The musings of a fourth year English medical student

Sunday, 30 August 2015

4 weeks post double jaw surgery.

Every week I'm tempted to start the post with 'Wow!'. But honestly, so much seems to happen as each week passes by.

I am amazed that 4 weeks ago I had my jaws broken and repositioned in a 5 hour operation... I still find it hard to believe.

I need to be honest. Last week, I mentioned some wobbles in my mood. This week has been far worse. I wanted to shy away from words like 'depressed' or 'desperate', but that is the honest truth. And that is the whole point of documenting this recovery process. There have been days or certain moments where I have felt incredibly helpless, depressed, distraught and frustrated. I have had very negative thoughts at times. I have thought about not eating or not getting up in the morning because "What's the point?". 

I'll elaborate further. I was lucky enough to go on holiday with my family last week to Spain. Both the surgeon and orthodontist were confident that this wouldn't be an issue. It just meant that I missed one week of appointments. And physically, I am recovering extremely well. 

On our travel day out to Spain, it was very hard to have enough liquids. I calculated that I only managed 523 calories that day. The problem was I never wanted to drink as then I would need a wee. And that's not always fun when you're on the window seat of a crowded EasyJet plane, or at the stinky, un-cleaned airport loos. I'm sorry, but when it comes to toilets I am unashamedly fussy. 

Each day the family would go to markets, supermarkets, tapas restaurants and ice cream parlours. I tried initially to go along with them, but it felt too painful watching them eat all that nice food! I also really enjoy speaking Spanish, but I was so self conscious of my elastics that I didn't want to talk to anyone. My Dad would constantly nag me to go out to dinner with them, which eventually led to me bursting into tears. I was so cross because I LOVE going out. I love spending time with my family. I wanted to do just that. But I honestly felt like I couldn't, I felt too embarrassed. I would get tired very quickly, or my jaw would start to ache after a day of trying to talk. Even at our villa, watching them have BBQ steaks and banana whilst I sipped on canned chicken soup was not fun. As I describe it to you now, it doesn't seem like much. It's just food. But honestly, I had quite a few breakdowns of uncontrollable sobbing. I want my life back. In that sense, I'm not a very good patient! I want to go out, be active, meet new people. I'm an extrovert and I like being busy. But the physical pain, emotional pain and embarrassment takes away those joys. There were times where I thought: "What's the point of living like this?".

The trip home was similar, but this time I didn't even touch 500 calories. I just wanted to crawl into bed. We had to drop my Granny home, and at her house our extended family were waiting to meet us. It was lovely to see them, but I felt uncomfortable with the attention. I kept raising my hand to my face, and then realising it was pointless. My granny kept asking why I wouldn't let her make me a smoothie, but I was not going to sit down and let all my family watch me slurp and dribble whilst they tucked in on fresh homemade cakes and chocolate-dipped strawberries. 

One of my elastics had snapped that morning so I just wanted to get home and try to put a new one on. This absolutely failed. My orthodontist told me to take a picture and then just "figure it out" if this ever were to happen. It's impossible! I can't get to the back of my mouth, the broken elastics won't come away. I'm trying to ring the maxfax on call doctors at my hospital and see if they can fix it. This frustration prompted another meltdown. 

I start medical school on 1st September and I'm scared. Scared because I won't be able to go out or have meals with my medic friends, but I don't want to be lonely. I also don't want them to pity me or feel like they have to look after me. I want to go out and enjoy my life, but I really do feel like a prisoner to my recovery. I understand that that does sound incredibly over-dramatic, but it is truly how I feel. I want the old me back; that never stops talking, goes out all the time and always has an opinion to share. Plus, the old Kate loved her food!! 

In many ways I was completely unprepared for this operation. Yes, I knew I'd be in hospital around 3 days, that the first 3 days are the worst, liquid diet for approximately 6-8 weeks, elastics for 6 weeks roughly..... But I had no idea it would have such a psychological effect. I really hope anyone undergoing this surgery thinks long and hard about it before making a decision. I still don't think I could do this again. 

