people, they'll find other things to tease you about that have nothing to do with your jaw. But some people are just jerks that way. They're probably insecure about the way they look and tease other people to distract everyone from their own flaws. Losers.

It's great that you're getting the surgery done while you're young, by the way. The younger you get it done, the quicker you heal and the less chance there is to be complications with nerve damage and that sort of thing. As much as it sucks, you're really fortunate to be doing this now, and not having to live for another 17 years (like me) with a short jaw and the pain it brings, physically and psychologically.

So, hooray for you!

And yes, from everything I've read about the surgery, you do have to have your wisdom teeth removed first. Fortunately, I had mine out when I was in my late teens, so I didn't have to worry about that before my jaw surgery.

Just one tip for you: If you can, go to an oral surgeon to have your wisdom teeth out and get them to give you the good drugs (IV drugs). I know some people who just went to a dentist to have them out and were quite traumatized. Besides, any excuse is a good excuse for the good drugs, in my books.

Best of luck to you, and please let me know how you are doing as things progress!

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Sunday, July 6, 2008

Super spinach salad

If any of you are having problems with post-surgery anemia, like I am, and you can chew softer foods, try this spinach salad. A friend gave me this recipe and I have been eating the salad non-stop ever since. It tastes awesome, but what's best about it is that it combines Vitamin C (from the strawberries) with the iron from the spinach, so your body will actually absorb the iron. Hooray!

Spinach Salad

Baby spinach
Sliced strawberries
Cilantro (or parsley)
Red onion
Feta cheese (or Chèvre)
Toasted pecans (or other nut/seeds)
Renee's Pear Guava salad dressing (or other sweet dressing, like raspberry vinaigrette)

Enjoy!

Thursday, July 3, 2008

Ask Bella: Physiotherapy and range of motion, part two

Q: As I read this, I am at work propping my mouth open with a pile of tongue depressors. They do make me tear up in the beginning, but now I went from 27 mm to almost 35 mm in about a week! Not too shabby. I'm hoping to get to the 40 mm mark in a week or two. I think I can do it...just need to buy more tongue depressors! (I'm up to 18, and I only bought 20). Anyway have you ever tried this?

A: Wow - 27 mm to 35 mm in one week? That's got to be some kind of a record or something! Congratulations! I was surprised at how well stacking tongue depressors on top of each other and using them to pry my mouth open works. (I'm up to about 24 tongue depressors at the moment.)

Once I grew out of my jaw jack, my surgeon told me to try this trick and attempt to add one more tongue depressor each day.

It's difficult, because the tongue depressors don't have any "give" to them like the jaw jack does, so once you've got them in there, they're in there. I'm a bit claustrophobic, so I have to remind myself that I can easily pull a couple of them out and I won't be stuck like that.

Another thing about the tongue depressors that is a bit annoying is that they really dry your mouth out, which can be uncomfortable. I was thinking that something that might help is to get a latex glove and put the tongue depressors in the fingers, stacking them on top of each other that way. Then, you get the advantages without the disadvantages.

Thanks for reminding me about this - I can't believe I didn't mention it before. The best thing about it is that it's a cheap alternative to some of the more expensive medical jaw stretching devices out there, and it works just as well.

Anyone else have good jaw rehabilitation tips they can share?

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Monday, June 30, 2008

Ask Bella: Hot tips

Q: Knowing what you know now, would you still go through the surgery? Is there anything you would change?

A: No regrets. I'd do it all again. Only this time, I'd be taking the homeopathic remedies before the surgery as well as after to help get the swelling down faster, I would have gone to lymph drainage massage as soon as humanly possible after the surgery instead of waiting two weeks to help get the swelling down, and I would have moved my expectations about being perfectly healed from three months post-surgery up to six months post-surgery. Oh, and I definitely would have upped my iron intake during my recovery.

Q: Any random tips/recommendations for any part of the process?

A: Do your research. Read all you can, look into natural remedies, know exactly what you're getting into, and keep a positive attitude and a sense of humour and you'll breeze through it (as much as anyone can "breeze through" major surgery, that is.)

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Thursday, June 26, 2008

Read it and weap, my friends!

Last Friday, in physiotherapy, I hit...

