Day 8: How to Drink a Tim Tam.

Left Jaw Pain: 1/10
Right Jaw Pain: 4/10
Hip Pain: 2/10
Inconvenience factor: 7/10

Today I woke up feeling good!

I'm not sure if it's related, but I also woke up hungry! Stomach grumbling HUNGRY!
This was particularly surprising as for the rest of the week, I've had no interest in food, literally having to force food down my throat because I know I need it and often feeling a little sick in the process. To date I have lost 4.5kg - fair effort in one week! But given the attack of the Prunes it could have been a whole lot worse!!!

Now, as only Murphy's Law could dictate, with my teeth intricately elastic banded together I get insatiably hungry. The irony is not lost. 

Today has become a ceaseless repetition of removing elastics, carefully spooning puree food into my mouth and then when I 'm done, extensively cleaning and rinsing my mouth out and rewiring it. It has been rather frustrating and slow (hence today's inconvenience factor). 

I feel like I have been eating non-stop like a certain caterpillar in the children's book.

Today's food intake:

2x Weetbix with yoghurt & milk
2x Up and Go
500ml Apple, carrot, celery and ginger Juice
250ml Orange and Pineapple Juice
250ml Orange Juice
1L water
2x Cups of Tea
200ml Leek and Potato Soup
200ml Pumpkin Soup
1/2 potato, mashed with cheese and butter
1/2 tin of baked beans (pureed)

Would you believe, after all of that I WAS STILL HUNGRY?!?!??!?!

So I concluded that I needed a sugar hit! :) Surely you know what genius is coming next! 

 
Grab a good blender and throw in:

• 2x Double Coat Tim Tams
• Good dash of Pouring Custard
• 3 scoops of vanilla ice cream
• As much milk as required to get the right consistency!

Blend, pour and off to heaven!

YUM!!! 

A few of these should stop that weight decline!

Day 7: I think I Need a Wiring Diagram for my Face!

Left Jaw Pain: 1/10
Right Jaw Pain: 4/10
Hip Pain: 1/10
Inconvenience factor: 8/10

Oh yeah! One Asymmetrical face!!!

Glad I like jigsaw puzzles. 4 elastics if you can count them!

A few of you may have noticed how often I have mentioned (complain about) the right side of my face!

 It's so sore! It's too hot to touch! It's too painful to touch! I must have an ear infection! It really just aches ALOT all of the time! It feels like it is going to explode off the side of my head! Arrrgh! 

The picture above shows the extra swelling and the reduced movement due to numbness that are still evident one week after surgery.

Last night before bed I really was a bit concerned by the epic heat radiating out of my right cheek. A wet face cloth used to douse the flames was hot to touch after only a 5 second compression. Oh well. Down the pain killers and ask surgeon in the morning! 

I woke up about 4:30am absolutely soaked to the skin. Shirt and shorts drenched and hair feeling like I'd just hopped out of the shower. My first thought was that I had caught the dreaded sweating fever currently sweeping through 16th Century England and was about to die. Then I realised I was not actually in the The Tudors, not in England, not in 1528 and happily not dying of sweating fever. Phew!!! (Thanks for nothing Bruce)!!! A quick shower, fresh PJs and it was back to la la land. When I woke this morning though, I immediately notice a distinct difference in my face. The right side was actually bearable without my morning drug hit. It wasn't a nuclear reactor, no ear ache and I could even touch it a bit! Hooray! My epic temperature must have driven the heat and fever out!

So what is the deal with my blasted right cheek then? Today was my date with the Surgeon for the Post-Op Review and I was prepared to get technical to get to the bottom of it. I am no surgeon. I have doctored the images below so can't say if they actually correct anymore but after listening and looking at a model skull, I have my interpretation and will try and explain it to you is my truth. X-rays will be available next week! :)

What happened is called an unfavourable condyle split.

