Ask Bella: Talking after unwiring

Q: I just had jaw surgery 3 1/2 weeks ago and I'm going to get the wires out next week. I'm pretty concerned with my speech 'cause I'm still in school and I have to practice on my public speaking skills. I know you can't exactly talk perfectly right away or open your mouth but I want to know how long did it take you to start talking normal and be able to open your mouth?

A: I didn't find that the surgery affected my speech at all. Once I was unwired, I could only open my mouth a little bit, but it was enough to speak clearly - more clearly than I could with my jaw wired shut, that's for sure!

I could open my mouth wide enough to get a small toothbrush as well as a spoon in there right away, so that's what really mattered to me. Food and clean teeth! More information on how long it took me to get my mouth opening back to normal can be found on my blog under the category "range of motion."

However, I will mention my jaw was only advanced 4 mm. I have heard of some people who had major advancements (more than 7 mm) and found it affected their speech enough that they had to go to speech therapy. So, it depends on how much of an advancement you got (I'm assuming you had the same lower jaw surgery I did.)

In any event, you will be fine. It might be great right away or it might take a little work, but you'll know for sure in a few days, right?

Best wishes, and please let me know how it goes.


*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Happy Jawiversary

February 12 marked my 12 month jawiversary, one full year after my face was sawed open and screwed and wired together. Wow. It's hard to believe. It feels both like forever ago and like it was just yesterday.

Things have finally started settling down for me. I still have the braces on my top teeth (put back on in October after three months of being off) and the gaps are closing nicely.

A month or two ago, I started developing some problems with my right joint - crackling and clicking and pain upon opening and chewing. Fortunately, a physiotherapy session helped resolve that. I am confident that once the braces are off again, the joint will settle into place, because I don't recall having problems with that joint when the braces were off last time.

My opening is at about 44 mm and my jaw swings slightly to the right when I open to my full range of motion. Again, some physiotherapy exercises are helping to correct that, and also build some more strength in the jaw. Though I am told that it will take months of these exercises before I will be opening straight. It's a marathon for this kind of thing, not a sprint.

I have my one-year checkup with my surgeon next week, so we'll see what he thinks. I have a feeling he'll be happy with how things are going. One thing I noticed over the past few weeks is that there's a spot on the left side of my jaw that's a bit tender. It seems like the location of where the screws are, so I'll have to ask him about that.

There is still a slight, slight amount of numbness in my chin. I only notice it when I run my finger very lightly across it. When I touch my face normally, it feels fine. I notice minute improvements still, so I know it continues to get better, even though it's at a slower pace than at the very beginning. I am hoping that full feeling will return eventually, though I can live with the amount that I have now without any discomfort, so I'm not too worried about it.

As for the depression I have been dealing with since after my surgery, it seems to be lifting with the proper drugs and treatment. I've had to accept that this will likely be a life-long struggle for me, as it runs in my family, but I am sure that I can fight it and come out on top.

I always come out on top.

I thought you might like to see some pictures of what I look like now:

10 months post-surgery

It's 10 months since my jaw surgery. WTF?

In good news, The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel has signed off on me, meaning that I don't have to go every week to get my jaw stretched anymore. My range of motion is somewhere between 42-46 mm now (depending on the day), which is well within normal range. Though he did mention that he expected that I would be a "long-term intermittent" patient of theirs.

I'm okay with the intermittentness, seeing that each appointment costs me $42 and doing that weekly for almost a year (on top of my many other appointments) has gotten pretty expensive.

Right now, my regular physiotherapist has me coming for TMJ classes, where I learn stretches for my jaw that I can do without her. She wants me to do them everyday for a period of time, with our sessions to evaluate whether I'm doing them correctly. Then, the responsibility will fall on my shoulders and I will only go to physio when the pain/tension gets really bad, due to stress, etc.

My braces are still on (having been taken off for three months and then put back on because my upper teeth relapsed), which causes some tenderness. Since they've been back on, I've noticed that my joint has been kind of crunchy and poppy when I open my mouth really wide. I hope that the joint is just settling and adapting to the new position of my teeth and that this isn't going to become a long-term problem.

In not-so-good news, I've been continuing to have problems with fatigue and depression. I haven't felt physically well since my surgery. I've tried to be upbeat and proactive about everything, but the stress of the long recovery and anemia seems to have taken its toll on my body and mental health.

It took a long time for my doctor and me to figure out that this is a depression, because there were so many other things going on with my body, and because the symptoms I was experiencing were very physical - headaches, aches and pains, fatigue, exhaustion, etc. I also have a family history of this kind of thing, so it's not too surprising that this is my body's reaction to something as intense as major jaw surgery.

