10.27.11 – First Dental Appointment

Finally got into the dentists office today, a referral from my surgeon. He wanted me to get a cleaning first and foremost, then have an exam tooth by tooth to see what stays, what goes, and what work I need moving forward.

The appointment actually went better than I had hoped. They took X-rays and then moved onto going through my tooth inventory. The X-rays looked better than I had hoped, they showed no cracked or dead teeth. He went through each tooth, including the snaggle tooth, and did various tests on some of them. The tests included cold (dipping the qtip in liquid nitrogen), electric stimulation, and knock (basically banging on the tooth with a metal object.) He only went through the lower center teeth and all but the snaggle tooth responded to the 3 tests positively. Not to say snaggle tooth is dead, but the sensation isn’t back yet and he said that could take up to a year. As far as he could tell the teeth were actually in remarkably good shape, all anchored well, and only a couple were even chipped. Best part, no cavities from not being able to brush or floss for almost 2 months while my mouth was wired shut.

What’s next, didn’t get to the cleaning this time, but have a follow up in a few weeks when I get a full 360 mouth X-ray, good cleaning (better as more sensation comes back each day), and the 3 part test on all my teeth. He’s also going to take a mold of my jaw to see what we’re up against trying to straighten everything out. He at first suggested surgery, I quickly said no way, not again, and that the surgeon said braces would work. He saw where I was coming from on that and said if the surgeon was cool with braces fixing things, he was too. Next step after this, to the orthodontist, hopefully sometime late Nov.

But on a positive note each day I get more feeling back in my face, my teeth hurt less, and the swelling goes down more and more. My back feels great and I’m running again, even started lifting and the pull-ups are slowly but surely coming back.

10.18.11 – 12 Week Follow up

Where are we at now, it seems like yesterday that I was laying in the hospital with little hope to be normal, today, I realize I’ve never really been normal. Many of you that know me more than agree with this. But more important, how is the jaw and how is the back?

For starters, had my back follow up last week, great news. The fractured has healed and I got the all clear to resume all normal activities. Describe normal, well, he said the back is healed and the bone won’t break, but don’t do anything to hurt myself otherwise. I did lose 1mm in height, but luckily I don’t do metric.

Since my appointment last week I’ve run 5 times, 5 out of 6 days to be exact. I slowly picked it up each time, a little longer, a little faster. I’m in terrible shape, but hell, I’m running so I couldn’t care less. My hammy’s are extremely sore, my lower back (not L3 but lower) is sore too, but I’m slowly stretching that out and feeling better each day. I can lift like a normal person again, albeit I’m a little more careful nowadays and lifting properly, meaning more with my legs.

Now how about that jaw and the old snaggle tooth? Had my 12 week with the Dr today and things are looking great. All is lined up, the teeth are mostly still alive apparently, and we’re two weeks away from new xrays, CT, and appointment with the endodontist. He’s asked me to start trying to chew with the bad side, to see how it responds. Once again he pointed out not to fall 20 feet off a ladder again, he doesn’t need the practice. Then commented on how I managed to break my jaw worse than a gunshot to the face. I take that as a compliment.

What’s going on with the face? The swelling is way down, still some around the wound but the rest of it is nearly normal. Still slowly getting feeling back in my right lower lip and chin, he is amazed that it’s coming back. He wasn’t sure it would, but sounds like it is. It can take up to a year for it to all come back, another luck is on my side dealio. The teeth, I can really start feeling which ones are toast, meaning root canals or removal. They don’t normally hurt at all, but you can really feel when they’re not alive, it just feels weird. The smaller plate in my upper jaw is still bugging me and he’ll probably yank that out with the endodontist, when he does root canals or tooth removals. Fun, yet another surgery. He also wants me to go to the dentist for a good cleaning, I’d go to mine but she’s a sweet grandma and would probably freak out if she saw my mouth. Ironic part being that I was scheduled for a cleaning on the day I busted my face open.

So more hurry up and wait. I still have no pain, although when I shave the upper plate is annoying. My feeling is coming back, albeit slowly, in the jaw, inside and out. The teeth, we’ll know soon what stays and what goes. The back, it rocks to be starting back to normal, but……….