...wait for it...

40 MILLIMETRES!!!!!

Oh yes, my pretties, you read that right. That's like a normal jaw opening, people! (As if anything about me or my jaw could be considered "normal", but that's beside the point, isn't it? And did I mention 40 freaking millimetres? Oh, yes, I guess I did.)

It's interesting to me that after all of the struggling and being stalled at 38 mm for the past several appointments, last week, my jaw joint and muscles seemed to loosen up for no apparent reason. By the time I made it to physio, it was as though my body was just ready to go there.

My physiotherapist said she could tell something was different. "Before, I was limited by your jaw joint. Now, I'm just limited by your pain," she said as she wedged her hands into my mouth and pried my jaw open, causing tears to roll down my cheeks.

"Cool! I made you cry!" she exclaimed.

I don't even care about the pain anymore - bring it on. I just want to hit 45 mm by the end of summer.

Tuesday, June 24, 2008

Ask Bella: Drooliscious

Q: When your jaw was wired shut, did you drool constantly, or is it just me? I feel like a rabid dog. It's not cute.

A: It seems so long ago that I had my jaw wired shut, but from what I remember, I didn't drool all the time - just when I was eating, which was decidedly not cute. (Though my boyfriend found it endlessly amusing when I would smear chocolate pudding all over my face without knowing it, because my chin and lower lip were numb.)

I have a feeling that I didn't drool much because I was able to get my swelling down quickly, and swelling would interfere with being able to close your mouth and keep the lovely liquids where they belong. Or maybe some people have more drool than others? I dunno.

Hang in there! One day, the wires will be gone and the drooling will be all but a distant memory. That, or all the drooling will dehydrate you to the point that your mouth will be no longer able to produce saliva; either way, it's gotta end sometime, right?

In any event, I bet you're still pretty darn cute, Chinderella.

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Sunday, June 22, 2008

Ask Bella: The real basics

Cecilieaux asks: Okay, what I have never understood is...why? (Or maybe I missed it.)


A: You missed it only if you've read all my archives, because I've been dealing with jaw problems for more than two years now. So you don't have to go digging for it, here's the story of why I subjected my face to the bone saw.

I had an overbite, which isn't a big deal for most people, but in a few, it can cause jaw joint problems. I was fine the majority of my life, until I started doing a lot of stage work, singing, acting and using my jaw a lot more than I was used to. Then, I developed crippling migraines and jaw pain while I was a poppy/jitterbug/citizen of the Emerald City in an extended run of the Wizard of Oz musical. Because of the overbite, I was thrusting my lower jaw forward in order to sing and enunciate properly, and that was putting strain on my jaw joint.

I saw an orthodontist, jaw physiotherapist, and orthognathic surgeon and all suggested that this surgery could help my TMJ problems get better. Of course, it wasn't guaranteed, but the stats I was told were that 70 per cent of people get better, 20 per cent stay the same, and 10 per cent get worse.

Singing is such a huge part of my life and my expression of who I am that I couldn't imagine not being able to do it because I was in too much pain. The TMJ pain was also interfering with my social life - I found myself not spending as much time with my friends because I had too much fun. After a night out of talking, laughing and smiling, I had migraines that kept me at home and alone for four days straight.

I had a strong feeling that for me, the surgery would work. I'm still recovering and haven't tried going back to the stage yet, so we'll see what happens in the next few months.

Thursday, June 19, 2008

Informed consent

Before I went in for jaw surgery, I was sent a very detailed (we're talking four pages here, people) consent form about the procedure. Not only did I have to read it and sign it, but I also had to initial each point to ensure I understood what I was getting into. Fortunately, I had done all my research before I even had my braces put on, so I knew the risks, but this form still filled me with fear and dread. How could it not?

I thought you might be interested in the consent form, so here it is: everything that could possibly go wrong with your surgery, but probably won't.

Preamble

Orthognathic surgery is sometimes called "Surgical Orthodontics" because, just as an orthodontist repositions teeth, an oral and maxillofacial surgeon uses orthognathic surgery to reposition one or both jaws. Just as "orthodontics" means "straight teeth", "orthognathic" means "straight jaws." In fact, because moving the jaws also moves the teeth, orthognathic surgery is usually performed in conjunction with orthodontics so that the teeth are in proper position after surgery.

