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!!

Free at last...kinda

I went to The Big City to see my surgeon for my one-year post-surgery appointment the other week and he said that my bite looks great and I don't have to go back to him anymore!

Yay!!

The only reason I would have to go see him is if the screws in my jaw get infected and have to be taken out, which he says is quite rare.

Double yay!!

Another exciting development is that when I go see my orthodontist today, I will not have to pull out my credit card to make my monthly payment. Because, last month, I made the FINAL one. After three years of monthly payments, I am done, baby!!

Triple yay!!

I did a little dance around the reception desk with my credit card, singing, "This is my final payment, this is my final payment" while the ladies laughed at me. My orthodontist didn't seem phased at all. Maybe he sees this a lot?

The only area where I am not free is in the upper braces department. But hey, after all I've been through, what's a bit longer?

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.

Ask Bella: Bite post-surgery

Q: Hi Bella. I'm having the exact same surgery in a month or so and your blog has helped me so much to prepare myself. Thank you so much for sharing your procedure! I've got a couple of questions (if you don't mind answering).

Immediately after surgery, do you have a normal bite? - Do your back molars touch?

My orthodontist will have me slide my lower jaw forward to give me (and him) an idea on how it will look after the surgery. When doing this, of course there is a strain and it's not comfortable. After surgery (and healing), does the moving of the jaw forward feel normal and comfortable/relaxed? - Does it feel like you're jutting your jaw forward all the time?

A: I do believe I had a normal bite after surgery. I was wired shut for two weeks, but from what I can remember, my molars did touch at the back.

As for your other question, it sounds like your orthodontist was trying to give you an idea of the aesthetics of your face post-surgery - the changes to your chin/jaw line and what you look like. That uncomfortable strain you were feeling isn't reflective of what it's going to feel like post-surgery because that's not what's going to be happening to your jaw.

You jutting your jaw forward pre-surgery means moving the lower jaw forward in its joint, which is not what the surgery does. The surgery cuts into the bones on the sides of the jaw and lengthens them, making your jaw bone longer. This way, your joint stays put and you're able to use your jaw the way "normal" people do - without jutting it forward to be able to have that function and aesthetic.

Does that make sense?

After the surgery, your joint and muscles will have to make some accommodations to get used to your new jaw length/position, but it won't be the same feeling as jutting it forward. I don't know how much advancement you're having (mine was 4 mm) but I imagine there is more of a difference in feeling with larger advancements because your muscles have to stretch/change their orientation to connect with a longer jaw. Also, don't forget that you will also have some numbness in your chin, which will affect your feeling of what's "normal."

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: Update on "Changes in appearance"

There was a strong response from my blog readers on this Ask Bella post a few months ago, so I'm sure you'll be happy to hear this update:

Kerry Rose has left a new comment on your post "Ask Bella: Changes in appearance":

I just wanted to email an update about this particular post. I am the gal that sent in the question in the first place. Its now 12-14-08 which means I am almost 3 months post-op.

I have adjusted to my altered appearance and my initial terrified reaction at my transformation.

In fact, my post-surgery experience unfolded in ways I never expected.

After I sent this message, I started to experience great amounts of pain as a result of muscle spasms. For about a week, I couldn't sleep because the muscle spasms would wake me up every few minutes. Using a combo of prescribed sleeping pills and the pain medications, I was able to overcome it.

Then about 6-weeks post-op, I experienced an unanticipated break-up with a person with whom I had been dating for 5 1/2 years.

Ironically, I have met a lot of fellow ortho patients whose surgeries were the catalyst for numerous major changes in their life (including break-ups like mine).

I can honestly say that I am better than great!

I still think that my doctor should have been more clear about the physical transformation I would go through. I would even suggest that going to a therapist that deals with body issues (specifically one that relates to people undergoing surgeries) should be done ahead of surgery.

Thanks for all of the comments. It turned out to be so important for me to express what I was going through - especially because I had become somewhat of a prisoner of my home and my body. I needed reaffirmation that there was some action I could take to change my situation.

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.

And the heavens opened and there was much rejoicing

Yesterday, I went on an epic quest in search of the elusive orthodontic wax.

I was positive that I had seen it on a particular shelf in a drug store the last time I was there. I went to a different location of the same chain, only to find they didn't carry it.

I then drove all the way across town to the original location where I'd seen the wax, expecting that it would be exactly where it was just a few days ago, but it wasn't there, either.

I begged the store clerks to help me find it, but they confirmed the fact that it wasn't there. I soon realized that I was so desperate for the stuff that I had actually been hallucinating it was at the store. They don't carry it, and hadn't carried it for years. It was all just a beautiful, beautiful dream created by my wax-deprived mind.

It's kind of sad, really.

I was almost in tears when I realized that you can't really buy this stuff in stores, at least not in my city. Also, my orthodontist doesn't have an office in town - he just comes in on weekends every few weeks, so it's not as though I could get some from him.

And then one of the clerks suggested I go to the dentist's office in the mall to see if they had any.

Good idea! I ran there and begged the clerk at the desk for some, conveniently not mentioning that I was not at all a patient at that office.

She wasn't sure if they had any, but after much searching in a back room, she came out with a plastic baggie with about a lifetime supply of the stuff. I almost kissed her, I was so relieved.

And then I mushed a whole bunch of that stuff into my wires and cried tears of joy.

Sigh.

Life is good.

Damn you, Four Months Ago Bella!

One of my new brackets is rubbing against the inside of my upper lip, creating a very raw bump that catches on the metal every time I talk, smile, eat and...do just about everything.

Last night, I tore apart my purse, bathroom, bedroom searching for that little magical box of orthodontic wax. The fact that I couldn't find it anywhere drove me absolutely nuts, because I'm the Queen of knowing exactly where all of my stuff is at any given time. It's my thing.

As I obsessed over where it could possibly be, I suddenly got a very distinct image in my mind of me tossing the box in the garbage four months ago and saying smugly to myself, "Hah! I'm never going to need that again!"

Right now, I would be quite happy to smack Four Months Ago Bella across her braceless face.

(In case you were wondering: Yup, braces + raw lip = cranky Bella.)