SNAGGLE TOOTH, YOUR DAYS ARE NUMBERED!!!

 

 

 

09.20.11 – 8 week post surgery follow up

Where are we today, we’re exactly 8 weeks out from that damn 14 hour marathon surgery and 2 weeks out from the surgery to remove everything. As the days progress I feel better and better and eat more and more (relying less on the protein shakes but still making them a part of the diet.) Due to all the open wounds from the trauma of the cuts I’ve had to keep with the protein shakes, and also since so many teeth were literally knocked out of their sockets.

So what did we see today. The Dr after examining me said things are looking great, thank god. The wound over the upper plate in the front of my jaw (the one I could actually see when I opened my mouth) is finally covered and most of the teeth that were loose are more solid in place. The jaw is showing good “bony” growth and is healing better than thought. No pain equals good results.

What’s on tap for the future, next appt is in 4 weeks where I’ll get xrays and CT scan (apparently getting them too soon on such small bones won’t really show any results) and in about 2-3 weeks I should have my first endodontist appointment, where we start the long process of evaluating each tooth and seeing what stays and what goes. Then in about a month a dental appointment for a good cleaning, and the follow on will be with an orthodontist to start the process of pushing and pulling the teeth into a better position.

Doc also said to push the jaw a little more in eating. Since the wound is now almost healed, it’s ok to try more food, tougher food (like chicken and steak), of course only chewing on my good side. But this is to help exercise the jaw, encouraging the muscles to grow and the flexibility to continue (I can open it about 3cm now.)

The swelling is starting to go down again. He said that the new influx of swelling was from the last surgery when he removed the wires. Unbeknownst to me (as I was drugged up)  he had to work the jaw pretty hard around the chin to get the wires out, which encouraged a lot more swelling. The soft swelling is almost gone but the harder swelling I guess can take up to 4-6 months to go away.

All in all good news, happy to hear it and always happy to hear the Dr’s happy with how things are going!

OK, time to grill up some salmon…

09.18.11 – Teeth starting to feel normal and back is, well, back

It’s been almost two weeks since I had surgery to have the wires and arch bars removed, and some more stitching as the gum isn’t covering over some of the plates in the jaw. Where are we at now?

Each day the jaw gets more and more loose (in a good way, like I can open it more) and the teeth seem to feel better and better. The first day everything came out my teeth felt like glass ready to shatter, now most of them feel just like normal teeth. The first days I could barely touch them with a toothbrush without feeling like every tooth was going to fall out, now I can brush normally without any pain. There are a couple teeth that still have that loose feeling, but will have that checked out at my next appointment on Tues. Then we’ll also talk about the endo/orthodontist plans to get my hillbilly like lower jawline to look less, well, hillbilly like. Still have that one rogue tooth sticking inside my mouth, glad to get that sucker out of there. I’m also still a little swollen on the right side too, but they said that could take up to a few months to totally go away, but hey, it isn’t all that bad and better than what it was.

Hillbilly Jaw

X scar

With the stitches in the mouth and still open wounds to the plates I’m sticking with the protein shakes (easy to clean out mouth after) but am getting in the cravings I had for so long when the mouth was wired shut. In this past week I built up from fried rice, to eggrolls, to pizza by the end of the week. I had the opposite experience with pizza this time, ate the whole thing in less time than one piece the day the wires came out. And best of all I thoroughly enjoyed it, and the beer chaser.

And the best part is the wicked X shaped scar on the right side of my chin. If you’re gonna wreck yourself, at least make sure the after effects are going to look cool.