I did feel really bad for my surgeon. After splitting 550 jaws, 3 perfectly within my face already, the last, my right mandible is the very first one that has ever split unfavourably on him. I can't imagine what feeling that gave him in the pit of his stomach - poor man!

The Plan

The Condyle is the rounded bit of the long sticky uppy bone you can see on the jaw below.

The idea is to cut the jaw and then split it. See the picture. Cut the the bone up from the bottom arrow and then across the top of the jaw line and then apply pressure at the second arrow to create the neat bone split pictured. This then allows you to easily shorten the jawbone and screw the two pieces back together neatly and firmly. No mess, no fuss!

What I think happened in my face. 

The cuts were made as planned, but when pressure was applied to split the jaw bone open, it did an inverted split. So the outside piece, which in 'The Plan' stays attached to the condyle, actually came away from that whole bone section leaving the condyle still completely attached to the main jaw bone (with the teeth in it) and some other bit of jaw bone that was detached and pretty useless. Impossible to shorten the still intact jaw bone.

To salvage the situation:

Cut the condyle off of the jaw bone. Re-split the jaw bone so that you can shorten it as planned. Then try and plate, screw and pin it all back together. 

Given the circumstances, I think the surgeon has done an incredible job under what must have been some pretty intense pressure. No follow up surgery will be required to fix any of the right side of my face and my bite is lining up amazingly. 

The stitches were removed from my face, my mouth washed and I was 'spec'ed up with some coloured bands direct from Italy to manipulate and hold my jaw in the position it needs to adopt its new functional bite. The muscles and soft tissue need time to settle into their new spaces and strengthen, and the guiding of my teeth will speed this up. The most effective configuration is as mind-boggling as the picture suggests. It's feeling pretty restrictive at the moment and it adds a whole new level of tedium to eating time - removing, cleaning and refitting the elastics but if anything it's great encouragement to workout how to drink through a straw so I don't have to untie them! :) I am just a bit jaded by how many pink, and how few purple elastics there are in the bag!

Day 6: Prune Juice - The Devil in Disguise!

Left Jaw Pain: 1/10
Right Jaw Pain: 7/10
Hip Pain: 2/10
Inconvenience factor: 10/10

Numerous times over the past week, the medical fraternity have decided to inform me of the elevated risk of constipation associated with my reduced food intact, my liquid diet and simply as a very common side affect of the pain killers I was on. There was even daily questioning by the ward nursing staff "Have your bowels moved today?", with the answer diligently recorded in your file. The lass in the bed next to me was even threatened with an enema! 

I had read on a number of blogs that a spot of prune juice from day one at home would see you right. So of course, trying to give myself the best possible chance for a speedy recovery I bought some and added it to my fridge last week. I drank about 30ml yesterday for breakfast and was a little bit keen to see if it had worked this morning. I had the right feeling, so got up and headed to the bathroom to see if the battle would be won today. What I was not prepared for was an EXPLOSION! Yes, as much as you all just cringed, I know that you have all been there!

What a cruel twist of fate. When you are on a liquid diet, struggling to get enough calories as it is, and when by far most of your calories are coming from dairy rich sources (which by the bible of gastro recovery is banned entirely), what the hell do you do when you get struck down with the Squits?

I can't eat crackers! I can't eat boiled rice!

In desperation, I've been sucking down electrolytes, energy gels and pumpkin soup like there is no tomorrow. My energy levels and hydration are okay but I have noticed that the pain medication is not quite as effective as it has been. :(

Lets hope the Attack of the Prunes is only a 24 hours thing! Needless to say the bottle has been banished to the bottom of the bin!!!

Day 5: Dealing with Life at Koala Speed.

Left Jaw Pain: 1/10

Right Jaw Pain: 6/10

Hip Pain: 3/10

Inconvenience factor: 8/10

Have you ever sat back enthralled watching a koala go about it's day? Quite honestly, I can't imagine that you have. They are terribly slow and boring and remain completely motionless for 16-18 hours every day. 

