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:

Medical claims

So, last year was quite the year for medical expenses for me. Fortunately, I do live in Canada, where my surgery and hospital stay were completely covered by our health care system.

But that doesn't mean that there weren't major costs associated with this surgery for me. The surgical splint was $500 and wasn't covered under any of my benefit plans. Also, I had my surgery in another city, which meant lots of travelling back and forth to see my surgeon. And then there was a lengthy recovery, which included extra insurance, medications, physiotherapy, massage therapy (including lymph drainage massage), acupuncture, naturopathy, homeopathy, orthodontics and dentistry.

I avoided totalling it all up until now. And the damage: more than $4,700.

Wow. That's a lot. And the above is just the amount my benefits didn't cover. If it were the full amount, it would be another few thousand for sure (not to mention the shortfall in my gross pay because of all the work I missed due to related illnesses over the past year.)

Then again, being able to chew like a normal person and replace frequent migraines with a winning smile?

Priceless.

And hey, at least I get a good tax return this year.

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!

Reality check

I have been feeling cruddy this past while, exhausted and weak, generally run down. When I start to feel sick, my jaw pain tends to act up as well. I didn't really pay much attention to it in the past, but thinking back on it, this has been happening for the past few years.

I feel tired and run down, my jaw tenses up, I get a debilitating headache and can't go to work and do my job. More unpaid sick leave for Bella. Hooray.

Today, I got high on codeine to take the edge off the jaw migraines triggered by the overall cruddiness, spent the day in bed and went to see my physiotherapist late afternoon for my weekly appointment.

She asked how I was doing, so I told her, mentioning that I felt like some allergies were being aggravated or that I was coming down with a cold and that my jaw acted up whenever I felt this way.

She told me that when an area of your body is in pain for a long period of time and the condition becomes chronic, as my jaw likely has, the area grows extra nerve endings and becomes sensitive to histamines. So, if you do have allergies or are coming down with a cold, the pain in that area will flare up.

The news hit me kind of hard. I realized that I have been in pain for the past three years, and, as a result, this is something that I will probably have to deal with for the rest of my life, surgery or not.

In the spring when the snow melts and the mold underneath the banks starts swirling around, during cold and flu season, on windy days...I'm going to feel sucky. My jaw is going to act up. I am going to get horrible headaches, and I probably won't be able to go to work.

While I don't regret the surgery, and I believe that it has improved my quality of life (chewing, talking and singing) and saved my jaw from more damage in the future, the damage was already done before I went under the bone saw. And I'm going to have to live with that. And figure out how to deal with it.

Anyone have any thoughts on how to handle this situation going forward? (That don't involve allergy drugs, because those aggravate other health conditions I have.)

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.

Ask Bella: Physiotherapy and range of motion

Q: I was curious about the "opening of the jaws" predicament you've been having. I was wondering, if you had tried harder or more often during the beginning of your recovery, do you think you would have needed to visit a physiotherapist at all? At what point did your oral surgeon suggest you see one? Do you have any advice about these exercises?

A: Once my jaw was unwired, my surgeon gave me jaw opening exercises to do. You put your index fingers on your bottom teeth, close together in the middle, and your thumbs on your upper teeth, far apart. You use your fingers to push your mouth open as far as you can, and then you hold it for ten seconds and do four repetitions, four times a day.

My surgeon wasn't the one who told me to go to physio, though I'm sure he would have at some point. I had been having problems with jaw pain for years, so I have a physiotherapist who is a jaw specialist; he was the one who recommended I start going as soon as possible after the surgery. My surgeon didn't want anyone putting pressure on the jaw for one month after the surgery, so I waited exactly one month and started going every week ever since.

At physio, they did stretching exercises and massaged my jaw muscles, and I did the finger exercises at home. A few weeks or a month in, they gave me the jaw jack to help. The thing with "the opening of the jaws" is no pain, no gain, so the rehabilitation is not fun.