L3 Fracture

Now, what’s going on with the back? Only good thigns I think. On the plus side, I got rid of the crappy neurosurgeon at UCSF and went and got a second opinion at Mt Tam Orthopedics (place that I had my hip surgery at) and was surprised at the difference in opinions. The quickest way at summing this up, one place cared about me and my healing, one place went “by the book” and cared about nothing. My experience with UCSF for my jaw and facial surgery is nothing short of amazing, my experience with the neurosurgery there is nothing short of disappointing. The neurosurgeon saw me for a grand total of 5 minutes over 8 weeks, and worst of all is telling me that I should be in my brace through at least Oct, which would equal 13 weeks. He also had me do a CT scan, in which he would review that same day and get back to me (me starting PT was waiting on the CT scan), a week later, after me calling everyday, sometimes twice, he called me back and said it’s healing but let’s “give it another month”, no apology, nothing for the delay. That’s when I decided this clown had to go. I went to Mt Tam Orthopedics where I had the exact opposite treatment. I had new xrays done, gave them all my exisiting xrays and CT scans, and had a new physical examination. He was surprised to see I was still in the brace after 8 weeks, and after seeing the healing in the xrays, and the fact that through the tests in the exam and not having felt pain, nor any pain in last 6 weeks. So first thing, ditch the brace, second thing, start PT asap. This is exactly what I hoped to hear. Back fracture is healing and I’m returning to a more normal life. I have a follow up in 4 weeks, he expects that if PT goes well and i continue to heal at this rate, I’ll be released to resume all normal activities, of course building up to them as I build strength back. As it is today, my lower back is sore by the end of the day from just holding my torso up.

But on to normal we go, going paddle boarding today with the dog, glad I didn’t totally miss summer!

09.06.11 – My big mouth is back! Wires and arch bars all taken out after 6 weeks.

OK, so today was the day that I had hoped it would be, wires cut, arch bars out, and my mouth actually opened wide enough (after 6 weeks and 1 day of being wired) to fit a fork and food inside (opened between 1-2 cm). But the day certainly didn’t start out with that in the forefront of my mind…

The night before the surgery what did I do, like everyone my mind raced and I felt like everything in the world that could possibly happen, would. Did my jawbone heal, is the maxillary stable, will any teeth fall out, did it heal straight, the list goes on. That worrying, to which I generally don’t give in to, leads to exactly zero sleep. So when I actually pseudo woke up this morning, I wasn’t exactly bringing my A game. Though I quickly rallied, and convinced myself that even though they said don’t drink anything other than water the morning of, I made up a nice cup of coffee or else I’d literally fall over.

My sister and brother in law took me to the appointment at the hospital, I was actually going to drive myself but the doc said hospital policy wouldn’t allow me to drive home, even though he said I’d probably be fine to. This is a prelude to some of the confusion to come…

Arriving early, got checked in and off to surgical prep. After changing into one of the depressing hospital gowns (based off what the doc told me, I didn’t think I’d need to do that) I started wondering what exactly was going to happen today. Was it just hospital policy that any surgery, no matter how small needed this. Answer, yes. Once you go into an OR, it’s gown downtown, no exceptions. Now normally most of this can just be done under local anesthesia in the office, but he also wanted to check out each tooth and do a little more stitching where the gums hadn’t healed, ok, I’m back with you on this. Gown it is. But I’m still operating under the idea that this would only take 20 or so minutes, that’s what the dr told me, I’m going with that.

Then in comes the anesthesiologist, that’s when all hell breaks loose. 3 of them come in with a couple OR nurses to prep me. I go with the flow until they start talking about intubating me through the nose since my jaw is wired shut and how many hours I’ll be out, and how long for recovery and if I planned an overnight stay. Umm, I think that’s not the idea. How do you tell a anesthesiologist they might be wrong? I learned that the direct approach isn’t the best. I said, “I thought the dr said this would only take about 20 minutes” then explained what the surgery entailed. She abruptly said, “well, surgeons underestimate this all the time” and followed with the line that it was for my safety that she does all this, that I could possibly choke or stop breathing during surgery and that’s why they need to intubate me. Doom and gloom for sure, and I appreciate all the concern and honestly am glad they were that worried about me, but come on, seriously, 20 minutes?