The objective of orthognathic surgery is the correction of a wide range of minor and major facial and jaw irregularities, and benefits include an improved ability to chew, speak and breathe. In many cases, an enhanced appearance can also result.

Orthognathic surgery is being planned for you and it is important that you understand the risks and benefits of the surgery. This is NOT a minor surgery and you have the right to be fully informed about your condition and the recommended treatment plan. It is important you are fully aware of all material risks and effects during and after the surgery.

For this reason, we are recommending that you read and review this document and ask any questions prior to the surgery. The disclosures and information in this consent are not meant to alarm you, but rather to provide information you need in order to give or withhold your consent to the planned surgery.

Risks

1. This is my consent for Dr. X and/or any other oral and maxillofacial surgeon(s) working with him and/or such assistants as may be selected by him/them to perform a mandibular advancement in order to treat the condition described as Class II malocclusion secondary to mandibular retrognathia.

2. The surgical procedure planned to treat the above condition has been explained to me and I understand the nature of the treatment to be to advance the lower jaw to improve the bite.

3. I have been informed of the possible alternative forms of treatment (if any).

4. My surgeon has explained to me that there are normal sequelae (after effects) and certain potential risks of the surgery, some of which may be serious. They include but are not limited to:

*Facial and jaw swelling after the surgery, usually lasting several days or weeks.

*Bleeding, both during and after the surgery, which may sometimes be severe enough to require a blood transfusion (less than one per cent). I have been advised of the opportunity for blood donation before surgery (if applicable) such that my own blood may be given back to me (auto transfusion if necessary). I further understand that there are risks with the process of auto transfusion.

*Allergic reaction to any of the medications or materials used during or after the surgery (less than one per cent).

*Delayed or non-healing of the bony segments; sometimes requiring a second surgery and/or bone graft to repair (less than one per cent).

*Relapse - the tendency for the repositioned bone segments to return to their original position, which may require additional treatment including additional orthodontics, surgery and/or bone grafting.

*Bruising and discolouration of the skin around the jaws, eyes and nose.

*Diminished sense of smell (if upper jaw surgery is done).

*A change in cosmetic appearance. Although this procedure is usually in part to restore jaw function, I am aware of some expected change in my appearance. This change is typically favourable; however, I understand that the changes cannot be exactly predicted.

*Loss of feeling, pain or tingling numbness in my chin, lips, tongue, gums or teeth, which occurs in a significant number of patients. These symptoms may last for several days, weeks or months, and I have been advised that there is a small chance that these changes may be permanent.

*Possible decreased function of the muscles of facial expression, which are typically transient or temporary but may be permanent in rare cases (less than one per cent).

*Scarring from the external incisions if any are required.

*The possible need for additional surgical procedures to remove wires, plates or screws (less than one per cent).

*In certain cases requiring bone cuts to be made in the narrow spaces between teeth, there is the possibility of devitalization of those teeth, which may later require root canal procedures and rarely may result in loss of those teeth (less than one per cent).

*In upper jaw surgery, the sinus will be affected for several weeks and there may be the need for further sinus surgery to remedy any lingering problems.

*Post-operative infection which may cause the loss of adjacent bone and/or teeth and which may require additional treatment for a long period of time (less than one per cent).

*Change in the position of the jaw joints, which may cause post-operative discomfort, bite change or chewing difficulties. If the jaw joint symptoms existed before surgery, there is no guarantee that there will be an improvement, and in rare cases, there may be a worsening of the symptoms after surgery.

*Stretching of the corners of the mouth, which may result in discomfort, cracking and slow healing.

*Inflammation of the veins that are used for IV fluids and medications, sometimes resulting in pain, swelling, discolouration and restriction of arm or hand movements for some time after surgery.

5. General anesthesia will be used for this surgery, and I have been advised of the risks of general anesthesia, including bronchitis, pneumonia, hoarseness or voice changes, cardiac irregularities, heart attack or death. We encourage you to discuss this with your surgeon or anesthesiologist. I am aware of the importance of not having anything by mouth, including clear liquids, unless specifically authorized by my surgeon or anesthesiologist (for eight hours prior to my anesthetic.) General anesthesia without a totally empty stomach may be life-threatening!

