The musings of a final year medical student

Tuesday, 4 August 2015

Post jaw surgery post: days 1-4


I honestly can’t believe everything that has happened over the past 5 days! It was a crazy and very intense experience and still is, but I am doing better at managing things.

Pictures will be shown of me looking pretty shit and some blood so if you are at all squeamish I would recommend you do not read this post or look at the photos.

This is a VERY long post, and so I know it won’t be for everyone. However, I wanted to include as much detail as possible for people I know who are going through or considering this process.

The night before the surgery I was pretty calm, I didn’t cry but I didn’t sleep much because I couldn’t stop thinking about the surgery. I wasn’t allowed any food after midnight and had my last bit of food at 9pm on Thursday evening.

I set my alarm for 6am on Friday morning, got up, showered and got all my things together for the operation. 

Pictures of me before the operation

Friday – day 0
I was asked to come into the pre-op admissions suite at 7.30am. Once I got there, the nurse made me go over the consent form I had already signed saying I was happy to have the operation and took a urine sample. Prior to that Friday the hospital had already taken two blood samples just to check I was fit and well before the operation. She gave me two hospital gowns and compressions socks to wear. The reason she gave me two gowns was because the gowns do tend to gape and so by wearing one as a dress and one  as a dressing gown on top it meant I could walk around the admissions suite with dignity in front of the other patients who were also having operations that day. Fortunately I was first on the operating list, but it still took a while for all the prep to be done. Once I was in my gown my surgeon briefly spoke to me, as well as his doctor colleague who was in charge of making sure I recovered okay over the weekend. The colleague told me it was likely I would be in till Sunday rather than Saturday because of how serious the operation is and because I am young (19). I was then seen by my anaesthetist who asked some routine questions about my lifestyle, e.g. if I was pregnant, was I smoker, do I drink alcohol, any allergies of family history worth noting. Then my mum went with me and they put me on a hospital bed and made me check the consent form one last time before heading to the anaesthetic room. I said goodbye to my mum which was actually less emotional than I thought; I was still relatively calm at this point. Once in the anaesthetic room they struggled to find a vein that they could insert a needle into because I have crap veins. They also had this problem the last time I had a general anaesthetic to have my wisdom teeth removed. After a lot of arm squeezing from the nurse and furious tapping of a vein on my right hand, they got the needle in and I quickly fell asleep. The insertion of the needle was relatively painless, but I can imagine that if you are afraid of needles then having two people squeezing and tapping your arm whilst trying to put a needle in it could be slightly distressing.

The operation was approximately 5 hours and I don’t know what time I woke up at, but I am guessing it was 2-3pm. I woke up and felt very disorientated. I quickly felt pain and swelling in my jaw. I was in a recovery room with a few doctors watching over me and keeping up my pain relief. I think they were giving me small doses of morphine and it kept wearing off really quickly and then I would be in pain again. It wasn’t great. I was still very drowsy from the anaesthetic at this point. I was told that my operation had been successful. I was wearing a special mask on my face called a Hilotherm; it circulated cold fluid at 15 degrees Celsius, and this really helped to reduce the swelling. I wore the Hilotherm for the whole weekend until I was discharged.

Later that day I was moved to an intensive care unit to stay overnight so that I could have one to one care by a nurse. There was a different doctor, a maxillo-facial senior house officer who was in charge of checking up on me when necessary. She was there for most of the weekend and I felt really sorry for her because by Sunday morning she was absolutely shattered. The ICU was quite loud as there were several other patients in the same room with various other problems. My surgeon  and his colleague came to see me again and were very reassuring and kind. By this point I was starting to have more of an understanding of what was happening and I found it incredibly overwhelming. For most of the time I was in hospital I was crying, not because of the pain or swelling but because I couldn’t believe what I was putting myself through. It all felt too much and at that point I really regretted my decision. I couldn’t talk properly, I had blood all over my mouth, nose and gown and I felt very lonely. I had lots of wires going in me and it made me feel very scared because I felt trapped. I couldn’t stand up or go anywhere, I couldn’t breathe easily and I couldn’t talk. I didn’t have any paper or a pen to write with so I couldn’t communicate well at all. The worst part was that the staff didn’t understand why I was crying, they thought I was scared of hospitals or how noisy it was, but it wasn’t that. I just had so much regret and wished I hadn’t done the operation. The first three days honestly felt like the worst experience of my life. I felt lonely and in pain and trapped in my own body and I wished that I could undo what I had done. I had two IVs and an arterial line. I found that the best drug they gave me for the pain was Tramadol. They would give it to me through my IV and it was brilliant at getting rid of the pain. I had these compression machines on my calves on top of the compression socks which intermittently squeezed my legs to encourage the circulation. 

