Cleaning Day

My last cleaning before surgery. I told Jess to do an extra-good job since I won't be able to clean inside my mouth for a while. Jess is an especially good hygienist because she: 1) loves reality TV and 2) makes me laugh. (She's also good at her job I'm sure.)

It went quickly. She said I'm doing a good job at keeping my teeth clean with no build-up. I thought my teeth looked grody (stained.) There's a noticeable difference following cleaning. I went from yellow corn to white corn kernels. (Proud to say never Indian Corn).

She gave me special fluoride rinse (to prevent cavities post surgery when I can't brush as well), some super floss (which I am addicted to), mini-tubes of toothpastes, and a baby toothbrush (for when I can't open my mouth very far.)

She recommends that I add Dexter to my viewing line-up during my convalescence. Done!

Pre-Op

Massachusetts General Hospital is a top-notch facility. Not only for its excellent physicians, but because of its proximity to Whole Foods and Pinkberry. My pre-op went from went from 7:45 into the afternoon.

Pre-Admission Testing Area

I called my mother to get some information on family reaction to anesthesia. She has hallucinations and my father had difficulty coming out of it. The doctors actually asked her come in to try to rouse him when they couldn't. (Anxiety level: 3) Can you see the doctor over my pale, unresponsive body looking up to the camera and yelling, "Don't you quit on me!!!!" (I can.)

They gave me a brochure with various tips: No ibuprofen or vitamins for 2 weeks prior to surgery, wear loose clothing the day of surgery, do not bring any electronics to the hospital (other patients' families will steal them.) Seriously? How f'ing hard is it to get an iPad? Who would take it from someone with a face that looks like a Mardi Gras float? Whatever. 

The lab took four vials of blood. I asked the technician what they were testing for. She replied, "Oh lots of things!" So I asked, "Really? Like what?" 

"Oh. All sorts of important things." Ok, can you test me for tolerance of vagueness? Because I think it might be low. Seriously, I never got a single direct answer. (Later that will turn out to be extra annoying.)

Anesthesiologist

A women named Brenda came in to talk to me about anesthesia. She seemed bubbly and high-energy. She looked me over and started talking fast. She referred to me as "abby." I asked her if she meant "abnormal." (The movie Young Frankenstein is the ONLY way I caught her meaning.) Turns out I am not obese and have no other major health concerns. So I should be a "piece of cake." She went on to tell me no fewer than 6 stories (some about her hear dresser) that I could barely follow. Listening to her was like a stream of consciousness. All I could think is, "Please don't really be my anesthesiologist." I don't even know if she is. I'm praying she's admin. only.  After her, I met with a nurse named Peter who was the opposite of Brenda. He asked me all of the same questions (including in-depth characterization of my bowel movement – which I only usually get to talk about with my sister. I was so glad to have someone as interested in hearing about them as I am about talking about them.) He was awesome. I really, really hope he will be one of my nurses after surgery. He was very calming and reassuring.

How Many Impressions Do You Do?

The answer is eight. They did eight impressions of my teeth. I'm very tolerant of medical stuff, but this was gross.

Before they started, she said she was going to slather the area around my mouth with Vaseline. I said that was fine "I'm used to that from my pageant days." (Well, I thought it was funny.) Actually, she is very nice and lets me take all the pictures I want so I like her.

She first sprayed the trays with something from a can. It left a greasy residue on the paper (see below) so I'm guessing it was something to get the impression out easy (like Ass-flavored Pam™). It sent crazy fumes up my nose (through the back of my mouth). I asked the nurse, "What is that horrible taste/smell? It's familiar, but I can't put my finger on it." She said, "Well, it reminds most people of nail polish." Yup!! That was it. It was like someone shoved a nail salon out through my nose. Vooof. Nasty.

It also left big tofu-like globs in the braces, but they give you a toothbrush kit that includes a dentist pick and needle-nosed pliers to get them out. All I can say is I WANT MY OWN PICK AND NEEDLE-NOSED PLIERS. It was the most satisfying toothbrushing of my life. Like sucking loose a piece of lobster x 10! Ahhh.