Above: day 22

Above: day 23
Above: day 26
Above: day 28





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Friday, 21 August 2015

3 weeks post double jaw surgery update

I would be lying if the last week hasn't posed its challenges. I have definitely had a wobble this week, even though the physical recovery has continued to go extremely well. As mentioned in the last blogpost, the elastics put on my brace by a new orthodontist were extremely tight. This went against what I was expecting, as I was led to believe that the elastics would become looser and more manageable as the weeks go by. Not only were these elastics incredibly tight, severely restricting movement, the elastics themselves covered the very front teeth. This was not only unsightly but extremely challenging to look after. Drinking liquids became harder; I had to make them more watery. In addition, any fibrous strands or strings of protein would get caught in it, making me self conscious and meaning I had to be even more diligent with my oral hygiene. It was also very embarrassing. The discomfort these elastics were giving me really brought my mood back down. I was on such a high; everything felt doable, and then I had three very emotional days. My mood was very low and I was crying all the time because I felt I was taking a major step back in recovery. It was pretty bad because these elastics made me not want to eat anything and so consequently the weight loss hasn't slowed down yet. Just as I was about to start integrating socially and think about driving and meeting up with people, I then felt unable to do those things. Partly through being self conscious of these obvious elastics, but also because of the discomfort. It hurt to talk and eat and still does sometimes. I had really hoped to see my friends but then had to cancel because I just wasn't up to it; I was in pain and so I knew I wouldn't be up for talking. That really frustrated me because most of my friends I haven't seen since the operation and given that my university dates are sooner than everyone else's (darn medicine) it would be the last chance I'd have to see them before I left. 

After those three days I got used to the new annoying tight elastics. My positivity slowly came back, but I am still frustrated. During week 2 I was talking quite a lot and now I am much less sociable because of the pain, and so I want these elastics altered so that I can talk again and feel like myself. 

Now, on day 21, I have seen this new orthodontist again and she has put on the same arrangement of elastics as last week. As I am on holiday next week, I won't see an orthodontist until 4th September, and I have been told that they will definitely be looser. As much as I hate these tight elastics I can see that they're holding my bite together nicely. I would say that the elastic changing appointments are more uncomfortable than standard brace tightening appointments I have had in the past, partly because it hurts to open my mouth wide. 

Nothing has changed really in terms of sensation. Chin and lower lip are fine, but everything above that has sensation but almost no movement. It feels so strange washing my face or applying makeup and not feeling it! I have more energy but haven't got back to exercising other than just walking because I can't breathe easily, so anything strenuous would be a no go.

The swelling has gone down well. I am still more swollen on my left side, but I am starting to look more human.

The cleaning routine of the mouth has stayed much the same. 3-4 salt mouthwashes a day and 3 Corsydyl mouthwashes; I  alternate them throughout the day. I brush twice or more per day with a baby toothbrush and Colgate toothpaste. The dissolvable stitches have started to fall out which is good. 

I am definitely getting my appetite back and long for normal food again. Before, normal food had no appeal and so the liquid diet didn't bother me. Now, every time I look in the fridge I gaze wistfully at the proper foods. I even dreamt about stir fry and Burger King last night! I haven't had a Burger King in at least 7 years. Needless to say, I cannot wait until the day the elastics come off and I can begin to introduce soft foods. Steak is a long way away, but I'm looking forward to that day! 

I am now back to driving which is good because I now have my independence back, however talking is still a problem. I feel self conscious and it hurts, which is disappointing. 

In terms of sleeping, I can now sleep on my side but not on my stomach. This has made sleeping hard because I'm so used to sleeping on my front. Oh well. 

I went to IKEA and got lots of bits and bobs for my new house - I cannot wait to move in and start second year of medical school! I was very jealous of the other IKEA customers having hotdogs and meatballs, the lucky buggers! There's so much anticipation for what it will be like and our first clinical placements as well, so much to look forward to. It's nice knowing now that I have my bearings on the city and know I'm going back to my lovely friends that I've met there. 


Above: day 15

Above: day 16

Above: day 17

Above: day 18

Above: day 19
Above: day 20
Above: day 21

Above: new elastics






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Friday, 14 August 2015

2 weeks post double jaw surgery

I cannot believe the surgery was 2 weeks ago! The last 14 days have flown by.

Today I had my weekly orthodontic appointment; the elastics were changed and they are actually a lot tighter than last week's, which surprised me. I saw a different orthodontist today because my usual man was on holiday, so perhaps that's why. It sounds weird, but it actually feels good to have the elastics on the braces tightly. The brief moment in the chair when I had no elastics on it felt so weird; I tried to keep as still as possible because I just didn't know what to do with my jaw. However, I wish they weren't THIS tight, I can barely open my mouth at all and it feels like a real strain. I was starting to have thicker liquids but now I think I'll have to make them thinner again because these elastics are so tight and they come right to the front of the mouth so there is physically so little room for liquids to pass through. I drove 40 minutes today to the hospital but then got my sister to drive back as she was with me, but I'm sure I could have done it myself, I was just being lazy. 

