Surgery - Day 0

Surgery Day

We arrived at MGH and I changed into my "johnny" (aka sick people clothes). I was wheeled down to a bed in a basement with the other people awaiting surgery. I waited for awhile and was visited by a few people who asked me questions. Here's the weird part. I remember when they started to wheel my bed to the operating room. I remember the hallway, then, "Mr. Shull, your surgery is over." Just like that. It was jarring and freaky. They asked me if I was in any pain. I remember saying, "My foot! My foot!" Oh my God, my foot was killing me. It was horrible pain. OK. ok. What the what? They break your face into pieces and you yell, "My foot!" Well, apparently my foot was pressed up against something during surgery for 7 hours. My foot hurt more than my jaw for the next few days.

Here's what I remember of post surgery:

- A very nice nurse taking good care of me.

- Getting very nauseous from the anesthesia. Vomiting lots of blood. No, reader. I really need you to stop and picture it. Don't pull any of that romantic Twilight erotic bloody-thirsty crap either. Don't picture me as Robert Pattinson (I know. It's hard. Try.)

- They told me I had visitors, but I didn't want to see anyone. I was freaked out, bloody, and nauseous. They told me they were going to let one in anyway. (Ok. here's where you just have to know that some nurses just know best. )

- Jeff brought me a bunch of balloons and presents. (Which they did not let him leave with me.) I had pre-recorded messages on my phone in my own voice which was really nice way to communicate. 

Here's me right after surgery. See if you can spot me among my crazy-eyed friends.

I look so terrified in that picture. If it helps, I took it myself. I look so crazy – the earrings, necklace, the red dress... 

They took me up to ICU because of my apnea. They wanted close monitoring of my breathing.

Pre-Op Photos

Before and Well, Up to Now Pictures

Before

After

Sorry for screwing with you. I couldn't resist. It's really too early really for before and afters. But with surgery tomorrow, I did want to show some up-to-now shots.

 This is my "moderately convex" profile. Btw, prior to this process, this is the picture that I avoided my whole life. Do you know how hard it is to avoid letting people see your profile? You have to quickly dart to face everyone. I call it "pigeoning." It's moderately effective.








The next two pictures were very early in the process. Notice no bottom braces yet. In the picture below I drew in a yellow line to point out the arch of my front teeth (which I had never noticed.) That (and my overbite) is why my bottom teeth used to rest against the roof of my mouth.

Doesn't it look like I'm biting down on a French Fried Onion? 











This is my current set of chompers. You can see that my upper arch is wider (less sort of v-shaped) and that my front bottom teeth are more of a straight line. They no longer touch the roof of my mouth.








Here is a (mildly horrific, fairly insane) picture that I can't believe I am about to post in the inter-web. You can see my overjet (which is going away tomorrow) and my severely deviated septum which will go away in another set of surgeries later (probably) next year.

 

 

Surgical Hooks in Place

I liked telling people I was getting my surgical hooks placed. They sound gruesome – surgical hooks. Yeah, that's right. They come with a wooden leg and an eye patch. They're placed with rusty pliers by the girl from the movie, The Grudge. Do I sound tough yet? If so, scroll down to the picture of me to undo that image.

Wires, No Elastics

So with one week to go before jaw dismantling surgery, they remove the elastics and use wires to hold everything in place. I love that Janine was apologetic about my not being able to pick out colors. Honestly, colored elastics are the last thing on my mind. Dried blood and sutures are really all I can picture right now. But, she was cool for putting in all the wires and letting me take the picture below which I LOVE. I also (quickly) played them like a musical instrument. (If they let you, take a chance to do that. WORTH IT.)

Surgical Hooks

So the hooks are these little tabs with an open groove at the bottom. She placed one on the wire then used pliers to squeeze the grove closed, locking it in place. She did this all the way around the top and bottom. These hooks will be used to secure my jaws together after surgery (with strong rubber bands).

I'd heard it was painful getting them placed. I was nervous because I didn't get a chance to eat before I went in and was afraid I'd be sore after. But it wasn't bad at all. There was a little pressure as she squeezed the hook closed to lock it in place, but nothing bad.

I also heard that they are bad for eating, brushing, etc. I'll let you know. So far I haven't even whipped out the old wax again. We'll see. I like them because they look like little antennae on my braces (and they help me hear the voices that tell me what do.)

More Importantly... Television

As you probably picked up, a major part of pre-op is selecting the entertainment for when you're recuperating. Obvious choices: Big Brother, Love in the Wild, Design Star. However, I'm branching out! I watched two episodes of True Blood on the way home from Hawaii (to wet my whistle). I was sitting next to a very nice older couple. Mental note: Don't watch an HBO show on a plane. Jump cut to: NAKED PEOPLE. I almost peed. All I could think was, "She things I'm watching porn on a plane." Sorry old lady. My bad.

Heather (who schedules my orthodontic appointments) has urged me to consider Downton Abbey in my convalescent television line-up. I thought it seemed too stuffy, but she promises "scandal." Ok I'm in. 

Follow-Up on the Picture

A couple posts ago, I put up the picture which I sent to my orthodontist of me pretending to forcibly bite down on a macadamia nut. Just so you know, he is an excellent orthodontist, but does not generally seem to appreciate my extreme cleverness stress-induced hijinks. He mentioned the photo and simply said, "Thank you for thinking of us." I'm not sure what he had to clench hard enough to get that out instead of what he really wanted to say. But that's why I like him. Have I mentioned he's a really good orthodontist? : )

Happy Anniversary

Hard to believe that it's been exactly two years since I started this process. It seemed like it was going to take forever and in just a couple weeks, I will have surgery. Well, my jaw surprised me with a getaway to Hawaii. Oh, Mandy, You are so thoughtful that way. I also couldn't resist and e-mailed the following to my orthodontist... (Yes, I really did.)

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.