After that, more X-rays. If you don't know, you see a lot of doctors to prepare for this surgery. Apparently sharing x-rays is not an option, so everyone wants their own set and they want before, during, pre-op, and after – from the front, side, with jaw retracted and jutting forward. Seriously, LOTS AND LOTS of x-rays. They say its about as much radiation exposure as you'd get flying from one side of the country to the other. (But I also frequently fly from one side of the country to the other.) I'm starting to worry that I might turn into a buck-toothed version of the hulk. I did joke to the technician that I'd name the tumor after her. She said, "My name is Michelle, but everyone calls me Shelly." I am not kidding. She specified to make sure her "legacy tumor" is correctly named. I liked her.

Do I have anything in
my teeth? No seriously.
 It feels like something is
stuck in my teeth.

Facebow

Dr. Messina did a bunch of measurements including my face bow. He put blue, weird goo in my mouth with a caulk gun and held a caliper-like thing to my head to take measurements. Ok. As I've mentioned before, I know I'm a goofy looking guy. I'm ok with that. I made peace with my face a long time ago. That's one of the benefits of getting older. Not giving a crap what other people think. Here's the rub. Dr. Messina is a new doctor to me and happens to be UNNERVINGLY HANDSOME. He looks like a TV doctor. So here's the thing. Who wants blue goo squirted into their braces and measurements taken of their face (that is so messed up it needs to be surgically corrected) by Dr. Squarejaw McHotstudly? It was a serious test of my self-esteem. Which I'll give myself a C- on. 

New Concern

So, Dr. McHotstudly said that because I'm so much older... (Seriously, just kick me in the nuts at this point.) Because I'm so much older, I will probably not regain feeling in my lower face. Crap. So here's the thing. First thing I thought about was kissing. Am I not going to feel kissing anymore? Weird thought, but I consider that a pretty serious loss in terms of quality of life. The next thing I thought was what about work? I teach people to do a method of communication that requires use of certain mouth configurations. Will I not be able to feel my articulation? I'm also a speech therapist. He said that my speech should not be affected though. It would affect sensation (feeling) not motor (movement.) I signed the consent form anyway.

The funny thing is that he then asked me, "So what is the lab testing your blood for?" OH MY GOD! I asked her like 3 times!!! Turns out I had to go back to the lab to get more blood drawn.

So, that was my pre-op. In the time I have left before my surgery, I've decided to go to Hawaii and to chew a lot while I'm there. Next stop Honolulu.

Dissect, To the Bone, Saw through the Mandible

Today, I had an appointment with my surgeon and 47 of his staff. Seriously, there were a lot of white coats in there.

They think "the plan" can be amended. They want to move my lower jaw 12mm instead of 10mm.

One (new) doctor went over the plan in more detail using a model skull (pictured). All I could think was, "That's me in 100 years."

So, I've already written about the plan, but here's what I got from today. "Operate entirely inside the mouth - no scars - dissect the gingiva to the bone - saw through the mandible - dissolvable sutures." A little gruesome.

My mouth will not be wired shut. I'll be able to open my mouth (a little), but I'll only eat blenderized food for 6 weeks. And no splint (some freakish thing wired to your palate to keep it widened). Yay. No splint. I can expect three days in the hospital in an "ICU-type situation" (What does that mean? Is it like a TV set of an ICU?). I'll have a 1:1 nurse because of my "apnea situation."

I went to Whole Foods after my appointment and had a minor freakout. Someone is going to saw off my jaws and chin? Who thought this was a good idea?

More Molds

My surgical hooks were not placed. (Yay.) They'll go on one week prior. That's good because they are "unpleasant" and "interfere with oral hygiene." And that's from my orthodontist. Why doesn't someone stick some blue cheese and gym socks in my mouth? Perhaps I could lick a hobo's foot? [Insert more "unpleasant things that interfere with oral hygiene" here.]

