Day 146: I’m About Over All This Surgery Now

I met with my surgeon earlier this week to clue him in on my recovery, or lack thereof. Before my 2nd procedure (the physical manipulation and steroid injection), I could open my mouth 15-16 tongue blades (roughly 22mm if my memory serves me right). It’s also about one sandwich width, provided I don’t stack it too high with tasty meats. After the procedure, I was only able to get it to about 14 blades. If you recall, I was pretty disappointed.

IMG_20160522_191916
I hadn’t planned on taking such a sad picture, but given my 6 hours of sleep ALL weekend, it’s just how it came out.

My surgeon was also disappointed, and he outlined me two choices from here. Really, though, they’re not choices, they’re what I’m going to do. First is PT, which I’m trying regardless. We are strongly hoping this will help because after PT, comes another SURGERY (not just a shot this time, but back to actually being opened up).

Before I expound on the above statements, let’s take a brief detour to talk about my luck. My surgeon, who is a great person, was technically retired when he did my procedure. In fact, he confided that he would have pawned me off on his assistant had my insurance company not been such a headache (switching surgeons may have caused the insurance company to not approve the surgery, which took 8 months the first time). So him being retired is something of a problem, as he’s only in the office once a week (Tuesdays) at best, and even then only for a few hours. He’s available on his cell because he really isn’t available any other way.

He has a physical therapist that he loves and who specializes in jaws. So he called her to see if she could take on a new patient. The good news? She can. The bad news? She’s going on an indefinite sabbatical in 3 weeks. While she “might” work one day in June and one day in July, it won’t be at her current office (she’s selling her practice) and there’s no guarantee of anything after that. So there’s some urgency in getting to see her. And some urgency in her being a miracle worker – like Miracle Max but without the being dead part.

I went twice last week, and her manipulation of the muscles (she thinks a major problem is the rigidity of the muscles in my mouth – if you open your mouth put your thumb all the way back to one corner of your mouth, those are the muscles we’re talking about here) is not in any way pleasant. I need to ice it as I massage because it risks inflammation. I’m also supposed to be taking anti-inflammatories regularly. Instead of tongue blades, I now take clothespins, jam them between my molars, and open them. I have a few other exercises I need to do regularly, none of which I’d classify as remotely enjoyable.

It sounds pretty drastic because, well, it is. She’s cramming months of PT into a few sessions. She *hopes* that she can talk to my normal PT (for my back) to see if someone there is trained in jaws and can continue what she’s doing, but again, no guarantees. So in the meantime, I have six sessions where she’s going to try to knead the crap out of my face.

And that’s the best case scenario. In one day she got me from 20mm to 22mm, which is something but not incredible. So the hope is that in the four remaining sessions, I can be enough on the right track to where I can get someone new to continue it, and with great success.

Remember that graphic I put in a blog about my jaw about six weeks ago? This one:

JawGraphic

I spoke about how he thinks the condyle is not actually getting to where it needs to be in the disk, how it’s not “clicking” into place. Well, if PT doesn’t stretch the muscles (and disk) enough to facilitate that click, the next surgery is to remove the disk altogether. If you’re like me, you’re thinking “But that doesn’t sound like a good idea, don’t you need that disk for something?” Because that’s exactly what I thought, being someone who liked all my body parts. Hell, I won’t get rid of my appendix unless I absolutely have to. And my surgeon’s response was that he doesn’t think it’s where it’s supposed to be anymore, thus not actually serving the purpose it’s supposed to, so it won’t exactly be a problem to get rid of it. Hard to argue that logic. It’s why Boston cut Pablo Sandoval, after all. (non sequitur zing!)

But it still stands that I don’t want any more stinkin’ surgery. I’m so done with it. So here’s to hoping my crash course in PT does something. But I have this nagging hunch that before long I’ll be going back under the knife. Under the tutelage of someone who retired almost a year ago. After the failure of someone who is very likely retiring during my treatment.

PAIN: 0

INCONVENIENCE: 3

REGRET/FML FACTOR: 5

Day 104: The Future

Ninjatographer strikes again!
Ninjatographer strikes again!

I realized that if I were able to open my mouth fully, my recovery would have been basically as good as I could have possibly expected it to go. However, I can’t open my mouth as wide as I should. Tonight I was able to start with 15 tongue blades somewhat easily, but try as I might I couldn’t get a 16th in. This is still progress, as I started at 11, but still not anywhere near where I should be at this juncture.

What does this mean? Well, juncture means a point of time, especially one made critical or important by a concurrence of circumstances. Pedantic win!

I met with my surgeon last week and, while he’s pleased how my teeth are coming along, he is obviously disappointed with my jaw. He takes these things personally, especially because my slow recovery is NOT my fault, nor really is it his. It’s just how my particular body reacted to the procedure. He described what is happening as “uncommon”. Not unheard of, but probably only happened a few times in his 30 years. I’ll try to describe what he THINKS is going on.

In the space where the jaw meets the side of my face is a disk, very much like the disks in your back (see diagram 20358.3927729 1/2 below). When you open your jaw, two separate things happen. At first, the condyle rotates down until the mouth is about halfway open. Then, in order to open the mouth more, that condyle glides forward, pushing into the disk. It allows the mouth to open more.

For whatever reason, my condyle is rotating fine (about halfway open mouth) but it isn’t able to shift at all. He thinks there may be something blocking it (an enlarged disk or some gunk or something else – we wouldn’t really know without an MRI). He verified this by asking me to push my lower jaw forward. I can a little, but my entire jaw shifts to the right when I try it (because that side isn’t actually pushing forward and the left side is). Also, when I try to move my jaw from side to side, I can only move it to the left about 2mm (peanuts, essentially).

So what does this mean? Peanuts is possibly the most successful and famous cartoon of all time, penned by icon Charles Schulz. If only watching the daily failings of a clinically depressed child were funny…

Anyway, my trusty surgeon has basically suggested that I will have to go back under the knife again. Nothing as severe as the first time, thankfully, but surgery is surgery. The goal here would be to open up the joint. Then, with me being knocked out, my jaw would theoretically be at its most relaxed, he would try to physically manipulate my jaw to see if he can determine/get past whatever it is blocking its progress. From there, he’d clean it out if necessary, give it a steroid injection to hopefully calm whatever is screwing the metaphorical pooch, and then wake me up.

Recovery for this wouldn’t be great, but not liquid-diet only. I’d likely have to revert back to softer foods for a week or so, and I have no idea how talking would be. Probably just like after a root canal I’m guessing.

I’m disappointed by this. But as he pointed out, there’s not much sense to having the whole major procedure allowing me better air if it means sacrificing eating anything larger than, say, a hot dog. It’s totally emasculating eating a hamburger by cutting it into thin slices.

This could happen as early as a few weeks from now. Right now, they’re trying to get my insurance to cover it, but really, he said either way we’ll likely do it, even if it means waiving his costs. You can tell he’s retired; he isn’t about trying to squeeze extra money out of this, he’s trying to make sure his final patient is able to live a happy life. He really is a phenomenal surgeon and person.

PAIN: 0

INCONVENIENCE: 5

REGRET FACTOR: 3