My appetite is starting to come back which is infuriating. Before I had no interest in proper food. I now look at meals that I would want to eat and get cross that I can't have it. I still like the liquid diet, the flavours of my foods are fine, I just miss eating my favourite foods. I've gone out occasionally with my family and it is starting to grate on me watching them eating food as I sip on water. In terms of weight loss I've lost roughly 5 pounds, not a lot. I am managing to get in the calories, but sometimes it's just too much effort to keep making smoothies. I tried my first bowl of Weetabix yesterday and it was lovely, but very runny of course. I normally have a cold coffee, actimel, juice and smoothie in the morning, soup for lunch, smoothie in the afternoon, another soup in the evening and possibly another smoothie after that. The dietician rang me up today to see how I was doing and said if I lose too much weight she will get more of the premade Fortisip shakes which are 300 calories per 125ml. How do they cram so many calories in those shakes?!

My lips and skin on my face are still really dry, not sure why though. A really thick lip balm is an essential for recovery. Nuxe's rêve de miel lip balm is great. 

The swelling has gone down really well, but I still sometimes get pain in my left jaw. I don't take any more pain relief which is good. 

Sensation hasn't really changed. Lower lip and chin are fine, but upper lip is very immobile but some sensation. It's really strange to have control of one lip but not the other, and means I really can't smile.   My whole face can feel sensation and pain but I can't move my nose, cheeks or upper lip much at all. I don't know why but immediately after the surgery my upper lip got really thin but it's starting to go back to its normal shape.

One thing I'm already planning is what I'm going to do when all the orthodontic treatment is done. When the braces are off and I'm fully healed I'm going to go to MAC and buy a lovely bold coloured lipstick and wear it constantly, just to show off that after 4 years of orthodontics and 2 operations under general anaesthetic I am finally DONE! It will be a wonderful feeling to know that I've finally done all my growing up and I will feel more like my age. I don't know a lot of 19 year olds with braces and I can't wait until I have them off. 

Above: Day 11
Above: day 12


Above: day 13


Above: day 14
Above: new tighter elastics - this is literally the widest I can open my mouth!





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Tuesday, 11 August 2015

Roses

My family gave me these gorgeous flowers as a get well soon gift, and I had to show you how wonderful they are! 
















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Monday, 10 August 2015

Jaw surgery: Day 10 of recovery

Today I saw my surgeon and I thought I would jot down some of his comments. Not much more to report except I haven't taken any pain relief for a couple of days and everything is going to plan.

Surgeon thinks I am doing amazingly well and the swelling is going down nicely. He has ordered me to speak as little as possible because the metal plates on the mandible have a degree of flexibility and I need to speak less in order to let them stay as they are whilst the jaws heal.

I had another look at my OPG x-ray with the surgeon and he explained the gap in the mandible bone that has been created will be healed as a blood clot will form in the gap and slowly develop into new bone! Isn't the human body amazing. 

I asked him why my nose had changed and he said he didn't think my nose looked different which is strange because it ABSOLUTELY is. It is noticeably smaller (but perhaps not in his eyes). Hence I didn't really get an explanation for why my nose is different.

The surgeon has reminded me that it's normal to have one side of the face that is more swollen, but I'm still not sure what that reason is. 

One thing I keep forgetting to mention is that my skin has been really dry since the surgery, including my lips. I've been putting on lots of moisturiser and Nuxe's rêve de miel lip balm, but even so I am really flaky and dry. 

I can now brush my teeth really well with a baby toothbrush because I have better mouth movement and I can actually smile widely enough to expose what the new elastics look like. Photo is shown below of these. 

Above: day 10
Above: what the new elastics look like (sorry about the stained elastics! Silly Heinz tomato soup)


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Sunday, 9 August 2015

Jaw surgery recovery: days 6 to 9

Hey all,

So far the changes are amazing and I see improvement everyday.

Above: me 1 week prior to surgery 


On Friday I saw my orthodontist who removed the plastic wafer and attached looser elastics. The appointment was a bit painful because for some reason opening my mouth that wide started to make the left side of my jaws really ache and throb; the same side that has greater swelling and was throbbing considerably in my initial recovery. I am seeing my surgeon on Monday so I shall ask him more about this then. However, I have been told that it’s normal to have one side of the jaw to hurt more, sometimes one side is harder to manipulate during surgery.

