Day 1 – The Peak of Just About Everything (Pain, Discomfort, Swelling, with a Dose of Self-Deprecation …)

Day 1 was an emotional roller coaster!

The morning was agonising. I was sent to the dental clinic in the hospital to have my mouth and nose cleaned by one of the doctors from my surgical team. My head felt really, really heavy, so I had to be wheeled down since I was in no clear state to be walking around. It felt like someone had attached iron weights to my temples; they were throbbing like crazy and I was just in sheer discomfort. On top of that, the pain was unbearable. After the doctor was done cleaning everything, I was tearing like a baby! Soooo embarrassing, but I felt so helpless at the same time so I didn’t spare my dignity any thought. I think everyone who saw me being wheeled back to the high dependency ward was probably wondering what the hell this girl with the big swollen face was put through. Haha at least nobody will be able to recognise me after this swelling goes down…

My doctor decided to give me stronger painkillers, which were injected instead of ingested. I puked (pretty badly) but the pain and discomfort subsided almost instantly. I was really quite comfortable after that. Fortunately, I didn’t actually face any problems breathing during the first few days, because my nose didn’t bleed at all so it didn’t get congested. They moved me back to the normal ward for one more night after removing all my IV drips and the urine catheter. The feeling of the catheter being removed is something I do not want to relive again. It wasn’t very painful, just very… weird and intrusive. Very intrusive.

In the normal ward, I applied cold packs every now and then, and I’m pretty sure my swelling peaked that night. My face didn’t really have a shape. It was just this… amorphous blob of… swollen-ness. Ok I don’t make much sense but basically I looked a lot like this:

Image

I just wasn’t as cute and much oilier.

I’ll post pictures when I’m past the one week mark. Firstly because most of the pictures aren’t taken on my phone and I’m a bit lazy to go ask for them, but mostly because I AM SO DISGUSTINGLY SWOLLEN so you have to give me a bit of time for my sanity to be regained.

I slept in 3 hour intervals the whole night. It really wasn’t that bad. I took the time to drink milo and reapply ice packs. The nurses were sooooo nice, they weren’t bothered at all by my constant bell-pressing and whiteboard-writing (because my teeth are banded shut so I cannot talk AT ALL. Frustrating.) I cannot stress how important a supportive and kind nursing team was to the whole experience! You should do everything in your ability to endear yourself to the nurses! In hindsight it would have been a good idea to bring some chocolates and maybe a ‘thank you’ card for the nursing team. I’ll definitely give them something when I go back to the hospital for my return check-up, though I have a feeling they won’t recognise me at all in a week or two…

Day 0 – Surgery

As I had a blood clotting problem detected earlier in the week, I was administered a bag of cold plasma and transemicacid before the procedure via IV to help me with bleeding issues. I was wheeled in to the waiting room of the operation theatre at around 9.30AM, where I waited for a pretty long time before my surgery started. I think it started at 12PM and I was wheeled out at around 7PM.

I thought that they were going to do the typical ‘put me to sleep’ procedure where they made me count backwards, but instead they put me on 100% oxygen and injected the anesthesia through my arm. I remember hyperventilating for a bit because I thought I couldn’t breathe (stupid, I know) but then before I knew it I was out like a light.

When I woke up in the recovery room I was in quite a considerable amount of pain, and was surprised that I did not face complete numbness anywhere on my face. After giving me some painkillers they wheeled me out of the operating place where my family was waiting for me outside. My brother snapped a few unglamorous pictures which I will post up soon when I get my hands on them.

I spent the night in the high dependency ward. It was terrible though. I was nauseous and puked a few times because my empty stomach couldn’t take the medicine. One thing I would suggest is being completely calm when puking. It’s easy to panic because your teeth are wired shut. But the gross stuff can easily ooze out of the gaps between your teeth and it helps A LOT if you keep calm.

For the whole night I could hardly sleep because my face was in so much pain, and at one point in I actually started tearing up a lot. At its worst I would put the pain at around 9/10. I honestly wasn’t expecting to feel much pain, since I thought I would come out of the operation completely numb. I guess it’s one or the other and I happened to land the option that induced intense short-term suffering.