Friday night was hard. In the evening I tried my first bit of water, and very shortly after having my first sips I was vomiting up blood that had gone into my stomach due to the operation. It was quite distressing because I was so thirsty, but each time I had water I then threw up more blood. I was sick three times I think and then after that it settled down. I had a drip attached to me to keep my fluid intake up because I couldn’t drink enough water. I initially had a nasal cannula but I didn’t need that for long as I could breath well on my own, but it was hard. It was also tricky to breathe through my nose because it was congested with dried blood. My parents came at a bad time as I was throwing up just as they arrived, but it settled down quickly. I was given a suction device that you’ve probably seen at the dentist’s, allowing me to suck up any excess blood or saliva from my mouth.

I didn’t sleep at all well that night because I regularly needed more pain relief, antibiotics and anti-nausea medication. They also had to keep checking my blood pressure and temperature.  One thing that really embarrassed me was using the bedpans to have a wee. I wasn’t well enough to go to the toilet as well as having all these wires in me, so I had to try to hold myself up off the bed and pee. The worst part was that the nurse would leave me for ages with this bedpan underneath me and I couldn’t move for fear of knocking the bedpan over, but I was so exhausted from holding myself up, and I couldn’t shout for help because I couldn’t talk anyway.

Saturday – day 1
By Saturday morning I felt even more distressed and was still crying. My surgeon, his colleague and the max-fax SHO came in and attached elastic wires to my brace. The elastic bands go vertically from the lower teeth attaching to the upper teeth, keeping the jaws in the correct position as they heal. I also had a piece of plastic in my mouth called a wafer, which worked in tandem with the elastics to keep the new bite in place. My drip was taken off. I was told that I couldn’t blow my nose for 2-3 weeks, but can breath gently through it. At this point, I still had 4-5 drains in my mouth but I couldn’t feel them. I was also told that I needed to keep myself seated either upright or in bed at a minimum of a 45 degree angle. I was then transferred to an ENT recovery ward, which has a lower ratio of NHS staff to patients. If I’m honest I was pretty pissed off with how they initially treated me because they left me in a hospital chair that was too far away from a buzzer and my suction, I still had the Hilotherm mask on so I couldn’t get up to find the buzzer and I couldn’t talk either so I had no way of alerting anyone if I needed help. I ended up waving my arms at a nurse who then helped me into bed and got me my suction. A doctor came along later and said that from now on I had to try and drink 50-100ml of water every hour and try to drink these high calorie Fortisip shakes. She took out the drains in my mouth which is what probably hurt the most out of everything. I started drinking water and shakes through syringes, but it hurt my jaws to try and open my mouth so that I could drink them. For some reason for the next 3 days my left side of my face was throbbing a lot more than the other, but I was told that this is normal. At this point, I was told that in order to be discharged I needed to be drinking at least 3 Fortisip shakes a day and drinking enough water every hour, as well as being able to rely on solely oral pain relief. I tried to take the Tramadol orally but the powder didn’t mix well in water so the syringes kept clogging up; it tasted so foul that I kept gagging and wanting to throw up. I managed 2 or 3 shakes that day. My elastics were tightened further by a doctor and the max-fax SHO. In the evening they were going to put me back on the drip so that I could sleep, but my crap veins let me down. My vein wasn’t taking in the water, and so I had an ultimatum between letting them try to put another IV in, which would undoubtedly take multiple attempts and be very stressful, or to not sleep and keep drinking water through a syringe overnight. I chose the latter, and barely slept because it would take me 25 minutes to drink 100ml of water by syringe. I was given more Tramadol overnight to help with my pain. The lack of sleep really got to me because the whole time I was in hospital I couldn’t sleep for more than two hours at a time because I either would get too dehydrated or be in too much pain, or someone was checking my blood pressure and temperature, or giving me my meds. I kept thinking that if I could sleep it would be more bearable, but I couldn’t switch off because it felt like so much was happening.