Then they break out what I can only assume is some sort of hospital bong and pour some clear liquid into it, plug it into an airline, stick it in my mouth and ask me to take deep breaths. A white mist billows out of both ends, then finally they explain what it is. It’s a nebulizer for a numbing agent to numb my mouth and my throat so if they HAVE TO intubate me (I tell you they are dying to do this) that I’ll be ready and numb so it won’t choke me as much. OK, I get it, weird, but I get it. Then as they were about to set the IV needle in I asked that we please wait for the dr. Reluctantly they agreed, but still managed to watch the student nurse screw up putting the IV in and they senior nurse finally took over and got it in right. But I will say that I was dehydrated from not drinking much so it’s not like it was too easy to find the vein. My sister was in the room this whole time and I could see what a circus she was thinking it was, and of course my brother in law, watching the shock in his eyes when they repeatably stabbed me looking for a vein. I wasn’t watching my arm, but I could see it wasn’t going well from the shock in their faces.

Dr comes in, immediately (thank god) sets everyone straight. I get the double take from him as he see’s me with my nebulizer bong. He’s going to do a local block in my mouth in the OR but needs them to lightly sedate me going in, simply enough, no intubating, no general anesthesia, I’m going to be awake and aware the whole time, no need for 3 anesthesiologists either, simple. Don’t know how the whole thing got blown up but glad he got them square. Did I mention I’m glad they weren’t knocking me out, making me stay overnight, and shoving an intubating tube up my nose?

They wheel me into the OR, kind of weird going in there totally awake and aware. I have a little high feeling like you get from morphine but still able to talk and communicate with everyone (2 surgeons, 1 resident, and a couple surgical nurses). Actually was pretty cool being there and aware for it all. First thing they did was put novicane (I think) into the gums around where the arch bars were attached to the roots of teeth. Then they cut the wires holding the jaw shut. Honestly, had no idea when they were done cutting, couldn’t tell since the jaw was wired shut for so long. It wasn’t until the physically moved it for me I realized I could move it. Then the big cutting and tugging, the arch bars. As I looked up into the octopus looking sets of lights on the ceiling I could feel them snapping and tugging the wires through the gums and teeth, more force than I realized it would take, but since they were numb basically felt nothing. Cracked a few bad jokes every now and then, so did they. Then after the bars were out they probed each tooth to see if they were loose, and none seemed to be, sweet. Maybe I can save them after all.

Last but not least, the metal plates holding the jaw shut. The gums hadn’t totally healed over them yet so they opted to put more stitching in to try and encourage the growth over them. Last ditch effort, if this doesn’t take they will come back in 6 more weeks and do another surgery taking some of the plates out after the bone heals, really not looking forward to that. Think positively…

All said and done, dr was very happy with how things turned out. I was actually able to open my mouth between 1-2 cm, enough to fit a bit of pizza or a fork with mashed potatoes on. Did that taste great, damn right it did! First food since July 20th, nothing ever tasted better. Took me an hour to chop up and slowly eat one slice and a few bits of potatoes, but it was AWESOME! Still followed it up with a protein shake, gotta keep the protein and calories high, have a lot of weight I need to put on. Did it feel weird, yes, chewing felt odd, felt like my bite was off and teeth all over felt sensitive. But I expected that and the normal feeling will come back in time, that’s what you get from not chewing or even moving your jaw for over 6 weeks.

Going forward I have to still be careful eating, I’m allowed to puree food now, but need to make sure to keep my stitch area very clean until they heal. I have a follow up in 2 weeks and we’ll see how it’s doing by then. I can eat soft foods but can only chew on my left (good side). Dr expects the jaw to open more and more over time, and the jaw strength to improve in the course of several weeks. Also in 3 weeks I’ll see the endodontist for the first time to figure out a plan with the teeth, which ones they think can be saved, if I’ll need braces, etc. Most likely one in front (second to right on bottom) will get yanked, it’s so torqued out of place that it could take a long time to put back in place, and it might not be worth it if I can just replace it and avoid a painful 1-2 years. The other molars on the right side, top and bottom, may need braces just to push them out a little, but they look pretty close.

But best of all, having an open mouth feels awesome. No more pain from wires cutting into your lip or cheek, no more mumbling, no more pain from wires tugging at your roots, you no longer fear sneezing and yawning, and no more weird stares from folks at the store when you order a coffee. Then of course have to follow it up with the story of what happened so they don’t think you’re an escaped lunatic.