I was trying to stave off negative thoughts the whole night. It was very difficult, being in so much pain at all, but I kept reminding myself why I decided to have this surgery and that in a few weeks I would (hopefully) find it was all worth it in the end. Thank goodness the nurses were pretty sympathetic and nice, otherwise the night would probably be more terrible.

T-1 Day – Packing List

Hi guys! I’m posting this from the hospital.

I can’t believe it is actually happening, after two weeks of running around from doctor to doctor because of an undetected blood clotting issue. Thank goodness it was not too serious and I can actually go ahead with the surgery, except now I have a haematology team as well!

Here’s what I brought to the hospital, based on very useful lists done by other bloggers.

  1. Toiletries, including baby toothbrush and normal toothbrush (for tonight)
  2. Entertainment: Macbook, iPad mini and my iPod. My mum will bring the first two home because the hospital advised me not to leave any valuables here overnight. I’ll probably have an early night because otherwise I’d be bored to death. There’s a small TV here though, but I wanted to watch Sherlock on my Mac. 😦
  3. Snacks in case I get hungry before I have to fast at 12midnight (very likely)
  4. Neck support pillow
  5. Thermal water face spray
  6. Cold packs (two so I can alternate)
  7. Cotton buds/Q-tips
  8. Wet napkins and a tissue box
  9. Stuff for communication: whiteboard, a paper printed with questions and statements
  10. Clothes and towels (though I shouldn’t have because the hospital gave me a set
  11. Mum will buy a portable standing mirror for me

A while ago, a medical student came in to ask me what I am doing here (everyone else is probably above 60 here). I had to explain the surgery and my underbite to her. It was pretty amusing. After that, the anaesthetist and my surgeon’s team came in to check up on me and ask if I had any questions. Here are their answers to a few questions that I asked:

Q: What is the possibility of anesthesia awareness occurring?
A: (From anaesthetist) Very little chance. We will take necessary precautions to ensure that you are in deep sleep, including monitoring brain waves.

Q: I brought ice packs. Will they help?
A: (From anaesthetist) We will be injecting steroids to help with the swelling. If steroids don’t work, then the ice probably won’t either.
(From surgeon) It will probably help, and you should use them since you have already brought them.

Q: I’m worried about nasal congestion after surgery due to swelling and nosebleeds. I brought a nasal strip to open up the air passages. Will they help?
A: (From anesthetist) Probably not by a significant amount. We will however insert a breathing tube and oxygen mask if you face problems breathing.

I am not sure if the haematology team will swing by later, or if they will just do their examination tomorrow. My surgery is scheduled to start at around 10AM. I’m not really scared or anxious now… maybe I will be tomorrow. Now it just feels kind of surreal because all those months of waiting are finally over.

I have been bracing myself for the worst recovery possible because I’ve always been one to plan like a pessimist. It’s important to have realistic expectations of recovery, I think. The first few days will probably be filled with regret and questions along the lines of “why-did-I-put-myself-through-this-torture-and-agony???”. But I need to keep reminding myself that the pay-off will come eventually. I find that it’s much easier to be optimistic when you expect the worst and end up having things a little better than what you expected. So I am trying to tone down my excitement and keep my expectations reasonable.

On an unrelated note, I have a friend who went through the same procedure about two weeks ago. She faced zero numbness on the outside. She could completely feel her face, including her lips!!!! How amazing is that?! Her recovery has been so quick, she can already eat rice now!

Speaking of rice, I’m starving. I hope the hospital serves dinner soon. In the meantime, I’m going to watch some Sherlock before my entertainment devices are taken away later.

I probably won’t feel well enough to blog for a while (plus I won’t have access to a laptop and blogging on the phone is troublesome) so I created a twitter account for me to fire quick tweets on my phone. I don’t have any tweets now, but it’s @kimsjawsurgery

See you on the flip side!

Blood & Stuff

Pre-op planning was going too smoothly, some things were bound to crop up.