Sunday – day 2

On Sunday morning, my surgeon, his colleague and the max-fax SHO were amazed by how much water I had drank and were satisfied I was well enough to go home. I was so determined to get out of hospital because I knew I would be happier in a familiar environment. They checked my elastics and were happy with them. I got a prescription for lots of liquid codeine, ibuprofen, paracetamol, Corsydyl mouthwash and Fortisip shakes. 

My parents arrived at midday on the Sunday and I left at 1.30pm. I kept crying on that day because although I was feeling better, I still felt very overwhelmed. I owe so much to my surgeon's doctor colleague because she made me feel like a person and treated me with so much respect, but didn’t molly coddle me either. She was incredibly inspirational and she really believed I would be a good doctor one day and was so impressed with how I had done. Her kindness just made me cry even more and she hugged me a lot to try and make me feel better – cue more crying! She also managed to arrange the prescription so that I could have the Fortisip flavours that I liked. 

I got home in the afternoon, and have been feeling so much better since. I feel quite hot at home, so I use some ice packs on my jaws when I feel like it in replacement of the Hilotherm. I had some more teary moments at home, but have been getting a lot more sleep. My mum has been my nurse for most of the time I’ve been home and she has been a star. We have an arranged rota of pain relief so that there’s always an option available if I need it and I keep a diary of what I’ve consumed.  She has very kindly slept in the same room as me since I got back just to make sure I can get pain relief in the night if I need it.

Monday – day 3
I went to see my orthodontist and was forewarned by my surgeon that he would put the elastics on nice and tight. However, when I saw my orthodontist, he was delighted with how it all looked and decided not to change them! He said the swelling was going down nicely and that it is normal to go through the ‘5 day blues’ after an op like this. He described the operation as a ‘controlled car crash’. But on this day I could really feel things turning around. My temperature was better, and things seemed more doable. I was taking less painkillers and was more sociable and happy. I found it embarrassing to walk around the hospital because I felt everyone was looking at me. But then I saw a heavily pregnant mum smoking with her young toddler by her side at the entrance and I realised I wasn’t the most embarrassing person there. I was due to have a facial x-ray on that day, too, but it wasn’t on their system so I am going back in on Friday to have it done. From now on I am having weekly appointments with either my surgeon or my orthodontist, slowly decreasing the tightness of the elastics and removing the wafer. If all goes to plan, the elastics and wafer will be out in time for me to go back to university, so I’ll be looking normal again and talking normally, too.

Tuesday – day 4
Today has been brilliant. I have loads more energy, can sleep for longer periods of time without taking painkillers or drinking water. I can now drink most things normally instead of using the syringes. I am finally starting to feel like ‘me’ again. I’m not as dependent on people doing things for me. I feel really happy. I’ve truly turned the corner and feel a million times better.

I can see that my nose is smaller and shorter; it protrudes less and looks more proportional with my face. My jaw doesn’t look massively different to me but with the swelling it’s hard to envisage what the final result will be like. I have normal sensation in my chin and lower lip, but from my upper lip to below my eyes it is very tingly. I keep getting itches that I can’t actually itch because the sensation hasn’t yet come back, so strange! At this stage, the bruising is meant to start showing, and I should get some yellow-green bruising on my jaw and neck.

I will keep you updated with more pictures as I go along. I'm not sure I could go through this process again as it was very emotionally draining, but I am so so glad that I have done it. 


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