One thing that is frustrating about recovery is some days I will wake up with loads of energy and quickly just after small activities like a short walk or hospital visit that energy is totally zapped. I am trying to resist napping during the daytime to establish a good routine, but sometimes I have to give in. Even seeing people for less than hour the talking can make me feel exhausted. I’m not good at sitting around doing nothing and I normally drive everywhere. I haven’t started driving because I don’t think it’s safe to drive when I’m tired and I can imagine driving will be able to zap energy from me in the same way that walking and talking does.

I keep getting these EXTREMELY IRRITATING itches on my face that I can’t actually itch because the sensation hasn’t fully returned to my face. Honestly, they are the bane of my life. You just have to distract yourself with something else, but they are sooooooo anooooyyyyyinggg.

I have nearly ran out of Fortisip shakes which is good in a way because it encourages me to eat ‘real food’. I am definitely eating more proper food than the shakes now, especially because the looser elastics allow me to eat thicker liquids. I now have my soups and smoothies a lot thicker and they are more filling. Everyone has their fave foods during recovery; for me I am loving those iced coffees you can get for around £1 at the supermarket, Innocent smoothies and my own homemade smoothies to get my fruit.  My absolute favourite thing is to make a smoothie that includes whole milk, one banana and custard. It is absolutely gorgeous. My mum also makes a lovely spicy curried parsnip soup and a starchy leek and potato soup that is very filling. Beware though, I made the mistake of having Heinz tomato soup and now have some lovely orange-stained elastics. Great. I have been using the Nutri Bullet and I HIGHLY recommend it! It can get through anything, so easy to use and clean. Of course, if you already have a hand blender or similar then a Nutri Bullet is not an essential, but it has really helped me to be independent and make food for myself really easily. It’s important to note I am very uncomfortable with very hot liquids and I am having all the soups around body temperature. I can drink everything from cups now but still use syringes for liquid pain relief because it’s just easier. I still don’t have any appetite so I don’t mind the liquid diet because I’m not craving real food yet.  



Above: the liquid diet


I sporadically still use ice packs on my face because I can get a bit hot. You definitely need to get some small icepacks for recovery once you have been discharged from hospital as they help so much with the swelling. Frozen peas would probably do at a pinch but really ice packs wrapped in a thin muslin cloth or flannel work wonders.



At times I have been irritated that my family members haven’t appreciated how serious my operation is and have tried to rush my recovery. On Friday my dad offered me bread with my soup with complete sincerity, and he’s a doctor! I had to remind him that the fact my mouth barely opens a centimetre rules out practically everything. It’s good to get out of the house and go on walks which I do most days, but sometimes I just feel like I have no energy and I have to really dig my heels in and stress to them how shattered I am. I don’t know if the lack of energy is primarily due to the general anaesthetic or the lack of calories, or maybe they both have equal contribution to the fatigue.

I am trying to be more like myself and make sure I get dressed and do my makeup and hair each morning so that I feel more like myself. Some days this feels so hard. It is really strange to dip my face in the shower water and not be able to feel the water hitting my cheeks, or when I dot foundation onto my face and I can’t actually feel the foundation brush buffing in the liquid. I am getting a lot of tingling, particularly on the right side of my face, but it hasn’t completely come back. My upper lip feels very stiff and immobile, which is odd when you can see I have complete control of my bottom lip.

I am really happy with the results of this operation. As I have mentioned previously, my nose is smaller which is a nice coincidence of the surgery, and now that the swelling has gone down considerably I can actually see my new jaw properly and it looks amazing. I feel extremely empowered and I feel very strongly that this is the ‘real me’ in a weird way. Even with the elastics in my mouth and the swelling, I feel more confident and very content. The orthodontist thinks I am recovering at a normal rate that he would expect, so I hope I can give hope to others that recovery really isn’t that bad. Yes, it isn’t exactly fun, but once you get through the first 3 horrible days, life becomes fun again. It is so exciting to see how the face changes each day; you start to feel normal again and can start doing things for yourself. Yes, the elastics are on for at least a month and therefore a good month of liquids only, but it isn’t as bad as it’s cracked up to be. Once you are through those first 3 testing days, you will feel euphoric and extremely positive.