Sure every now and again, one will open it's eye, maybe to scratch an itch, maybe to rearrange its position in the branches so that you'll stop staring at it and then the eyes close and the koala sleeps again. Maybe you've been lucky enough to catch it in a rare moment of lucidity between fermented gum leaf stupours. It's still not stellar viewing, watching it tediously devour a dozen leaves, or even amble up another branch before well, you know it, it nods back off to sleep.

Time for a life readjustment.Previously I was an ant on the Get up and Go scale, now I am the epitome of that koala. Sleep; drug stupor, eat; sleep; rearrange position; drug stupor; eat; sleep. Repeat. 

This morning it took me 45 minutes to consume my breakfast. A huge breakfast consisting of:

• 1/6 cup of porridge with enough milk added to turn it into porridge soup
• 30ml prune juice (sage advice from www.doublejawsurgery.com blog which will be well heeded)
• 150ml  cup of pineapple juice
• 1x 250ml Chocolate Up & Go (with 60% more protein).

I was actually pretty pleased with this. Compared to what I have been managing to get down my throat this was enormous! So huge in fact, that it wiped me out physically with the effort. Soon after mouth rinsing (no cleaning teeth for this poor sucker) I had to take myself off to bed. A two hour snooze sorted me out!

Why is eating so hard?

1. My entire bottom lip and the skin down to my chin tip are numb. This makes it not only hilarious to watch me eat, as food unbeknown to me dribbles down my face and eventually splashes into my lap. But it also means that I can not use a straw. It is impossible to create a seal for effective suction with no control over your lip. So all liquids go into my mouth via a syringe!  
2. The interior of my mouth is rather swollen and my teeth are held closed with elastic bands. I may remove the elastic band on one side (the left) to get a bit of an opening for eating. It is a very small hole and only the tip of  teaspoon can fit in (make sure the bottom of the spoon is wiped clean or it will end up on your shirt). Prior to today, even after getting any solid food into my mouth - all I wanted to do was gag. There is lots of gunk up my nose still and not being able to breathe or open your mouth for a quick intake of air should you need it creates a bit of panic. Today with my watery porridge I overcame this fear! 

 Well....that's it from the koala - I should really go and eat something but just the thought of the effort required is making me tired. Maybe I will go nap first. :)

Day 4: Life Too Fast.....Finally Home. Breathe Out!

Left Jaw Pain: 3/10

Right Jaw Pain: 7/10

Hip Pain: 4/10

Inconvenience factor: 10/10

I think I've hit maximum swelling!

Today was the day I was due to head home. I've taken awhile to write about this day. I have been trying to keep this blog fairly light hearted and this day just does not fit. I still can not find the shiny side of that day. Apart from the fact I did, in the end, make it home.

I remember waking and feeling tired and overwhelmed and completely over being in hospital. The hot, the cold, the constant movement of people, the perpetual squeezing of my arm in a blood pressure wrap and sticking of thermometers in my ear, the lights and sounds, the shouting angry people, the sore hurting people, the food they kept sending me that I could not eat, the pain in jaw, my ear, my arm, my hand, my hip.....it all just was too much. I yearned to run away, retreat somewhere comfortable, familiar and quiet and lick my wounds alone.

After yet another glass of juice for breakfast, one of the surgical team arrived, had a look at my head, commented on the extensive swelling and said "You should be right to go home today. But I need to send you for an X-Ray. When I've had a look at it, I'll let you know if you can go or not". This was received with a mix of emotions. As much as I wanted to get out of this place, the lesson I learnt the day before was still in the forefront of my mind. Was it a good idea to go home and be all alone? Doubt crept in. I wanted to cry.

