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:

Ask Bella: Fatigue and depression

Q: I appreciate your discussion of fatigue and depression post surgery, and hope you will continue to raise this concern in your forthcoming blog updates. Depression and fatigue are two matters that I am worried about because I already struggle with these difficulties. I would appreciate learning more about the strategies you have used (or that others have used) for managing fatigue and depression after surgery.

A: Thank you so much for this question. I've noticed that a fair amount of people who find my blog through Internet searches are looking for information on this topic, and I also know that this is one of those things not a lot of people want to talk about, because of the stigma attached to depression.

For those of us who already struggle with fatigue and depression (myself included) on an ongoing basis, surgery can trigger these problems, which, in turn, can lengthen the recovery period.

I had a physiotherapist who told me once that many of the people she saw in rehabilitation programs (after major car accidents, injuries, etc.) were having serious mental illness problems. The way she put it was that everyone has his/her breaking point - there is only so much the mind can take. So, some people may be coping with regular everyday life just fine, but intense stress, such as that caused by a physical injury or illness, will push them over that edge.

I found that piece of information very interesting, particularly because I know how regular stress can affect my ability to cope with everyday life. That was part of the reason I worked so hard at being educated and mentally prepared for the surgery, with the determination to stay as positive as I possibly could about it. Unfortunately, even with my best efforts, I did plunge into depression and have been struggling with that combined with fatigue for this past year.

I don't say this to scare anyone with mental health problems from having this surgery - I still believe the positives far outweigh the negatives. It's just that I now have an additional level of healing to deal with than others who have had the same surgery.

In addition to mentally preparing yourself and having a really good understanding of what you're getting into, there are some other preparations you can make to deal with depression, post-surgery or otherwise:

Supplements: There are a number of supplements I take to help with depression/anxiety and I find they do help (please check with your doctor before taking any supplements):

• B Complex - I take B50 complex twice a day (with meals). It's good for nerves and I find I deal much better with life when I'm on it. On the plus side, it can also help your nerve endings repair themselves after surgery.


• Vitamin C - I take 1,000 mgs twice a day (with meals). Taking up to 3,000 mgs, from what I understand, is helpful with depression.


• Omega 3 Fatty Acids - I take 1,000 mgs of salmon oil (you could substitute other fish oil or flax seed oil - liquid or caplets) twice a day (with meals). This is one of the few supplements psychiatrists agree really help people with mental health issues.


• Vitamin D - I take 2,000 mgs once a day (with breakfast). Those of us in more northern climates don't get enough of this essential vitamin because we don't get as much sunlight. This is especially important in the winter and Vitamin D deficiency may be a cause of seasonal depression.


• Calcium/Magnesium - If I'm having problems sleeping due to stress, I will take a calcium supplement (1,000 mgs, with a small snack) before bed. The reason you want a calcium/magnesium combination supplement is that calcium on its own can cause constipation.

Know the physical symptoms of depression: It's easy to slip into depression without knowing it. It can kind of sneak up on you. Sometimes, I have the classic symptoms and I know right away when to start seeking help. After the surgery, I just thought I was exhausted and had the flu all the time (for months and months and months, which should have tipped me off.) It was only after I went back to my doctor for numerous tests (once the anemia issue was cleared up) that she suggested that I may actually be depressed instead of having something physically wrong with me.

Seek medical help: Going to your doctor to talk about depression can be scary and intimidating if you've never done it before, or even if you have. No one wants to have to say those words. Then again, they can be very empowering because by speaking the truth out loud, you are able to do something about it. Get checked out for the other physical possibilities that could be causing the symptoms - your doctor will know what to look for (such as anemia, thyroid problems, etc.)

Get a specialist: If you have a history of mental health issues or have mental health problems running in your family, it's a good idea to have a psychiatrist. They know the drugs a lot better than general practitioners do, and you want someone with knowledge on your side for those situations where a family history may make your case a bit more complicated.

In my opinion, it's even better to get yourself in with a specialist when you're in a good place and not in crisis (i.e. well before the surgery.) In doing so, you can develop a relationship with your psychiatrist before something happens, and he/she can get to know you when you're at your best. That way, you are less vulnerable when something happens and have a better chance of being an active participant in your own care. Not to mention that there are usually long waiting lists for specialists (here in Saskatchewan, it's 8-9 months to get in with a psychiatrist when you're referred by a family doctor!!)

Therapy: Talking to someone can help get the weight of the world off your shoulders and give you some perspective on stressful situations. In some cases, this can be enough to keep you from sliding down into depression. In others, it can help you manage the depression and claw your way out. There are really no downsides to this. Get it all out!

Drugs: Along with the medical help and psychiatrists are, you guessed it, drugs. Some people are really against this route. I have been one of those people in the past. However, I got to a point where I could no longer function in everyday life and the only way I could get out of bed, make it to work and be even remotely social was to start taking antidepressants.

Not saying that this is the choice for everyone, but I didn't really have a choice. I fought it for a long time, because of the stigma, because of the fact that I didn't want to admit that I had something that I had seen others in my family struggle with, because I wanted to be "stronger" than that and pull myself out of that pit with my own sheer willpower.