So, I'm off work for awhile to rest and get this fatigue/depression taken care of. I'm optimistic that in the next few months, I'll get back to my old fabulous self, with a winning smile that I can't help but show off.

8 months post-surgery

It's hard to believe eight months has gone by since my surgery. It feels like forever, making me wonder if it ever happened in the first place. But I need only look in the mirror to see my new chin and smile to remind myself that yes, it really did happen.

In good news, I went to my physiotherapist yesterday and we got up to 45 mm for the first time! I'm almost at the end of my range of motion, so that's incredibly exciting. I still have some work to do, though, because my muscle memory is interfering with my mouth opening properly.

When I open my mouth wide, my jaw swings to the right, because the muscles are remembering the way my jaw was positioned for 32 years (it was a bit asymmetric before). So, I have to start doing exercises using my hands to guide my jaw into the proper position while opening my mouth.

I've also noticed the muscle thing when I smile. My smile is still somewhat crooked because my muscles have been compensating for the asymmetric jaw. I have to start taking time each day to practice smiling in the mirror so my muscles can relearn what to do.

I have to spend hours in front of a mirror smiling at myself? How tragic.

In other good news, I have full feeling in my chin now - no more numbness! If I pay super close attention and use a very light touch across my chin and lower lip, I can tell that the feeling isn't 100% back yet, but it's barely noticeable (we're talking 99.999876%). There are still improvements every day and I am positive that I will get to 100% in the next few months.

In the not-so-good news department, I am one week away from getting my top braces back on to close a couple of gaps that opened up at the back.

Until then, I will be eating popcorn, corn on the cob, apples, and other crunchy "forbidden" foods to my heart's content!

Chow down!

High...um...I mean "hi"

The last time I went to see The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel, he put me through so much pain that I was gasping for air, crying, and doing Lamaze breathing to get through the appointment.

I wanted to hate him and swear I would never go back, but the dude's effective - he got my mouth opening from 30 mm to 36 mm in one session.

So, I just swore. A lot.

It takes months to get in with him, which gave me time to psych myself up for round number two. I decided that there was no way I was going into my next session sober. I was going to get very, very high on painkillers first. Fortunately, it doesn't take much to impair my brain function, which made me wonder a bit about the stability of my brain function, a thought that quickly disappeared with two T3s (codeine) taken in the waiting room before my appointment.

By the time they called me in, I was flying. An intern was the first one to see me.

Intern: The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel is running a bit late, so I'm here to get you started. How are you doing today?
Bella: I'm doing GREAT!!
Intern: You certainly are chipper today.
Bella: I'm high. He's mean, so I had to get high so I wouldn't have to breathe like I'm giving birth, not that I know what it's like to give birth or anything, but yeah.
Intern: Uh...okay.
Bella: He makes me cry when he uses his Thumbs of Steel.
Intern: I have heard that before, actually. Though I don't know anyone else who had to get high before they saw him.
Bella: I'm special.
Intern: Yes, I can see that.
Bella: Codeine is goooooood.

By the time The Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel came in, I was even more far gone.

Bella: German orthodontic fetishists like me, you know.
Jaw Master Grand Pouba of Physiotherapy with Thumbs of Steel: [puts Thumbs of Steel in Bella's mouth and pries her jaw open]
Bella: You're mean. Codeine sucks!!
Jaw Master Grant Pouba of Physiotherapy with Thumbs of Steel: [cranks Bella's mouth even farther] Feel that? That's the end of your range of motion. Your mouth won't ever open farther than this because this is how far the bones will let me go. Let's just hold it here for a bit and measure it so we can see where we're at.
Bella: Aaaaaaaaaaaaaaaaaaaghhhhhhhhhhhhhhhh!

Then I said a bunch of other weird incoherent stuff I don't really remember and accused him of various human rights abuses. All I know is that they were pretty amused by my altered state.

However, in the end, I discovered that the end of my range of motion is about 47 mm, and in our session, he was able to get me from 42 mm to 44 mm, so I'm pretty much there. By the end of the year, my jaw physiotherapy torture sessions will be a distant, painful memory.

The next time I see him is in December. Hmmm...I'm pretty sure I have some liquid hydromorphone left over from my surgery...

