Inside I'm hollowed out / Outside's a paper shroud / And all the rest's illusion

[nullalux]

I've been Twittering a bit about my upcoming jaw surgery, but not in any detail. However, I had another consultation yesterday, and finally have a general timeline for the whole process.

It's not particularly noticeable (unless one is looking at my face in profile) but my lower jaw (mandible) is rather small. This causes all manner of delightful muddles like uneven bite pressure, odd wear on my teeth, and temporomandibular joint (TMJ) stress. I don't have sleep apnea, but a sleep study a couple of years ago indicated that my respiration rate during the night was slow enough to cause undue stress on my heart. About eight years ago, jaw surgery was recommended as a possible solution, but I wasn't too keen on the idea. At that point, they wanted to break both my upper jaw (maxilla) and my mandible, and wire my mouth closed for six weeks; eek! So we pursued other options. My teeth have always been pretty straight, but I wore a twin-block retainer for a couple of years to train my mandible forward, and then braces for a year to approximate a proper bite. I take a low dose of Aleve (naproxen sodium, an over-the-counter anti-inflammatory) twice a day if my TMJ starts to grumble. These issues haven't been a big deal, but then again, they haven't been ideal.

So when I acquired health insurance again recently, I procured a referral to Dr. JT, a maxillofacial surgeon at Kaiser in Santa Clara. I gathered up a portfolio of radiographs, panoramic x-rays, dental photos, and models of my teeth and jaw from my previous doctors to bring to our meeting. During our initial consultation, she examined my data, performed measurements, and announced that I only required the mandibular portion of the surgery, and that my jaws would most likely not have to be wired closed during recovery. I was very pleased. The procedure is called a mandibular osteotomy. Dr. JT also demonstrated the surgery on a model of the skull for me (so cool!). Then she walked me through the process:

1. wisdom teeth removal with Dr. LM (three oral surgeon visits done, one scheduled) [Done!]
2. any dental sealants necessary with Dr. GB (three dentist visits done, one scheduled) [Done!]
3. pre-surgery orthodontia with Dr. KT for six months (consultation done, two more ortho visits scheduled, then monthly follow-up appts) [Done!]
4. surgery with Dr. JT (two-and-a-half hour surgery, including a bone graft, hospitalization at Kaiser Santa Clara for three days, at least two weeks before returning to work)
5. post-surgery orthodontia with Dr. KT for six months (monthly follow-up appts, then one to remove brackets)

Slightly boggled, I went on my way with another list of appointments to schedule. So far, I've had my wisdom teeth removed and had half the dental sealants completed (final appointment on 17 Nov). Orthodontia needs to be installed beforehand in order to anchor my jaws during surgery and to fine-tune my new bite, so that will be done on 29 Nov (but I'm able to have clear ceramic brackets on top, which is pleasant). The main surgery at Kaiser Santa Clara is scheduled for June 2008, after another consultation with Dr. JT three weeks prior, in which she goes over the recovery process. For six weeks I'll be restricted to blended foods, which will be an adventure.

Getting my wisdom teeth out was my first experience with general anaesthesia, which served as a little preview for the main surgery. It went very well, and I seem to have no long-term nerve damage (impressively, one of my mandibular nerves was actually tangled up in the root of wisdom tooth #17). My oral surgeon, Dr. LM, performs the tricky surgeries that others won't, and she's all kinds of awesome. (And she gave me Vicodin.) During the upcoming jaw surgery with Dr. JT at Kaiser, there's a 20% chance of permanent nerve damage, but it shouldn't be extensive if it does occur.

So, yes, I'm more than a little preoccupied by all this. In particular, the financial wranglings haven't been very fun. Kaiser covers almost the entire main surgery, but absolutely none of the other steps. I do have Delta Dental, but it has been almost entirely unhelpful (so far our out-of-pocket total has been almost 10K, which is simultaneously ridiculous and terrifying on a teaching salary). But I digress. As I told a friend recently: on the one hand, the upcoming year promises to be, well, rather wretched―but then it will be behind me, and I can look back and hopefully be impressed at how gracefully I've navigated my way through. Plus, I can has more chin! This almost reconciles me to the fact that the words "bone saw" and "my skull" are involved.

Comments

[as2.livejournal.com]

You will get through it ("bone saw", "skull" and all) and I am willing to be bet you will be glad you did it when it's over. I was.

Recovering at home is a drag - - look for me on AIM when you get to that point (maggieas2)

[as2.livejournal.com]

you can look for me there at any time (duh). I am happy to talk about my experiences with jaw surgery . . . or anything else for that matter.