I went for my pre-admissions testing today (taking a blood sample HURT. I have a pretty high pain tolerance so I don’t really know why a little needle hurt so much! The actual prick didn’t hurt, but when they extracted the blood I could actually feel it leaving me. I don’t know it was really weird.) I was supposed to get my autologous blood donation done, but my blood test results had a couple of problems. My Prothrombin Time (PT), which is a test that measures how long it takes blood to clot, was higher than norm. This means that my blood takes longer to clot than the normal person, which might be a problem since blood loss during jaw surgery is a pretty major concern. Blood sodium levels are slightly low too.

I’m going back to the hospital on the 31st to do another blood test, and see a haematologist if the results persist. A family friend who studied medicine suggested that I eat more dark, leafy vegetables and soy products to increase my Vitamin K intake, which is supposed to help blood clot. Those two foods happen to the very things I always avoid!!!

Hope all will turn out well in the end. The last thing I want is for the surgery to be postponed!

FINAL Appointment with my Surgeon

Yesterday’s 2-hour appointment with my surgeon was veryyyyy eventful. She spent an hour informing my mother and me about the exact procedures involved and explaining the recovery process, and another hour measuring my face.

Basically, I am diagnosed with a ‘dentofacial deformity’ (how blunt), specifically a Class III Malocclusion. My surgery will involve Lefort I + bilateral sagittal split osteotomy (BSSO) + KIV genioplasty. That is surgeon-speak for double jaw surgery with a possibility of chin advancement if the surgeon decides during the surgery that it is necessary. The surgery is planned to be five hours, although with all the pre- and post-op preparations, I will be in the operating ward for a total of around eight hours.

Risks & Complications

She was very thorough in going through every single risk and assessing the possibility of things going wrong. These include:

  1. My body rejecting the blood that is given to me
  2. Severe blood loss
  3. Tiny foreign instruments getting left behind in the open wound (when the tip of the instruments break off, or if a surgical hook falls out)
  4. Damaging some facial nerve that will result in a lopsided smile
  5. Something going wrong on the day after the surgery such that I need to go for a second surgery
  6. Developing an infection
  7. Permanent residual numbness
  8. Relapse

In short, many many many things could go wrong.

The first 5 are highly unlikely, but the last 3 are definitely valid concerns. Apparently 10% of patients are left with permanent numbness (not total numbness, but more like a degraded sense of feeling in some spots on their chin/lips), and the risk generally rises with age. I’m less worried about that, and more anxious about the possibility of relapse, which can be as high as 50%, especially when the jaw movement is large. My movement is quite significant, so there is a higher probability of relapse. Thankfully, my surgeon stresses that the degree of relapse in most cases is negligible, and in all likelihood I will not go back to an underbite.

Fingers crossed that Murphy’s Law won’t apply to me and it will all be smooth sailing!

Recovery Timeline

  • I will spend an hour or two under intensive monitoring. The first night will be in the high dependency unit.
  • I will probably be able to check out after the first or second night if nothing goes wrong and I am comfortable with my progress. Swelling will peak on the second day.
  • Week 1: Liquid diet. This includes Ensure, juice, melted ice cream, yoghurt, strained soup, etc. Elastic bands everywhere!
  • Week 2-6: Soft food, no chew diet. If I’m not wrong, by this point there will only be one elastic band on either side of my mouth.
  • Week 4: Splint is removed
  • Week 6 onwards: Slow transition back to normality

Post-Surgical Changes

Besides being able to tear food properly and comfortably close my lips, and having improved pronunciation, my surgeon also talked about the aesthetic changes that the surgery will bring. She emphasised that this isn’t a cosmetic surgery, although it does have a cosmetic effect.

My front teeth will become much more prominent, and my profile will become convex instead of concave. There will be ‘more support’ at the mid-section of my face, where my cheeks are, so my cheek bones will become more prominent and I will probably become ‘chubbier’. My nose will be ‘lifted’, so it will become more upturned, and the base will be slightly larger. She warned me in a very serious tone that I will look girlier. I don’t know why she sounded so grave about it, really. I’m female after all, I wouldn’t mind looking girlier!