Ask Bella: Physiotherapy and range of motion, part two

Q: As I read this, I am at work propping my mouth open with a pile of tongue depressors. They do make me tear up in the beginning, but now I went from 27 mm to almost 35 mm in about a week! Not too shabby. I'm hoping to get to the 40 mm mark in a week or two. I think I can do it...just need to buy more tongue depressors! (I'm up to 18, and I only bought 20). Anyway have you ever tried this?

A: Wow - 27 mm to 35 mm in one week? That's got to be some kind of a record or something! Congratulations! I was surprised at how well stacking tongue depressors on top of each other and using them to pry my mouth open works. (I'm up to about 24 tongue depressors at the moment.)

Once I grew out of my jaw jack, my surgeon told me to try this trick and attempt to add one more tongue depressor each day.

It's difficult, because the tongue depressors don't have any "give" to them like the jaw jack does, so once you've got them in there, they're in there. I'm a bit claustrophobic, so I have to remind myself that I can easily pull a couple of them out and I won't be stuck like that.

Another thing about the tongue depressors that is a bit annoying is that they really dry your mouth out, which can be uncomfortable. I was thinking that something that might help is to get a latex glove and put the tongue depressors in the fingers, stacking them on top of each other that way. Then, you get the advantages without the disadvantages.

Thanks for reminding me about this - I can't believe I didn't mention it before. The best thing about it is that it's a cheap alternative to some of the more expensive medical jaw stretching devices out there, and it works just as well.

Anyone else have good jaw rehabilitation tips they can share?

*To ask Bella a question about her jaw surgery, email her at smilingbella at gmail dot com or leave a comment on this post. Go ahead: ask away!!

Read it and weap, my friends!

Last Friday, in physiotherapy, I hit...

...wait for it...

40 MILLIMETRES!!!!!

Oh yes, my pretties, you read that right. That's like a normal jaw opening, people! (As if anything about me or my jaw could be considered "normal", but that's beside the point, isn't it? And did I mention 40 freaking millimetres? Oh, yes, I guess I did.)

It's interesting to me that after all of the struggling and being stalled at 38 mm for the past several appointments, last week, my jaw joint and muscles seemed to loosen up for no apparent reason. By the time I made it to physio, it was as though my body was just ready to go there.

My physiotherapist said she could tell something was different. "Before, I was limited by your jaw joint. Now, I'm just limited by your pain," she said as she wedged her hands into my mouth and pried my jaw open, causing tears to roll down my cheeks.

"Cool! I made you cry!" she exclaimed.

I don't even care about the pain anymore - bring it on. I just want to hit 45 mm by the end of summer.

Where, oh where is George when you need him?

I am longing for my ex-boyfriend, George the Morphine Dispenser.

Sure, he was a fair weather boyfriend who was only there for me during the high-flying good times in the hospital, and then he dumped me and never called again, but I don't care. If I knew where to find him right now, I'd beg for him to take me back and I wouldn't even care if he cheated on me with all the other jaw surgery patients.

I'm not usually the kind of gal who likes to share her men, but in this case, I'd make an exception.

You see, I just came back from a physiotherapy session. Not just any physiotherapy session, but one with the Grand Pouba of Jaw Physiotherapy. The Man with Thumbs of Steel. The Jaw Master.

This dude is in such high demand that the only appointment I could get with him was 8:30 at night. And even then, I didn't actually get in to see him until 9:30.

Now, my regular physiotherapist is pretty hard core. She often makes me gasp and wince in pain, to which she responds, "That doesn't hurt. You just think it does" and continues merrily dislocating my jaw from the rest of my head.

But this dude, this dude took it to a whole new level. He used his hands to inflict more pain than this torture device ever could.

The pain was so intense, I had tears in my eyes, I was crying out, and I actually started doing Lamaze breathing to try and get through. Or at least I think it was Lamaze breathing. I'm not sure what I was doing. All I know is that it hurt. A lot.

Brutal. Brutal. Brutal. Medieval, really. I still can't believe it.

But the thing is, I went in there tonight only being able to open my mouth 30 mm, and I left with 36 mm to my name. My surgeon told me that if I could open 40 mm or more, he would be a happy camper. So half an hour of pain (and lord knows how I'll feel for the next few days) brought me to the point where I can almost open my mouth like a normal person.

I guess what they say really is true: No pain, no gain.

And in other news, I'm really glad I didn't get rid of those leftover painkillers from my surgery. I don't think I've been this high since the last time George and I made out.

And in unrelated news: Wheeeeeeeeeeeeeeeeeeeeeeeeeee.

Good news, finally!

I went to see my surgeon this weekend. Since I got my jaw unwired, I see him every six weeks to make sure my jaw is healing on schedule. This was my second six-week follow-up and I have to admit I wasn't looking forward to it because of my last experience.