6. I realize the importance of providing true and accurate information about my health, especially concerning possible pregnancy, allergies, medications and the history of drug or alcohol use. If I misinform my surgeon or anesthesiologist, I understand the consequences may be life-threatening or otherwise adversely affect the results of my surgery.

7. If my teeth are wired together after this surgery, I understand there are certain associated risks and complications: oral hygiene will be diminished, there may be resultant gum disease, my teeth will feel slightly loose for some time after the wiring, and there is always some concern about airway obstruction. I agree to carry wire cutters with me at all times when my jaws are wired and to avoid the use of alcohol and other activities that may cause nausea or airway problems.

Information for Female Patients

I have informed my surgeon about the use of oral contraceptive or birth control pills. I have been advised that certain antibiotics and other medications may neutralized the preventative effect of birth control pills, allowing for conception and pregnancy. I agree to consult with my personal physician to initiate additional forms of contraception during the period of my treatment.

Consent

The fee for services has been explained to me and is satisfactory, and I understand that there is no warranty or guarantee as to the result and/or cure and that my condition may return or become worse.

By signing this consent form, I acknowledge that I have read it completely and understand the procedure to be performed, the risks and the alternatives to surgery (if any). I have had all of my questions answered to my satisfaction. I was under no pressure to sign this form and have had sufficient time to fully review this form and consider my choices. I have made a voluntary choice to proceed with surgery. I certify that I speak, read and write English.

Monday, June 16, 2008

Ask Bella: Physiotherapy and range of motion

Q: I was curious about the "opening of the jaws" predicament you've been having. I was wondering, if you had tried harder or more often during the beginning of your recovery, do you think you would have needed to visit a physiotherapist at all? At what point did your oral surgeon suggest you see one? Do you have any advice about these exercises?

A: Once my jaw was unwired, my surgeon gave me jaw opening exercises to do. You put your index fingers on your bottom teeth, close together in the middle, and your thumbs on your upper teeth, far apart. You use your fingers to push your mouth open as far as you can, and then you hold it for ten seconds and do four repetitions, four times a day.

My surgeon wasn't the one who told me to go to physio, though I'm sure he would have at some point. I had been having problems with jaw pain for years, so I have a physiotherapist who is a jaw specialist; he was the one who recommended I start going as soon as possible after the surgery. My surgeon didn't want anyone putting pressure on the jaw for one month after the surgery, so I waited exactly one month and started going every week ever since.

At physio, they did stretching exercises and massaged my jaw muscles, and I did the finger exercises at home. A few weeks or a month in, they gave me the jaw jack to help. The thing with "the opening of the jaws" is no pain, no gain, so the rehabilitation is not fun.

I would take it slow at first, because your body is healing and you don't want to do anything to damage your jaw so soon after the surgery. Do some research in your area to find a physiotherapist who specializes in jaws and just talk to them and see what they think. Your surgeon or orthodontist might be able to refer you as well.


Q: I am six weeks post-surgery and have an opening of 27 mm, which my oral surgeon is not thrilled about. I try every day to do the exercises, but I do experience a lot of pain, particularly on one side of my jaw. Do you think 27 mm is that horrible? I've read about your struggles with that device your physiotherapist gave you. Do you have any recommendations to make the exercises easier? Or to help me get a bigger opening, without using any kind of device?

A: When I was at six weeks post-surgery, I had an opening of 25 mm as well, and my surgeon said that this was average. So, if you're at 27 mm, you're on track in my surgeon's world.

I'm a very big fan of physiotherapy, myself. My physiotherapist will massage my jaw muscles and do milder stretches before getting into the bigger ones. This helps with the pain and also advances my mouth opening far more than I could myself. You could always do some massaging of your own muscles before and after the exercises to help make them easier.

I've also taken painkillers before doing the exercises on my own and gotten good results. Though you do have to be careful not to push yourself too far and injure your jaw. Good luck!

Oh, and in case you were wondering, I'm now at four months post-surgery and I have a 38 mm opening. Two to seven millimetres to go. Hooray!

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

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