My friend (and planned lift home) arrived around 10:30am. She bounced around, packed up all my things ready to exit the second we got the nod. It lifted my mood....Home is definitely where I needed to be. An hour later, we were still sitting there, slightly less bouncy and beginning to wondering when this X-ray was going to take place. Just before midday, an orderly arrived with a wheelchair. Let's get the show on the road! I gingerly climbed into the chair and settled in. As we took off out of the room, my senses were immediately assaulted by the bright flashing of lights, the speed of the corridor rushing past, the sounds crashing all around me. I felt nauseous again! What the heck? It seemed that my senses had gone into hypersensitive mode. My head was freaking out and it took all my power not yet out "STOP" to the orderly. I closed my eyes and focused inwards. 

Shortly, we arrived at a holding bay! Yup, they line up the beds and chairs with the sick people in them, facing each other, 3 each side to wait. I didn't know where to look. I didn't want to look. It was so noisy and bright. I went inwards again. Damn this chair is really hurting my hip. At one point one of the nurses came over and asked if I was okay. I said I would be, I'd only just gotten my last pain killer and it had not kicked in quite yet (which was true). I don't really know what she would have done if I'd said no. I wasn't going to say no. I just wanted to get the hell out of here, the hospital but firstly, this damn waiting bay. I am not sure but I think I sat there for a good 30 minutes before they took me in. 

My hip was giving me proper jip by then so when given the option to stand for the first X-ray, I took it. There were two ladies taking the X-rays. The first lovely lady instructed me to stand there, press your forehead on here, bite on this, hold here. Biting the 'thing' was near impossible but I shut up and tried anyway. Just get this done! The other lady I am going to assume was in training. Either that or she is an idiot. I know that is harsh but if someone has just had double jaw surgery 4 days earlier, you DO NOT GRAB their face and try to move it when they don't put it quite where you want it! I squeezed out "Gentle, gentle" and closed my eyes.  That familiar hot, cold pain started creeping up the side of my face. They exited the room to take the X-ray. I spent all of my energy focusing on quietening the pain and staying still....I didn't want to pass out or have to have a reshoot. When they returned I indicated that I needed the wheelchair. One more X-ray and I was free. The 'trainee' wheeled me through to the next room, of course bumping into the cupboard and door on the way through. I stayed in the chair for the next X-ray. Then it was back to the waiting bay. I felt like a dog at the RSPCA. Every time, an orderly turned up I would beg, "Please, PLEASE, be here for me!" Eye contact and a smile just increased the glimmer of hope. In the end I couldn't handle the disappointment anymore and closed my eyes. Finally, I was rescued and returned to my bed in the ward, over an hour after I had left. The relief to be back in my bed and the look of concern from my friend was enough to send me into tears, the first and only I have shed during recovery.

At least now, we were one step closer. I think the call from the surgeon came somewhere around 2pm, saying that I was good to go home!!!! GIDDY UP! All I needed before leaving was the drugs from the pharmacy. The pharmacist prescribed me antibiotics, liquid panadol and liquid oxycodene and said he'd fax it off to the hospital chemist. Then the bombshell "Your drugs should be here in 1 and half to 2 hours". 
Pardon? Did you just say 1.5 to 2 hours??!?! But my ride home has to pick up her son at 3:30pm. She can't wait until 4pm to take me home! The pharmacist very kindly offered to ring a few chemist on our route to see if they could fill the script. Unfortunately, Oxycodene is a registered drug and isn't often dispensed from normal chemist, let alone in the liquid form. No Joy! I was just going to have to wait it out. My friend left and I sat there on top of the bed for 2 hours. Waiting to go to my refuge. The ultimate final test.

Thankfully, I have many, many amazing friends and was able to ring in another chariot home. I finally arrived at 5:30pm. Utterly drained, both physically and mentally. I remember sitting on my couch feeling small and overwhelmed. My friends put me under their wing and looked after me in true tag team style, for which I will forever be grateful. One even stayed over night with me. 

I had completely underestimated how ordinary I would feel when I got home from hospital. To have two angels floating around, making sure I was alright, made everything okay. 
Thank you!

Day 3: Hold up Sister. Take it Easy!