This illness is something that runs quite rampantly in my family, and I had to face the reality that my biology needs some chemical help. That's just the way it is, and it doesn't make me a weaker or lesser person than anyone else (though I still have moments when I think this - I'll have to work on that in therapy, I suppose.)

Things have been getting better, but we're still trying to get the drug doses right, so it's not like the drugs are a cure-all by any means. I know that I have to continue doing everything else on this list to ensure that my mental health is taken care of. Which brings us to...

Exercise: Yeah, I'm still working on this one. They say that exercise improves pretty much every mental illness. But the problem with mental illness is that you're too exhausted/depressed/anxious to exercise. I mean, if you can't get out of bed in the morning, are you seriously going to go for a jog around the block? I think not! But I'm hoping that the drugs can put me in a good enough place that I can start exercising to stop the cycle of depression.

Does anyone else want to add to the list? How do you cope with depression?

*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!!

Ask Bella: Changes in appearance

Q: I had upper and lower jaw surgery (turbinates removal & genioplasty as well) about 2 1/2 weeks ago. Like most people, I did this surgery for purposes of function and not appearance. I loved my appearance - I loved how dainty I thought I looked.

While I don't think my reaction a week post-op is much indication of how I will feel forever...after most of the swelling had gone down and I could tell what I would look like, I was devastated. I didn't recognize myself. I had this dysmorphic type of reaction to the results of my surgery and I couldn't stop staring at what I saw as the destruction of my appearance. Even 2 1/2 weeks out, the steroids have worn off, I'm not on meds, I'm getting normal sleep, I'm not in much pain at all....yet my reaction to the alteration of my appearance still stays.

Have you received emails from other people that have had this reaction? Do you know how they overcame it?

A: I'm so sorry you're going through such a hard time. Your email made me want to reach out and hug you.

My surgery wasn't nearly as extensive as yours, so I can't speak to the dysmorphic reaction to your reflection from personal experience; however, I have read on message boards about other people who have had similar reactions to yours.

And, really, who can blame you? We all identify with our outer appearance - you've lived within this skull and skin your entire life and then one day, suddenly, you look in the mirror and don't recognize the person staring back at you? That is a huge shock to the senses, psyche, and identity. How are you supposed to just accept that you look completely different in just 2 1/2 weeks?

Let yourself mourn your old appearance. It's okay to feel sad because you have lost something that was a big part of who you are. But at the same time, try to find things that you like about your new appearance. Take a good look. Check out your profile. (I know I always hated mine because my weak chin made my nose look bigger. Now, it's more in proportion, which I like a lot.) Make a list of what you like and focus on that as much as you can. Because the reality is that this is what you look like now, so you need to find ways to look at yourself in the mirror and like what you see, after the surgery.

I think time will help, focusing on the positive will help, and then if you still feel that things aren't where you would like them to be, talking to a therapist would be the next step.

When I'm frustrated and upset about the fact that I still don't feel like myself these days (I'm struggling with a lot of fatigue, even after my post-surgery anemia has gotten better), my boyfriend always says to me, "You're pretty hard on yourself, you know." It makes me realize that I do put a lot of pressure on myself to be perfect, to be healthy, to be this super achiever and that sometimes, I just need to be good to myself and say, "It's okay if it's not happening as fast as I want. I'll get there" and just give myself a break for once.

Two and a half weeks is not that long. Even if everything seems to be going swimmingly, you've had major, major surgery where they took a bone saw to your face and rearranged your bones. That affects your body and your mind and your spirit in a big way. So, don't pressure yourself to be totally healed and accepting of everything just yet.

Just be good to yourself. I hope everything goes well for you.

*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!!

Ask Bella: Post-surgical depression

Q: I discovered you blog via a google search of "orthognathic surgery recovery depression." My son had surgical advancement of both lower and upper jaws on June 6. My question is regarding depression. He does not want to see any of his friends, which I am attributing to mild post surgical depression. He said it's because they make him smile and laugh which still hurts. Do you think I should insist that he he allow his friends to visit? How important were/are visits from friends during your recovery time?

A: I can really relate to what your son is going through. And it sounds like his surgery was far more extensive than mine, so his recovery will likely be more difficult.

Depression post-surgery is quite common, from what I've read, and what I've experienced first-hand. During the surgery, they pump you full of steroids to keep the swelling down. The steroids stay in your system for a week and during that time, you're feeling pretty good. Then, after a week, you go into steroid withdrawal and crash into depression.

It was very severe for me and I was absolutely miserable. Fortunately, it passed quite quickly - three or four days at the bottom and then things got better, particularly after I talked online with other people who had had the surgery and been through the same kind of thing. (I also went through a bout of depression at the three-month mark, which you can read about here.)

I can also relate to his problem of being in pain after having fun. I have had jaw problems for a number of years and have often felt torn between doing what's going to be healthy for me psychologically (i.e. going out and having fun with friends) or what was best for my jaw. Because going out, having fun, and laughing and smiling with my friends meant that I would have migraines for four days afterward and pretty much not be able to do anything. So, was it worth it? Or to what extent could I do it? Could I try not to have too much fun?