After that, she spent an hour measuring every aspect of my face. It was pretty funnily awkward to keep still and stare straight into the eyes of my surgeon as she appraised every single aspect of my facial appearance. She was very verbal about her evaluations, and some of her comments were quite amusing:

“Your eyes are very symmetrical. That’s really good, the eyes are the window to the soul.”

“Hm. Your lower midline seems to be a little off. Just a little. Actually if I tilt my head a little I wouldn’t notice it at all.”

“Your lower jaw is really long! That’s great, then you won’t get a double chin when we push the lower jaw back.”

“I think you are going to look like that woman.” *Points at model on the dental implant poster* “But don’t quote me on it.” (Sorry doc.)

She was pretty optimistic about my post-op aesthetic changes, and told me that I might need to get a new passport done. Before that appointment, I was honestly not expecting my facial changes to be very drastic, because a couple of people I know from school went for the operation and they don’t really look dramatically different. I still don’t want to expect much, because I reckon it’ll be pretty disappointing if I’m expecting significant change but I hardly get any, and aesthetics isn’t my main reason for the surgery anyway.

My surgeon sent me away with the line: “See you on the 9th of January.” Yes, the next time I see her will be on my op day! Which is just a little more than a month away. Everything is in her hands now. The only things left for me to do between now and then are an autologous blood donation on Boxing Day and just a bit more waiting.

Gosh it’s crazy how close it is.

Last Pre-op Ortho Appointment

Quick update! I had an appointment on 28 Nov. Thought it wouldn’t be much so I wasn’t intending to blog about it, but my surgeon ended up having me go for some necessary pre-op stuff so I thought I’d just put it down before I forget.

My dentist removed my power chains and put in this metallic wire thing around my brackets to prevent my teeth from moving anymore. Unfortunately a few days before the appointment, my power chain snapped in several places so I now have a slight gap between my central and lateral incisor. ): On a more optimistic note, I officially have no more pre-op orthodontic appointments! Pretty wonderful if you ask me.

After that, I had X-rays taken, and lots of photographs. The coolest bit was the 3D facial modeling system! Had my photo taken and a 3D model of my face was constructed on a computer. I had to do it multiple times (about 10) to get it right, because apparently the lights weren’t reaching some parts under my chin, presumably because I have a really steep jaw line that blocked the light from that area.

They are using the 3D model to make post-op projections. I really hope I get to see it before my surgery, it would be pretty awesome.

Ah, that’s about it for that day. It was a pretty long appointment, took about 2-3 hours. Hopefully that cuts some time from the appointment with my surgeon on the 5th of December.

MY A LEVELS ARE OVER I am so happy!!!!!!!!!!!!!

 

 

Surgical Hooks Are In!

Had my SECOND LAST pre-op orthodontic appointment today. The last one will be in a month, and my ortho will take my final dental impressions. She put in 10 surgical hooks today, which cost SGD$80 in total! So it’s like 8 bucks a piece for that tiny metal, yeeesh.

Photo on 2013-10-31 at 21.03 #3

It seems a bit early to have these in, I think. Usually people have them installed a few weeks before the actual op, but mine are in a bit more than two months before. They are not too bad, except now food gets lodged there pretty easily so I might have to resort to carrying my interdental brush around.

Ah, these things make the operation seem so real now. I’m not thinking about it too much though, because I have a more important and imminent worry – bloody ‘A’ levels. Good god this examination will potentially decide my course of life. If only I was American and only had to take the SATs… At least I can retake that if I don’t do well the first time. If I screw my A levels up… oh I don’t even want to think about it.

Okay, I’m off to hit the books. I’ll be back on 5th December with an update on my very long and probably very eventful pre-op appointment with my surgeon!

A Projection of My Post-Op Bite

I had another ortho appointment today! 🙂 This adjustment was MUCH less painful than prior ones, which must mean that my teeth are more or less right where they should be pre-op! Yay! 🙂

I got to see the impressions of my teeth! I had to wait one hour for them to set after the ortho imprinted my bite just today. She also discovered I had two developing cavities, so an appointment was immediately scheduled with another orthodontist to help me check those out and add fillings. I only had to wait about 10 minutes before I got called in to another dentist’s clinic. I love how efficient the National Dental Centre is!