Left Jaw Pain: 3/10

Right Jaw Pain: 8/10

Hip Pain: 1/10

Inconvenience factor: 10/10

The normal rituals of the ward continued today. The anonymous strange noise man and the other jaw surgery girl were released into the wild and were soon replaced by a man who in a drunken rage had punched a window and suffered lacerations and a Chinese student who needed his eye flushed every hour on the hour or he would go blind (what condition is that?). Mr Wilson continued to draw, cough and click and wave politely to me whenever I would shuffle past!

Finally, someone was bringing me liquid meals, but only at morning tea, afternoon tea and supper. I was now officially drinking food for those in risk of malnutrition! Albeit 20mls at a time from a syringe! Ha ha!

More bits had been removed from me in the past 24 hours which was very pleasing - no more oxygen was needed, the Pain Buster ball was cut free, the four stickers on my front were ripped off, the cannula in my left hand was banished (as the night before it had come out of the vein and resulted in my anti-nausea injection being subcutaneous rather than intraveneous - OUCH) and the actual subcutaneous injection point on my right shoulder was also removed. Feeling good!!!

The morning was passed in the company of early morning visitors, The Rock and then the Scallywag Control Freak. I'm not sure how focused I was, the oxycodene haze did not wear off until around noon, but I was very grateful for their company!

At one point one of the surgeons stuck his head in and said maybe I could go home today, tomorrow...or well, maybe Tuesday! He'd look into it! Today! That was great! Sure I didn't have anyone lined up to take me home today but I could certainly find someone! My own bed! I felt good! Surely I was ready!

Shortly after Scallywag left, it was my turn for a shower. And boy did it feel good. I slowly rolled my head back, letting my hair get wet and enjoying the warm water. It was as if the soap suds and water were melting away my reality, a very welcome reprieve right at that moment. As I reached down to scrub my ankle it hit me. A hot, cold shooting pain came over the entire right side of my face. It was so strong I gasped, then my eyesight started prickling. I slammed the water off, grabbed a towel and lunged for the toilet a metre or so away. I barely made it. Thank goodness for the old people bars. I clung on, grimly fighting the whiteness, trying to find a focus. Eventually, I was able to pull it together, dry, dress and wobble out of the bathroom. Waiting in the corridor for me was my Auntie! With the look of me right at that moment, I think I might have put the fear of god into her (sorry Ingrid). I got back to my bed and the nurse was there immediately, taking my blood pressure and making sure I was okay. I was, but not surprisingly, my blood pressure was a bit low!

It was a HUGE wake up call for me. A big fat Memo to Self that I really had to take things easy. Give myself time to get better. Just because I felt good, didn't mean I was good! 

Please don't send me home today, I'm pretty sure I'm not ready! Thankfully they agreed. Tomorrow we'd try again!

I spent the remainder of the day reflecting and resting (and yes, planning).

Day 2: When Right is Not Quite Right!

Left Jaw Pain: 3/10

Right Jaw Pain: 7/10

Hip Pain: 0/10

Inconvenience factor: 10/10

Note: Early on basic things like reading text messages, books or computer screens made me feel immediately nauseous. It took a number of days to get past this. All these early post-surgery blog entries are retrospective but hopefully still capture the key points and feelings as best as I can remember them. 

Attempting to eat via syringe!

The hip - with Pain Buster line-in visible!

My first full day in the wards....Time to take stock and assess the state of play. Good grief! 

One of the first things that I really noticed when I woke up was the number of things stuck into and onto me. Simply moving was fraught with danger.

The full compliment of my accessories were:

1) An IV drip in the back of my left hand pumping fluids, pain killers and I think antibiotics into me constantly. The tube and needle were stuck down with a LOT of tape.

 2) A sub-cutaneous injection point on my right upper arm - also secured in place with a lot of tape.

3) Four round tabs with metal discs in the centre stuck about my front (for monitoring my vitals during surgery?)