At my unwiring appointment, he fastened four elastics - two on each side of my mouth - connecting my upper and lower teeth and told me to wear them at all times. These were to train my jaw to open symmetrically. They were placed at an angle to keep my lower jaw in its new position and to ensure it didn't start regressing back to where it was before the surgery. At night, I had to wear a single elastic connecting my front upper and lower teeth.

The problem was that my teeth move easily and quickly. So, instead of keeping my teeth in their current position, the elastics started pulling them forward. Over the course of the six weeks from my unwiring to my next appointment, my teeth shifted into an underbite position, with the lower teeth on the outside of the upper.

My lower jaw was slightly further out than it should be.
But I'm still totally cute.

As you can imagine, when I went to my surgeon with an underbite two months after my surgery, he was not pleased with the results. I had expected that he would just reverse the elastics until my teeth went back to where they were supposed to be.

But that's not all he did. Oh no.

In addition to changing the elastics, he took his thumbs and pushed my lower teeth until they sat behind my upper teeth.

Let me repeat that: He pushed my teeth into place with his thumbs.

I'll wait while you imagine that and twitch, because I'm still twitching thinking back on it.

After four days of migraines, my teeth were back to where they belonged. And six weeks later, it was time to make the two-hour drive to see the surgeon again.

In addition to having waking nightmares about his thumbs coming after me, I was a bit stressed about being able to open my mouth wide enough. When I got unwired, my surgeon told me I had to work up to opening my mouth 30 mm before I could go back to my orthodontist and continue with braces adjustments.

The last appointment, I only made it to 25 mm, and in the six weeks since then, I had been struggling to stretch it farther than that, and not making much progress. Fortunately, about a week before the appointment, my jaw finally started to give.

I took my jaw stretching device on the road and used it in the car on the way to the appointment. And, miraculously, when I saw my surgeon, not only did he not come after me with his powerful thumbs, but he also announced that I had made it to 32 mm.

32 mm!! Wooo hoooo!!!! No more surgical hooks on these teeth, and one step closer to debracing!!

Finally, some good news.

Tools of the trade

Tomorrow marks the two-month anniversary of my jaw surgery. It's hard to believe that eight weeks has passed since my super high-five happy times, but here we are.

The bruising is gone, the swelling is gone, those awful wires binding my jaw together are gone, and people tell me that I look like a million bucks. And yet, my recovery is not over. Not in the least. There's the small matter of being able to open my mouth and chew things. Yeah, that little detail.

After I got my jaw unwired, I could only open my mouth a few millimetres. My surgeon gave me some exercises to do to help get my opening back. After one month, I was only able to open my mouth 15 millimetres.

In case you're wondering how much that is, here's a ruler. Put some household objects up to it and imagine only being able to open your mouth that wide.

15 mm = One thumb's width.
The diameter of a small coin.
Less than one Scrabble tile.
And keep in mind, it's 15 mm, teeth to teeth.

Do you know what you can eat when you can only open your mouth 15 mm? Not a whole lot. Unless you chop it up into eensie teensie little pieces.

The situation of sharing the same food as my friend's baby was getting kind of old. I had to get on top of that sucker. So, I ran to my physiotherapist, stat.

She stretched my jaw, moved it around, massaged it, and then handed me this:

I wondered if perhaps she was giving me some tools
so I could break into the pharmacy late at night
and swipe some of the good drugs
so I would no longer care that I couldn't really eat.

Alas, this was not the case.
I was supposed to use this device to stretch my mouth open.
That piece on the end goes into your mouth,
and then you use the grip to crank it open.

Seriously??
Look, I don't like you, and you don't like me,
but we're in this together, so we better make the best of it, alright?

At first, I couldn't even get my mouth around the thing.
But after a few stretches, I was ready.
I wasn't able to crank it open for quite some time,
but after a few weeks of baby steps...

Crank, crank, crank, crank, crank.
That's five, in case you were counting.
25 millimetres.

25 mm=two finger widths
The spine of a substantial self-help book
The width of a fork.

And might I mention,
it feels as comfortable as it looks.

The thing is, 25 mm is not enough. My surgeon won't let me go back to my orthodontist for braces adjustments until I reach 30 mm. And I am not considered fully recovered from this surgery until I have a "functional opening", which is around 40 mm. The physiotherapy torture device has 10 clicks on it. I have only been able to reach 5-6 clicks at this point.

This is what the torture device looks like when open 10 clicks.