I wouldn't push him too hard, but I might suggest limited activities, such as going out for ice cream for just 1/2 an hour, or going to a movie so there wouldn't be too much talking/laughing but he'd still be out and around other people, which is important. Maybe his friends could bring over some DVDs or video games?

I think it's important not to isolate yourself when you're recovering, but at the same time, I get where he's coming from. I found that for a month after my surgery, I was very exhausted and had to have a two-hour nap after I did just about anything, even laundry. So, don't push him too hard, but make sure he doesn't totally cut himself off from the rest of the world while he's still listening to his body's need for rest.

Best of luck to you both!

*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!!

In-valid

I'm struggling. Struggling to be well. Struggling to maintain a positive attitude. Struggling against the perceptions of others. Just struggling.

It's funny. You prepare and you do your research and you're ready for the worst when going in for major surgery. But that's the easy part. What they don't tell you is what happens afterward.

When you get your face cracked open, you expect that there will be massive swelling, nasty bruises and grotesque stitches. You mentally prepare yourself for that, and when it happens, it's not quite as bad as you thought it would be. You figure that once your jaw gets unwired and the physical signs of the procedure are gone, you're home free.

If you want the truth, I would gladly go back to having my jaw wired shut right now. Because the moment the wires came off was when things started getting difficult.

I expected it would be tough to eat for awhile, but not for as long as it has been. I still can't eat anything chewy or hard (raisins or fresh vegetables, for instance), because I literally can't chew it. And it's been more than two and a half months since the surgery now.

I expected that my mouth would have a limited opening for awhile, but I didn't expect that getting my range of motion back would be such a painful, slow struggle.

I expected that I would have some pain and that I might be tired, but I didn't expect that every physical action would be so exhausting.

Anesthetic stays in your body for up to a year after surgery. It slows you down, you forget things, you lose your train of thought, you stumble into doorways, and you get tired easily. When you go off prescription painkillers, you can plunge into depression because of the withdrawal. And after major surgery, your immune system is compromised, you're more susceptible to viruses and they hit you a lot harder than they did before.

You go to the mirror and see someone staring back at you who looks fantastic and you can't figure out why she just can't get it together already. The surgery is over. The time off work is over. Why is it getting harder instead of easier? What is wrong with me?

One day, I posted this status on Facebook: "Bella looks absolutely fabulous but feels utterly miserable." It's rare that I have a status that is less than racy or bizarre, so a friend of mine who had major brain surgery a few years ago responded with concern. I wrote him back:

It's the post-surgery stuff. Everyone is so supportive when you're just out of surgery and you look like hell. Flowers, cards, understanding, etc. But once you look okay, they forget that you've been through this major procedure and treat you like you're back to normal. But you're not.

I'm finding right now to be one of the most difficult times because I look great - you'd never know I had surgery. However, I'm so tired and everything is an effort. I misplace things, use the wrong words, forget what I'm doing, etc. Stupid anesthetic brain. Anyway, it's tough.

How long was it for you until you felt fully functional after surgery?

His response was right on the mark:

How long? In my case, I'm still waiting....The way I thought about what you're describing was to re-pronounce the word 'invalid' - i.e. as 'valid' with a prefix, meaning 'not a valid person.' I suspect that like mine, your inner person is seeking validation for the experience and the way it's making her feel. How to find validation? I dunno. Is it frivolous to suggest dark eye shadow UNDER the eyes, a sallow make-up foundation, and a carefully understated limp?

It felt good to talk to someone who knows what this is like. These days, I just feel frustrated. Frustrated that I can't do everything that I could do before. Frustrated that anything that contributes to my stress levels becomes unmanageable quickly. Frustrated that just when I think I'm doing okay, something as simple as chanting in a mellow yoga class re-injures my jaw and leaves me with crippling migraines for four days straight.

Frustrated that the people around me respond, if at all, with patronization or their own frustration at my lack of ability to be my usual high-functioning, overachieving, reliable self.

Frustrated, alienated, alone. Depressed. In-valid.

Week two, in pictures

Here's my second week, post-surgery, in photographic form.

On Day 9, I went for lymph drainage massage.
This is a very gentle massage that helps reduce swelling.
I saw an immediate difference.
It was like the puffiness was melting away.
I wish I'd have started these treatments the day after surgery.

I was not a happy camper on Day 10. Can you tell?
I couldn't figure out what was wrong with me.
I just crashed. My whole body hurt and I felt really depressed.
I thought the surgery was just catching up to me.
That, or I was losing it.
I later found out that they give you steroids during the surgery and these get you all wired for about a week, and then you crash and go through withdrawal.
Glad to know I'm not going crazy after all.

By Day 12, the swelling and bruising was almost gone.
I'm starting to look like my usual cute self!

Two weeks after the surgery and there's no more bruising.
A bit of swelling remains, but I'm the only one who can see it.