In terms of pain relief, I am nearly off it! I take maybe one or two ibuprofen a day, partly because it helps to reduce inflammation, and sometimes paracetamol if I get a bad headache. This is so much different to a week ago, when I had a pretty hefty prescription of codeine. I used to be taking some sort of pain relief every 3-4 hours, alternating between codeine, ibuprofen and paracetamol. Therefore  you really need to keep a pain relief diary at the start so that you don’t take too much and you keep them spaced out so that you have a certain amount of pain relief left over that you can take if suddenly the pain comes back.





As I reflect on this surgery, it truly is amazing. It isn’t for everyone – you need to think long and hard and assess if the surgery will make a notable change to your day-to-day life. I am so thrilled that I can keep my mouth closed comfortably without pain; this is the first time I’ve been able to do that since I was a child. I am excited to see how normal eating will be as this was quite difficult when I had my overbite.

If your jaw deformity is affecting you on a daily basis psychologically or physically in one or several ways, I think that would suggest you would benefit from jaw surgery. If your overbite/underbite/open bite/cross bite does not affect your daily routines and you are content with your jaw, and there is no medical knowledge that suggests you will develop any complications later in life if you DON’T have it, then I wouldn’t suggest it. I used to be irritated with friends who would often exclaim, “But I can’t see anything wrong with your jaw?!” An overbite can be very subtle and sometimes you only see things if you’re looking for them. I didn’t have a clue that my jaws were ‘weird’ until my orthodontist told me at 15, and then I realised it was the reason behind the daily discomfort I was putting up with. For others, a jaw deformity can have a severe effect on mental health and some people have suffered relentless bullying for it; I am so lucky to say I am not one of them.


I cannot stress how horrible those first 3 days were, physically and emotionally. Because of that, I wouldn’t want anyone to rush into the surgery. It honestly is life changing, but I wouldn’t want anyone to go through this process unless they really deemed it necessary because it’s hardcore. Some people may smirk at that and think it isn’t that bad, but honestly I really don’t think I could go through it a second time.  Pain may be temporary, but the brief time I was in hospital I did not enjoy one bit. Truly, having this operation is my proudest achievement because it tested me so much, and only now do I appreciate how major an operation it is. I remember crying my eyes out in my hospital bed as I was throwing up blood, saying to my mum, “Why have I done this to myself?” My orthodontist constantly describes me as being a car crash survivor, and that I’ve been hit in the face by a bus. That may sound terribly morbid, but that’s the gravity of the operation.



Above: bruising from the needles

Above: day 6

Above: day 7 


Above: day 8


Above: day 9 
Above: the new elastics allow much more movement. Please excuse my very dry skin and lips!



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Wednesday, 5 August 2015

Post jaw surgery recovery: day 5

Last night was the first night I managed to sleep the whole night without taking painkillers. However, when I woke up I was in pain and needed to take pain relief straight away. My mum didn't need to sleep in the same room as me which is good because I felt bad for burdening her in that way. 

I’m actually doing pretty well at the liquid diet; although I don’t enjoy it I don’t loathe it either. Everyone keeps asking me if I hate it and I personally don't think it's that bad. I get hungry but not to the point where my tummy is rumbling loads. I have a combination of the premade Fortisip shakes and smoothies and soups that my mum makes. She adds cream to them to for extra calories, as was advised by the dietician. I can now drink everything from a cup rather than a syringe, with the exception of the liquid codeine and ibuprofen because they are such a small volumes of liquid it’s just easier to use a syringe. I still need to wear a towel around my neck and have a tissue at hand when I eat because I tend to dribble and sometimes I overestimate how much liquid I can sip at a time. All liquids still need to be at a watery consistency; I tried thicker soups and smoothies today but they were too much and I had to thin them out. 

I am getting used to having my jaw wired shut with the elastics but it does ache whenever I try to talk which is a shame.

I also forgot to add that I have to do 3 saltwater mouthwashes a day and 3-4 Corsydyl mouthwashes. I have tried using a baby toothbrush as recommended by my orthodontist but it does very little because I can’t get to most of my teeth and only one side of them.

I have a light yellow bruise going all the way down my neck, as expected. But I also have some bruising on one of eyelids, which is odd.

In terms of sensation, parts of my nose are back to normal, my chin and lower lip are totally fine but it tingles from the upper lip to just below my eyes.

I’ve been a lot more tired today and managed to sleep 11pm-9.30am and then had another nap 11am-midday. I’m not sure why this is, but I was very talkative and enthusiastic yesterday so I am putting it down to that.













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