Ask Bella: Numbness and nerve damage

Q: During my meeting with the surgeon last week, he warned me about the small possibility of damaging the nerves. I kind of knew the risks that exist with these types of surgeries, but as I sat there listening to him, I really had this overwhelming fear that I will lose feeling on some parts of my face. So then I started really to research more about it. Given that, I wanted to ask you the following questions:

1. Did you have huge concerns over nerve damage?
   
   A: I was concerned, but I did a lot of research, read people's stories on the Internet and talked to people who had the procedure done. I also looked into alternative health practices that would help with nerve repair, such as acupuncture, supplements, and homeopathic remedies. You can see my list of homeopathic/supplements that I took before and after surgery here. Also, all my posts that deal specifically with numbness can be found here.
   
   
   
2. What did your surgeon tell you about the risks involved and how likely it is that something will go "wrong"?
   
   A: My surgeon told me that there was a risk for permanent numbness in the chin/lower lip and that risk went up with age. So, at 32 years old, I had a 32 per cent chance of having permanent numbness. However, this guy had been doing this surgery for longer than I have been alive, so I had faith in his abilities to minimize damage and risk.
   
   
   
3. Did you hesitate about going through the surgery? If so, why did you decide to go ahead?
   
   A: No hesitation. Once I did all my research and felt comfortable with the surgery, I moved forward and never looked back. I did this surgery because I was having a lot of TMJ pain as a result of my overbite and knew that it would get worse if I didn't do something.
   
   
   
4. Do you regret having gone through the surgery because of nerve issues?
   
   A: No regrets. And no major nerve problems because of the surgery.
   
   
   
5. Has all the feeling gone back to your chin/jaw/lip areas?
   
   A: A year after surgery, I have almost full feeling in my lower lip and chin. It is more than 99 per cent there and improves everyday. I don't notice it unless I touch the area very, very lightly. If I use a regular touch, it feels like the rest of my face, and I can't tell the difference. The majority of the feeling in my chin/lip came back very quickly (within a month of surgery) and then slowed down, but improved on an ongoing basis. I have faith I'll have full feeling return, but even if I don't, I can live with the way it is - it's not weird at all.
   
   
   
6. Would you have done something differently?
   
   A: I would have taken iron supplements post-surgery. It was the only thing I didn't think about doing and I became anemic as a result. Of course, this isn't the case for everyone, but it was for me. I also would not have let my orthodontist take off my braces when he did - it was too soon and gaps opened up between my teeth and I had to have the braces put back on a few months later. Otherwise, no "what ifs". I was very prepared.
   
   
   
7. Knowing what you know now, will you do the surgery all over again?
   
   A: Absolutely. No regrets. I'm happy with the results, and I am looking forward to a pain-free life with a winning smile.

Of course, this is my situation and experience and everyone is different.

Thanks for your questions, and good luck!

*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: 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: Supplements and nerve regrowth

Q: I was just reading your post from Mar. 30 where you mentioned the odds of nerve damage following BSSO increasing with one's age. My surgeon brought up B12 as something he might want me to take. He said there's some research going on to see if it will help. Do you have references that support the use of B12?

A: B12 supplement is a very good thing to take before/after the surgery. My naturopath recommended it for me to take as well because it's very good for nerve repair. I found a really cool B12 product that's perfect for when your jaw is wired shut: B12 dissolving strips that are like those Listerine Pocket Packs. They're even minty!

If you have the opportunity to go to a naturopath, I'd recommend it. There are some homeopathic remedies can help with nerve pain/regrowth, such as Hypericum Perforatum. It's worth looking into.

*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: Hot tips

Q: Knowing what you know now, would you still go through the surgery? Is there anything you would change?

A: No regrets. I'd do it all again. Only this time, I'd be taking the homeopathic remedies before the surgery as well as after to help get the swelling down faster, I would have gone to lymph drainage massage as soon as humanly possible after the surgery instead of waiting two weeks to help get the swelling down, and I would have moved my expectations about being perfectly healed from three months post-surgery up to six months post-surgery. Oh, and I definitely would have upped my iron intake during my recovery.

Q: Any random tips/recommendations for any part of the process?

A: Do your research. Read all you can, look into natural remedies, know exactly what you're getting into, and keep a positive attitude and a sense of humour and you'll breeze through it (as much as anyone can "breeze through" major surgery, that is.)

*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!!

Anemialiscious

This post-surgery anemia business is far more complicated than it first seemed. You think - okay, my iron levels are low, so I'll just take iron pills and eat some spinach.

Not so much.

The first thing I learned was that you have to take iron supplements with Vitamin C or your body won't absorb them. My doctor never mentioned this when she told me to take the iron; I got this information from a friend. So, one more pill to take.

Then, I decided to look up information on foods with high iron content so I could be sure I was eating right. I was surprised to learn that not only there is a list of foods that enhance iron absorption, but there is also a list of foods that block iron absorption. These include sweet potatoes, red wine, soy and spinach.