All we did were new molds. No that's not Jake Gyllenhaal. That's actually me. I know. Uncanny.

Approval of Service

I'm approved!

I got a letter from my insurance today – approved coverage:

RECONSTRUCT MIDFACE, LEFORT
RECONSTRUCT LWR JAW W/FIXATION
PREPARE FACE/ORAL PROSTHESIS

Also approved genioglossus and hyoid suspension procedure.

(All caps actually in letter, not just used for dramatic effect.)

Btw, just wondering, what do you picture with "oral prosthesis"? Not trying to be leading, just wondering.

Next stop, pre-op.

New Episodes of Cougar Town!!

Remember when Cougar Town disappeared and EVERYONE collectively cried out, complained, and brought it back?!?

The one with Courtney Cox.

Ok, well, never mind. I like that show. My point is, you've been anxiously awaiting this latest blog entry. Your nails are chewed away, but reading Extreme Makeover: Tom Edition fan fiction got you through! Can I start referring to this blog as EMTE? Will you help it catch on?

To the point...  I went to my orthodontist – having pre-selected my elastics thanks to this little picture on my iPhone...

Please use this to advise future elestic decisions and patterns.

I chose Mediterranean (I looked up at the picture to spell it correctly) and also had to have my "chain" replaced (which I got last month). [see below] It's purpose is to close the gaps in the front, including that persistent front gap.

The exciting part is that I got my surgical wires placed. They are the thickest ones you get. They move your teeth immediately and cause some significant discomfort – like the slightly less-advanced "punch in the face".

Now that they are in place, if my surgery gets approved, I'll be ready to go for face-mangling surgery in July.

I did ask Dr. Murthy about when the surgical hooks are placed. He said, "Just one week prior. You won't be happy with me." Ok, for those early in the process, when a doctor tells you something may cause "discomfort" then GRAB HOLD OF THE CHAIR AND BITE DOWN ON YOUR LEATHER BELT!!!!!!!!!!!!!! Another blog also reports that the hooks can be painful. Oh well, I'll plan a visit to my pain specialist (read: bartender).

Things may be picking up on EMTE soon. (The new name is  already catching ooooooonnnn!!!!) I remember when I started this process, the timeline seemed so unbearably long and surgery so far off. Now it seems like its flown by. I can't believe my surgery date is coming up.

Gulp.

F CPAP

First off, I know.

I look great in EVERYTHING!! Weird, right?

In a nutshell, I used CPAP faithfully for a few weeks. I had to switch sides of the bed. Contrary to the presenters of "Sex and the CPAP" (see previous blog entry), this thing does not do anything for the love life.

Also, it did not seal well due to my physiology messed up nose. I woke up with gnarly headaches and was more fatigued than I've ever been. My reaction was crappy enough that I went to see a sleep doctor at Beth Israel. He thinks that I'm just not a good candidate for CPAP. He asked if I might be interested in other items to Velcro to my body (minds out of the gutter) to help hold me in certain positions to potentially breathe better. He also asked me if I had heard about the one-way valves I could stick into my nostrils each night. Really? Enough already.

On Your Nose with a Rubber Hose, Nightly.

So, fun fact. If you don't try a CPAP (Continuous Positive Air Pressure) machine, your insurance company might decline your surgery. Read your policy.

My CPAP machine arrived today. The technician was very nice and explained everything very well. (We also talked about Walking Dead. I promised to start watching.)

It has a reservoir to hold distilled water that gives you some moisture and that can be heated. (Bacteria sandwich anyone?) I chose an over-the-nose mask because I couldn't get a seal with the under-the-nose-nostril-pluggers.

See the antenna in the back? Ding, ding, ding, ding, dong, dong, dong, ksh, wee-ooo, wee-ooo. Yes, that's the sound of the modem that send reports on your usage to ensure compliance. If you don't use it, they'll know it. Well, whatever. I am a very compliant patient AND people with apnea say they get great sleep with these.