My Projected Post-Op Bite~

My Projected Post-Op Bite~

HOW AMAZING IS THAT?! That perfect bite will be mine in only a couple of months!

If you are wondering why it is this odd green-ish colour, then I think it’s because they haven’t casted it in plaster yet. The plaster impressions of my bite before treatment are white.

So a quick summary of the appointments I have left pre-op (as of today):

  1. 31 October with my orthodontist to make another impression
  2. 28 November with my orthdontist to make the final impressions (Yes, I am spending the day after my final ‘A’ level paper getting a mould of my teeth done. My idea of fun.)
  3. 5 December with my surgeon to make facial impressions and… other stuff. I still don’t know yet, but it will take the whole morning.

GOSH I AM SO EXCITED. I will be fantasising about my perfect bite in the next few days to come. As if I hadn’t been doing it everyday already. 

A random observation: I was surprised how many people with underbites I saw in the one hour I spent in the waiting room waiting for the impressions to set (and no, the clinic doesn’t specialise in orthognathic surgery.) I guess this is a more common affliction than I thought. I know more than six people in my grade alone who have/had an underbite, of which one is a really good friend who will be going for her surgery two weeks before mine (yes, a real life surgery buddy! I’m quite lucky). Do any of you guys know of other underbiters/openbiters in real life (an overbite is more common from what I understand)? Or are you the only one in your social circle with the condition?

Metal Braces & Three Months Pre-Op Pictures

Had another dental appointment today. I hate having orthodontic work done, it is SO brutal. Changing the wires can sometimes hurt. Nothing unbearable, but sometimes when it is really tight, I have to take soft food for two days or so after the day of appointment. I thought adjustments would be less painful the longer I had braces on, but they really don’t get much better.

I don’t see much progress anymore with regard to teeth movement, so I guess it’s just the waiting game now. Next appointment is in a little more than 10 days. I’m not too sure what’s on my ortho’s agenda, but she said I’d have to wait an hour or so for the mould to solidify, so sounds like it’ll be more than just an adjustment. 🙂

About Having Metal Braces

Recently, I’ve been reading quite a few orthoblogs and I realised that many don’t have the traditional metal brackets. Some have lingual braces, invisalign or ceramic brackets.

It was quite surprising. My ortho told me, in my first visit, that the only option for patients who are intending to undergo orthognathic surgery is metal braces. I guess it depends on the clinic and the orthodontist. I don’t mind it too much, actually. Not the most aesthetically pleasing, but my bite is a mess anyway so it is not too much harm done.

Also, metal braces are considerably cheaper than the other options. My parents are paying for the treatment since I’m still schooling (thanks mum and dad!), so I don’t really want to incur any additional expenses.

Pictures: 13 Months in Braces/3.5 Months Before The Op

I AM SO SAD. My stupid hard-disk crashed so I lost ALLLLL my progress photos. 😦 In fact, it crashed TWICE. In a month.

I’m probably going to back up my pre-op pictures on this blog. Will probably make a ‘Pictures’ page that can be accessed in the side bar.

I doubt my bite will change much in the months prior to the op since the pre-op orthodontic work seems to be more or less done, so they should be good for comparison later on.

Photo on 2013-09-20 at 22.25 #5

Photo on 2013-09-22 at 18.41

Front - upper row of teeth are not too visible

Front – upper row of teeth are not too visible

Profile - Left

Profile – Left

Profile - Right

Profile – Right

My profile takes after the shape of my jaw a lot, so I have a very steep mandible angle and a very long lower jaw. There’s also the typical sunken mid-face of a class III. I really hate any candid pictures that capture my profile.

Okay, off to catch up on Masterchef Season 4! Go Luca!!! (Yeah, I know the results are out and the season is over, but I like to pretend that I’m watching it in real-time)

Quick question for anyone who has already gone through the surgery: I was thinking of applying for a two-week internship that will be exactly 4 weeks after my surgery. Is that feasible or does that sound like a horrid idea?