4) A hospital medical bracelet

5) A bandaid on my inner left elbow where I had been stuck with a needle previously

6) A big wadger of fake skin covering my hip incision (see above)

7) A draining tube from my hip wound that allowed blood to drain into a bag (rather gross - so photographic evidence removed). This was taken out early in the morning thankfully!

8) Tubing from a Pain Buster ball inserted into the hip wound. The tube was actually stitched onto my skin in two places. All taped over. (The Pain Buster ball uses pressure to slowly release general aenasthetic directly onto the hip bone graft site - really clever!). 

9) A dressing over some stitches on my face.
10) Oxygen tubes tucked around my ears and blasting air up my nose. 

All this stuff made what should have been a simple trip to the bathroom, an epic mission. Firstly get yourself to the edge of the bed, remove oxygen, arrange all the bits you need to hold, drag, carry to the toilet with you. Then stand. Put on flip flops, make sure the gown is still being modest. Pick up Buster Ball, and drainage bag in right hand. Grab IV stand with left hand making sure the tubes don't all get tangled and now shuffle to the bathroom! Then work out how to lock the door and sit down. Talk about doing things the hard way. In protest I pulled off the bandaid on my inner left arm and binned it. There!!! Down to single figure attachments!!

By the time I had struggled back to bed, my breakfast had been delivered. I'd been told that I needed to start to taking thing orally as my drip would be taken away soon and I'd have to hydrate in the conventional by-mouth way! Breakfast was porridge. Nice THICK porridge. Umm...what was I meant to do with that? Did you not get the memo that I have had jaw surgery and my teeth are elastic banded essentially SHUT!??!?! I am meant to be on a LIQUID diet for 2 weeks! In desperation, would you believe, I actually tried to use a paddle pop stick to push little chunks of porridge in the small gap between the elastics. No, it did not work. Breakfast consisted of 100ml of orange juice syringed into my mouth! Good thing I wasn't particularly hungry.

I was pretty tired and out of it until about noon when I jumped in the shower (ok - I didn't really jump). The IV and drainage bag were out so at least I didn't have to deal with them anymore. Finally a bit cleaner and back in my own clothes, I felt kind of okay - or maybe that was the drugs settling in. Lunch arrived. Mashed potato and puree pumpkin. No, they seriously appeared not to have gotten the memo. I pointed it out to a nurse and asked for some LIQUID food so that I didn't fade away. Lunch = 100ml syringed orange juice. At least I'd not get scurvy!

In some downtime, I started gently prodding bits of my face. I am completely numb from the bottom lip down to my chin tip and there are some other patches of skin around the place that just lightly tingle (I guess these are the nerves coming back to life). Occasionally, it feels like liquid is running down my face, but when I go to wipe it, there is nothing there. My tongue often feels like I have just burned it on hot food and it is a bit painful and tender. I can feel the new bone that has been placed up into my cheeks. Weird!!! And there is a whole heap of really gross stuff still wedged up my nose.

Even before these first tentative explorations, I knew my face was unbalanced. The left side was a bit tender and puffy, but the right side was screaming hot, permanently achy and impossible to touch without intense pain. It also felt like I had a severe ear infection on the right side and kept asking the nurses to check. They assured me that I didn't. The surgeon came past, told me how great I was looking (yeah right) and how pleasing the results were. He asked how I felt. I asked him about the right side of my face. Turns out that the bone didn't behave as it should have on that side. 

"It didn't quite split right, which made a bit of a mess of things for awhile, but we fixed it and you'll still get that perfect bite, Don't Worry!" :) Then he was gone. Hmmm....

I distinctly remember the bright lights, the weird noises, the hot air, the cold air, the constant blood pressure checks, the nurse hand overs, the lack of sleep, my sore ear, my burning face, and the general discomfort each taking turns to press on me. Thankfully, I had good company to keep me calm and entertained. And a seemingly endless suppy of Oxycodene to send me away for a time out when it all got a bit too much. :)