One last note: my sleep specialist had attended a professional development seminar on Sex and the CPAP. Really? What kind of roleplay can you do with CPAP?

[Cut to...]
Oh no! My mask fell from the overhead compartment. Our plane is going to crash!! But I haven't had sex... yet. (cue music)

Are you as turned on as I'm not?

Happy Anniversary, Braces...

What you forgot our anniversary?! It's like my braces invited their boss to dinner without telling me (and other married couple, sit-com set-ups). I just passed the one year mark with braces. I also met with my surgeon to discuss my progress. He said I'm ready for an orange sheet. For those of you not in-the-know, we "orange-sheeters" are surgery-ready. (I like hyphens as much as I like parentheses.)

My surgery is scheduled for July 17th.

Pre-Op
Our last day of school is June 21st. The next day I go for pre-op. I will meet with the anesthesiologist (I didn't spell that right the first time) and have an extensive history taken. They will take a "face bow" and model of my face.

Oh God. I just googled images for Facebow...

OK. Only one of these is a face bow picture. The other is a picture of me wearing a banana hanger.

Surgery

The final plan is to move my upper jaw 5mm and my lower jaw 10mm. Oh, right and we're also going to go for a genioplasty... um, that's where the doctor plans to MOVE MY CHIN. Yeah that's cool. What evs. I'm not completely freaking out or anything. Dr. Kaban says it will "help pull more tissue forward." And if there's anything I love, it's pulling my tissue forward. But anything to open my windpipe, right?

Here's my latest. Not much to see. My overjet is definitely expanded and my upper teeth are now wider. Oh, and the gap is back. (He's a fighter.)

The Plan

Why I am a Horrible Blogger
Looking over previous posts I realized I've never outlined the plan – what my surgeries will entail. From the picture you can tell I have a Class II Malocclusion (overbite instead of underbite). You might also suppose that the person taking the picture needs surgery to correct their one abnormally shorter leg that causes them to list to one side. But you can read more about that in another blog.

As a side note, I have noticed that the Class III Malocclusion patients (underbiters) have done a much better job with the blogs. Come on Class IIs!!! We have to fight the stereotype of being buck-toothed hicks!!!! For those of you who don't know, the Class IIs and Class IIIs have a fierce rivalry resembling that between werewolves and vampires in the Twilight series. (Almost exactly mirroring it actually. In fact, I am brooding about it right now.)

The Actual Steps
So after consultations with a handful of various doctors, here's the plan:

1. Braces Get braces to increase my overjet (decrease the distance my jaw will be moved in surgery) and widen my narrow upper arch. (done)

2. Wisdom Teeth Extraction Remove three severely impacted teeth early. The gaps left in my jaws need time to fill-in before the jaws are broken in surgery. Also, have excess irony removed. (done and done)

3. Orthognathic Surgery Break upper and lower jaws and move them forward. Set with titanium screws. Use braces to hold in place. My mother is very concerned that I will lose too much weight. I am concerned that I will not be thinner than my arch rival – Abraham Lincoln.

4. Rhinoplasty and Septoplasty Straighten septum. Remove my "dorsal hump." (Before you get excited, that is just the bump on my nose. I am not a mutant, half man/half fish crime fighter. That would be a "dorsal fin". I hope that cleared up any confusion.) My doctor told me that everyone with a recessed chin has a dorsal hump on their nose. Would you like to obsessively look for that on everyone in the subway like I do? Go for it.

Also, when I try to breath through my nose, the sides collapse. So they will remove some cartilage from a rib and use it to strengthen the sides of the nose. (I have encouraged them to remove as many ribs as necessary. While my heart would be largely unprotected, I'd fit into size 29-waist pants. I know. Medical decisions like these can be so difficult to tease apart.)

5. Throw Pillows and Candlesticks The final bits will involve finishing my orthodontics and cosmetic dentistry stuff and I should be a breathing sleeper-through-the-night.