I would take it slow at first, because your body is healing and you don't want to do anything to damage your jaw so soon after the surgery. Do some research in your area to find a physiotherapist who specializes in jaws and just talk to them and see what they think. Your surgeon or orthodontist might be able to refer you as well.


Q: I am six weeks post-surgery and have an opening of 27 mm, which my oral surgeon is not thrilled about. I try every day to do the exercises, but I do experience a lot of pain, particularly on one side of my jaw. Do you think 27 mm is that horrible? I've read about your struggles with that device your physiotherapist gave you. Do you have any recommendations to make the exercises easier? Or to help me get a bigger opening, without using any kind of device?

A: When I was at six weeks post-surgery, I had an opening of 25 mm as well, and my surgeon said that this was average. So, if you're at 27 mm, you're on track in my surgeon's world.

I'm a very big fan of physiotherapy, myself. My physiotherapist will massage my jaw muscles and do milder stretches before getting into the bigger ones. This helps with the pain and also advances my mouth opening far more than I could myself. You could always do some massaging of your own muscles before and after the exercises to help make them easier.

I've also taken painkillers before doing the exercises on my own and gotten good results. Though you do have to be careful not to push yourself too far and injure your jaw. Good luck!

Oh, and in case you were wondering, I'm now at four months post-surgery and I have a 38 mm opening. Two to seven millimetres to go. Hooray!

*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!!

Anemia is the new black

This long weekend, while everyone else was out camping, sunbathing, and enjoying not being at work, I was sleeping 15 hours each day. I thought it was fallout from the torture session with my physiotherapist or I was coming down with (yet another) cold or flu. My whole body felt heavy and run down.

On Tuesday, I talked to my doctor about the tests I requested last week and she informed me I am mildly anemic. This is a new thing, because I had the same blood tests run a month before my surgery and I was fine.

A number of factors can affect your blood iron levels, and surgery is a big one. Fortunately, the solution to my problem is pretty simple; my doctor wants me to take iron pills for a month and then get my blood tested again (iron builds up in your body and can become toxic, so it's important to get levels re-tested regularly if you're taking iron supplements.)

I hope the iron deficiency also explains why, since the surgery, I'm constantly picking up viruses, getting easily worn out, having problems getting out of bed in the morning, and, as a result, missing waaaay too much work. Because not only do I have zero sick days left, I actually owe my employer for all of the time I've taken off for health reasons. And let me tell you, all of that physiotherapy, homeopathy, supplements and acupuncture don't come cheap. Bella needs a paycheque.

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.

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.

Is that my jaw you're trying to pull out of my mouth?

I met with the orthodontist again, three and a half years after my first appointment, and told him about the problems I had been having with my jaw. He took some impressions of my teeth, some pictures, and then referred me to a physiotherapist.

"Let's see if they can do something for you first," he said.

I didn't know there was such a thing as jaw physiotherapists before. The idea intrigued me. What exactly were they going to do? Did they just massage your jaw muscles? Give you exercises to do? Or maybe there were even little mini jaw weights to lift? I had no clue. But it was worth a shot.

I discovered that the procedure consists of someone pushing on the parts of your jaw that hurt, and you trying not to scream "physiotherapy is the devil!!" It also involves the therapist putting rubber-gloved hands inside your mouth and attempting to pull your jaw out of your head. The best part is that when the hands come out, they leave trails of your own saliva all over your face. This just makes all the pain seem worthwhile.

Apparently, the musical theatre experience created a huge amount of tension in my jaw and made my TMJ problems worse. As the physiotherapist held my face, she kept telling me to stop clenching my jaw.

"But it's not clenched," I said.

Her response: "Oh dear."

Fortunately, I discovered that the first session was the worst of it. My muscles were the tensest they've ever been before I went to physiotherapy. Over the past two years, it's been easier and easier to go, and the relief I get from these sessions is amazing.

But it became clear to me that the physiotherapy wouldn't be enough. There was something wrong with my jaw, and if it meant that singing would make my life hell, then I definitely had to do something to fix this problem. Because a life without singing would out right suck. Far worse than getting your jaw broken and wired shut.