More than a little daunting.

Infuriating, really.

But mostly depressing.

But I'll keep at it. I'm a trooper that way. A pathetic trooper who can't open her mouth wide enough to eat an ice cream cone, but a trooper nonetheless.

21st century wireless gal

Now where was I? Ah, yes, I left off at the part of the story where my jaw was wired shut. That kinda sucked, didn't it? Don't worry, sweet Internets. The wired Bella only lasted two weeks. I'm one of the lucky ones - some jaw surgery patients are wired for six weeks. I can't even imagine.

When I left the hospital, the nurse gave me wire cutters and told me I had to carry them with me AT ALL TIMES. Sorry for the use of the capital letters there, but they were very serious about this point. I even had to sign a document promising that I would carry them AT ALL TIMES.

I knew they weren't to be used if you were throwing up. (Apparently, you're supposed to use your fingers to open up your lips, bend over, and let the vomit run out from between your teeth. Mmmmmm. Fun.) I assumed their only use would be if your airway were obstructed or you weren't breathing and someone needed to perform CPR.

Bella: So, how do you use these?
Nurse: I don't know.
Bella: I should know how to use them if I have to carry them at all times, don't you think?
Nurse: I'll ask and find out.

I think I was the first person to ask this question. That's kind of disturbing, when you think about it. How many jaw surgery patients are carrying these things around with no real idea of what to do with them?

Nurse: You just give them to the paramedics if something happens to you.
Bella: Uh...okay.
Nurse: We've never known of anyone who's actually had to use them before.
Bella: But what if I need to?
Nurse: Just get in there and start cutting everything.
Bella: Alrighty then.

The infamous wire cutters that no one uses.

As you can imagine, I was not going to miss carrying those things around in my purse. Their very existence reminded me that I was in a precarious position, choking wise. Something I'd rather not think about when my jaw's wired shut for two weeks.

Other things I was not going to miss: crazy concoctions made in the blender that, more often than not, turned out to be very unappealing; talking through clenched teeth; and finessing one of my pills, which couldn't be crushed up, through the tiny space behind my back teeth so I could swallow it.

But then, the magical day came. The day I got with the 21st century and went wireless (thanks for that turn of phrase, DK.)

The boyfriend had gone to plug the meter just before I got called into the office, so I held the camera up as the surgeon cut the wires and took all these pictures myself. My surgeon asked, "You can take those all by yourself?" My response: "Trust me, when you're as narcissistic as I am, you become very good at taking pictures of yourself!"

The first cut is the sweetest.

Get that finger in there. Good times.

He also had to cut the rubber bands that were over the wires.
Those snapped back something fierce.

At least he knows what to do with the wire cutters.

Can you tell I'm having fun here?

It was a very involved process and went on for awhile.

Also, it kinda hurt.

Except delete the word "kinda."

Freeeeeeeedoooooooommmmmmmmm!!!!

It was a very weird feeling to have those wires off for the first time. It was actually uncomfortable. My jaw was sore and I could barely open my mouth. If you look at my mouth in the above picture, that was literally as far as I could open it after being unwired. It felt really unstable. At that moment, I would have been quite happy had he said he was putting the wires back on.

But then, he gave me a toothbrush and some paste and told me to brush.

And the heavens opened and there was much rejoicing. Because let me tell you - not being able to brush the backs of your teeth for two weeks straight = downright disgusting. My tongue had been brushing up against a layer of fuzz for a week at least, so brushing was a higher priority than being able to eat.

My teeth just after unwiring and before brushing.
Pretty gross, hey?

I brushed for about 20 minutes to get all the stains off. At first, I couldn't even fit the toothbrush into my mouth to get at the backs of the teeth. But I was determined to get that gunk off, so I held my jaw and pressed the bristles against my lower teeth until some of them went on the other side. It was the best feeling in the word. I was so relieved once I was done.

It was then that I realized - I can talk! (So, I babbled the surgeon's head off.) And then it dawned on me - hey, I can eat! (So, I stopped talking and got the hell out of the office so we could go for lunch.)

Now we know Bella's hierarchy of needs: Brushing, Talking, Eating.

The boyfriend and I grabbed a friend of mine who lives in The Big City and went to my favourite Mexican restaurant to eat My First Meal As Someone Who Can Open Her Mouth. I was still not allowed to chew anything, so I had to get something soft and mushy. I ordered the mexi dip, which is refried beans, fresh salsa and cheese baked in a tortilla shell. And I ate that mo-fo with a spoon and a side of guacamole and sour cream.

And it was sublime.