Oh yeah, and you can actually kiss your wife on the lips now too…

09.02.11 – The home stretch…

Friday, last weekend (albeit a long weekend) that I endure only protein shakes. Surgery is scheduled for Tuesday afternoon. Why surgical, mainly because the doctor is thinking of taking everything out if the jaw looks good, and apparently that’s quite a chore and can be very uncomfortable if not painful.

Basically the surgery will consist of a few phases, first is cutting the wires (the easy part) and then evaluating the jaw. Once cut he’s going to stretch it and put it through some range of motion exercises, to both test the healing as well as help me get a good start to my jaw’s mobility. This includes sides to side as well as up and down. If that goes well, next step is removal of the arch bars, if it’s not quite healed he may leave in the arch bars and put in rubber bands in place of the wires (boo). Once the arch bars are out (thinking positively here) he’ll throw in a few stitches for good measure (gums are mostly healed but as of last check not totally covering the roots and plates).

So best outcome, I wake up after an hour with a sore, but free mouth. From what he says, this is the most likely outcome. Options, less likely and of course less desired, he leaves in the arch bars for a few weeks, maybe leaves them in with rubber bands, worst case he leaves it all in (can’t see that happening.)

Also next week I get an updated CT scan of my back, and since last appointment, this is the scan that should allow me to ditch the back brace if the bone has been healing well. Given the fact that since breaking my hip last year I’ve learned to follow all the rules, I’m hoping for gold. Hard to believe that this time next week I may be almost normal (although many of you will disagree and state I’ve never been normal.)

I haven’t eaten anything since July 20th, other than juice, water, and protein shakes. In fact I only had juice and water for the first week, which of course explains why I lost 20 lbs. Still down 20 lbs today, hard to take enough calories to put it on, but at least haven’t lost any weight since I left the hospital.

I can’t even imagine what it will be like to chew again, can’t wait to try. I may pick up a large pizza on the way home Tuesday, selfishly I will eat the whole thing myself…

08.27.11 – Fractured back results are in…

And survey says…………….

Two more weeks in the back brace, but the vertebra are showing good signs of healing and bone formation so the neurosurgeon is confident that in 2 weeks I’ll ditch the brace and start physical therapy.

With the xray’s they took yesterday I got a good idea of exactly what the break was. It basically looks like a piece of pie (mmm, pie) broke off the front of the vertebra (front meaning towards my belly button). This piece was held on by a little bone and that allowed new bone to form in between so they are more than 90% confident I won’t need surgery. Also lucky because if the bone broke off on the other side, towards the back, he said “we’d be having a different conversation” meaning they’d have to go in and fixate it as that would screw up my spinal cord. So once again, I’d rather be lucky than good.

He did allow me to start working out a little, basically right now just sitting on a recumbent bike, but hey, that’s a start! Long term he’s being very conservative (as the worker’s comp nurse was there) stating that I won’t be 100% released until the end of the year, but I guess the back takes a little longer to heal than most bones. Most restrictions will be lifted by mid-Oct though.

Now the jaw, I know it’s only been a few days since my last dr’s appt, but I swear the wires are coming loose again. I check them and they seem ok, but my jaw is starting to spasm more and feels like I’m biting down (which I’m told is a good sign). I know that’s it’s mostly spasms, and since it’s been 5 weeks the bones mainly stable, but it still feels strange. Also off and on getting the itchy sensation in the numb part of my chin, once again told that’s a good sign as it means the nerves are coming back.

A week and a half to go to lose the wires, and yes, I’m counting down most every hour.

08.23.11 – 4 week follow up, 2 more long weeks to go!