[chalepa-ta-kala.livejournal.com]

Thank you, I will. juvernaz mentioned that you might be an excellent resource.

[evilgrins.livejournal.com]

something similar was recommended to me (got one Hell of an overbite) but I opted out of it cuz...well, I didn't want to. Having had extensive dental surgery on my mouth many a year back, didn't wanna go through that kinda pain again unless it was absolutely necessary.

Although, I did discover, as i couldn't eat anything solid for an entire 2 months, you literally can make everything in a cuisinart.

[tsgeisel.livejournal.com]

I've never tried it, but I don't understand this aversion to blending food. Does saliva add to the flavor of food? Is it a conditioning thing, that the act of chewing really does make food taste better?

Or perhaps it's something in the nature of food itself, that it *does* taste better when you chew it?

I'm curious as to your experience here (and not meaning to hijack the commentary, but I'm sure it will be useful info all around...)

[chalepa-ta-kala.livejournal.com]

"Will it blend? That is the question."

[vvvexation.livejournal.com]

Well, the experience of eating isn't just about the taste, it's also about the texture. And saliva does add to or at least change the flavor, in that starches in the food get broken down into sugars by enzymes in the saliva.

[evilgrins.livejournal.com]

Saliva isn't key to the taste experience so far as I know.

[litgoddess.livejournal.com]

At least it will be done.
Smoothies in June! Will you even notice all the blended food? :) Remember to hit your teacher friends up for company when the times comes. ;)

[zhaneel69.livejournal.com]

That's a helluva lot of scary, but I'm glad you seem to have found a dentist you can trust and who will take care of you.

Zhaneel

[chalepa-ta-kala.livejournal.com]

Thanks for your kind thoughts.

It feels very odd to have a whole team of doctors working on this (my dentist actually plays a pretty small role): my general practitioner (who's a TMJ specialist at Kaiser Redwood City); my dentist, my oral surgeon and my orthodontist (all of whom have private practices), and finally my maxillofacial surgeon (at Kaiser Santa Clara). It's a wee bit confusing, but they seem to be working in tandem fairly well.

[zhaneel69.livejournal.com]

Oh wow, that's even more impressive. Doctors work together well so rarely. I'm glad that this is appearing to be as low stress (as it can be, given the circumstances) as it is. Though I wish better insurance coverage and lesser out of pocket expenses.

Zhaneel

flexible spending account???

[notmy-realname.livejournal.com]

Any chance you can pay for some of the upcoming expenses with pre-tax money by enrolling in a flexible spending account at your work? When I had my dental implant and gum grafts, I purposely scheduled them for the following calendar year after I decided to go ahead with them, specifically so I would have the opportunity to enroll in the FSA and pay for them pre-tax. If the only pain you can remove from the situation is economic, it's still something. Just a thought.

Re: flexible spending account???

[chalepa-ta-kala.livejournal.com]

Good thought; thank you.

[iterum.livejournal.com]

Oof! That's a whole lotta dental and mandibular action. Bona fortuna.

[dicedork.livejournal.com]

I rather like your profile. But I'm all for anything that can increase your general health in the long run.

If we ever match up our schedules, the smoothies are on me.

[teawiththecheat.livejournal.com]

I wish you luck in the long and tedious process and would be honored to treat you to something blended or perhaps blend something myself. :)

[feyandstrange.livejournal.com]

I will now say a wee prayer of thanks, as I have a very small mouth and have had to have some interesting dental surgery in my time, but at least it didn't involve breaking my jaw. I did have to have all the wisdom teeth out surgically, and a few others, including an interesting tooth removal which involved drilling into my nasal sinuses, which story usually beats most people's dental adventures unless some sort of accident was involved.

Dental sealants are really awesome. I'm sure I owe mine a lot.

Naproxen is my friend too. You might want to ask if you can have a prescription-strength muscle relaxant as well during the recovery process.

I see somebody already suggested a HSA or other flexible spending account; these are sometimes offered at banks or credit unions as well as through work. And some of this medical mess may also be a tax write-off, one hopes.

And if you feel so inclined, the enforced liquid diet can also be a great time to make any other diet changes you feel obliged to make; my friend drank nothing but veggie juice and healthy smoothies after she had to have a partial jaw rebuild, and lost fifteen pounds; she said it was less gross to have to drink her veggies than to actually chew and taste them. Knowing me, I would be more inclined to make some dark chocolate syrup with brandy.