What? Spinach inhibits iron absorption? Isn't it supposed to be chock full of irony goodness? Well, it is, but it also contains an acid that blocks iron absorption. In order to absorb the iron in spinach, you have to eat it with iron absorption enhancing foods, such as meat, tomatoes, and Vitamin C-rich fruits.

Note to self: people put strawberries, oranges and bacon in spinach salad for a reason, not just because it makes the salad look pretty. Go figure.

Not surprisingly, the iron that is most easily absorbed by our bodies is found in meat, poultry and fish. Making it extra difficult for vegetarians.

So, I took my iron supplements with Vitamin C like a good girl for a few weeks and...nothing happened. I didn't feel any better. I was still exhausted and sick all the time. What the heck was going on? Was there something else horribly wrong with me?

On Monday, I went to see my naturopath and mentioned it to her. She asked what else I was taking the iron supplements with, and I named off my arsenal of capsules and pills.

"You have to make sure that you don't take calcium and iron supplements together. The calcium competes with the iron for absorption and the calcium always wins. Then, the iron is just this toxin floating around your body."

In other words, all that iron I had been taking these past few weeks was not absorbed, even though I was taking it with Vitamin C, because the calcium blocked the iron.

Grrrr.

On the plus side, I started taking the iron away from the calcium on Tuesday, and by Friday, I had already started feeling better. So, there's hope for me yet.

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.

Homeopathic healing

A lot of people have expressed amazement on how quickly my bruising and swelling went away. While I maintain that a positive attitude does make a difference when you're healing from major surgery, I certainly don't credit alone with my progress.

Before my surgery, I went to see my naturopathic doctor and she prescribed a number of homeopathic remedies and supplements.

Homeopathic remedies operate on the principle that like cures like. So, if something in great amounts causes a headache, then the theory is that a very, very, very small amount of the same thing will cure a headache. Homeopathic remedies dilute those substances to microscopic levels and then use them to treat that ailment.

There is a constant debate going on as to whether or not it really works. In my experience, it has. But everyone is different. The way I see it is there's no harm in trying. If it works, it works. If not, the remedies are relatively inexpensive (I paid $7 per vial, Canadian Dollars, for mine), so you're really not losing anything.

My arsenal of non-drug remedies.

This is what my naturopath recommended for me (please consult your doctor/surgeon/homeopathic practitioner before taking any supplements):

1. Arnica Montana, 200K pellets. One or two pellets at a time, taken away from food, as often as needed to reduce bruising and swelling.
2. Hypericum Perforatum, 200K pellets. One or two pellets at a time, taken away from food, as often as needed to reduce nerve pain.
3. Calendula, 200K pellets. One or two pellets at a time, taken away from food, as often as needed to heal wounds post-surgery.
4. Thiosinaminum, 6CH pellets. One or two pellets at a time, taken away from food, as often as needed to break down scar tissue.
5. Wobenzym N., enteric coated tablets. One tablet three times a day, taken away from food, to break down inflammation. (Note: Wobenzym contains Bromelain, a digestive enzyme made out of pineapple. I know of a lot of jaw surgery patients who just take Bromelain, which would have the same sort of result if you're unable to find Wobenzym.)
6. Traumeel, oral drops. This is a complex homeopathic with a variety of compounds in it. Five drops, three times daily, taken away from food, to reduce swelling, bruising and inflammation.
7. Vitamin B12. She didn't give me an amount on this, but said that it helped encourage nerve regrowth and reduce nerve pain. I found these great dissolving Vitamin B12 strips that I could put in my cheek while my jaw was wired shut and they would dissolve. Awesome!
8. Mediclear, protein and vitamin powder. One scoop in rice milk in the morning with breakfast. Provides protein essential for healing and liver support post-anesthesia.

If I had to do it again, there were some changes I would have made.

Firstly, I would have found as many of the homeopathic remedies in tinctures/oral drops to make them easier to take when I was wired shut. I used a method for taking the pellets called "pulsing" where you put a very tiny amount of water in a glass and dissolve the pellets in it before swallowing. It worked fine, but the usual method is to dissolve the pellets under your tongue. Drops would have been much more convenient.

Secondly, I would have started taking the Arnica and the Traumeel several days before surgery. You get a much better result that way. I took the Arnica just one day before, and I didn't start on the Traumeel until three weeks after the surgery. It turned out well for me, but it would have been even better to start earlier.

Otherwise, it's been going very well. I wasn't able to take the Wobenzym while I was wired shut, but I am taking it now. While I was wired, I focused more on taking the Arnica and Calendula as much as possible. Now that the swelling is mostly gone, I'm concentrating more on the Hypericum and the Thiosinaminum as well as making sure I'm taking my Mediclear every day. I added the Traumeel because I noticed there was just a tiny bit of swelling left that wasn't going down as much as I would have liked and I figured it would help.

The really nice thing about homeopathic medicine is that it is so diluted that it's impossible to take too much of it and it is not going to interact with any drugs, or so I'm told. It's kind of idiot-proof, which serves me quite well.