Well today started off with a lot of hope, ended with me still happy with how things are going. The hope was due to the fact that there was a possibility of the wires coming off next week, at the 5 week mark, this was quickly dashed as the Dr believed that this type of complex fracture really needed the full 6 weeks. He actually told me today that it was the most complex fracture he’s ever dealt with (hence the 12+ hours of surgery), and he’s even worked on a gunshot to the jaw shattering it into 50 pieces. What he did mention was that the gums are filling in great, the teeth have remained aligned, and the wires still seem strong and aren’t slipping or loosening. That’s why he wants the full 6 weeks, if the wires kept loosening or the jaw was slipping, he would have taken them off next week, not ideal, but it would be safer than leaving the jaw loosely wired. So basically, getting an extra week on the bricks for wires doing well and me following instructions. Counterintuitive, but hey, he’s the best and I’m going with whatever he says.

I also learned today that the itchy feeling I have in my chin, which I can’t scratch because it’s numb and I can’t feel it when I scratch, is a very good sign the nerves are coming back. He stated that due to the trauma they weren’t sure all the feeling in that area would ever come back, but at 4 weeks and I’m having those sensations, that’s a very good sign that the nerves are coming back.

The eye is looking great, the feeling and sensation are coming back all around already, that’s also ahead of schedule. Also the gums are looking good, but in two weeks when the wires come off, if they aren’t totally healed back up (can barely see the tip of one of the plates) he’s going to put a few more stitches in. That also means I’m stuck on the same liquid diet, no pureed foods, just basically protein milkshakes and ensures, through the end of the whole thing. Ugh, but gotta follow the rules I guess. Although I’m dying to dive into some liquified mashed potatoes or split pea soup, but that’ll have to wait another couple of weeks.

I’ll be going under when they take the wires out since he may want to sew up a few things and they’ll also, more than likely, take the arch bars out at the same time instead of waiting another couple of weeks. Putting me under allows him to exercise my jaw without the pain I’ll have when I first move it, so he can determine whether it’s properly aligned and not shifting side to side. So basically I’ll have no idea of the outcome until I wake up, worst case I wake up with arch bars and rubber bands that allow me to open a little, but keep the jaw in alignment. Best case, all this damn hardware comes out and I start the rehab of building the muscles back up in the jaw, which he anticipates to only be weeks, not months.

Next up, neurosurgeon appointment on Friday morning, hoping to get the all clear to start PT and ditch this damn back brace. Then I can go back to work full time too, which I’m dying to get back to. I started back part time end of last week, nice just doing something. That and working out, finally can put some “good” weight back on.

08.16.11 – 3 week follow-up and wire tightening

Here we are, 3 weeks down, 3 weeks to go (although there is a slight chance that I may be released at 5 weeks instead of 6). Wires on my left side were coming loose, turns out mainly due to the arch bar slipping up. What does tightening the wire feel like? An instant crushing pain in your jaw but only for a quick second, it subsides very quickly.

Gums are starting to heal, maybe by next week I’ll be on puree, but he did say they were closing up nicely. Also the swelling is looking good on the jaw and around the eye and sinus, some positive news.

I also got ahold of the scans from SF General today, put some red-boxes around the break areas so you can see where all the fractures occurred.

Next appt is a week from today, that’s the big day we find out about whether or not the wires can come off early. Also when the endodontists start reviewing everything for the numerous follow on visits I’ll have with the ortho and dentist.

08.12.11 – 3 weeks since the accident

So what has changed, I’ve already burnt out on milkshakes, ensure, and all other sweet stuff. I just bought some new supplements (banana flavored muscle milk) to try and get some different flavors. Till now been pretty much sticking with chocolate or vanilla with a peanut butter kicker. Trying to stick to 2500 calories a day and at least 75g of protein, it’s hard to do believe it or not. I wind up forcing myself to eat at times when I really don’t want to. But hopefully in just over a week I’ll get cleared for puree and more savory food as my gums do appear (at least to me) to finally be healing.

Most the pain is gone, no more pain meds, only strange thing is that I’m feeling like my jaw is moving as the wires loosen up. One in the back is loose, and will have to talk to the talk about fixing it, I only hope the other’s hold till my next appt. If not, yet another run back to the hospital.

Two weeks for my neuro follow up on the back too, can’t wait as it feels great and I’m hopeful they’ll let me start PT and resume normal activity without wearing the brace. I’m dying to get back to work and a more normal life!

Once again thanks for all the notes and well wishes!