Questions and more questions

For the first time on Wednesday, I heard the truth from an oral surgeon, an expert in his field: "your injuries are severe".  This vindicated what I've been feeling all along, and echoed what Dr. T has been telling me. I've mentioned in previous posts that it's been a road to acceptance of what's happened to me, and the extent of it wasn't revealed to me all at once. Obviously some of that came from me. Feeling the pain, where my mouth and teeth were, all that, also told me a bit about what's going on and made me feel like I knew it all along - this situation isn't good. 

So now hearing that I need to have the most serious of all jaw surgeries is also something I need to come to accept. That, or get some more information about how or if this beast can be avoided. You never expect to hear that the best solution for you is the most extreme one in the arsenal. 

To give you an idea, the process involves creating a custom set of prosthetic joints for my face. The surgeon sends my CT scans to the company who manufactures them, where they use computer assisted design to create a model of my head, which then gets sent to my surgeon. He will remove the bone from the model where he wants it removed and sends it back to the prosthetic company. They will create the joints based on the model and then they are ready for implantation. 

As far as the surgery goes, they will make an incision in front of my ears, up into my hairline and down along my ear. Another will be done under my chin.  Then they will dissect the muscles from my joint and cut out the bone. It will take 8 hours. The recovery is difficult and painful. The primary purpose of the surgery is not to relieve pain..it is to regain joint function. There is a risk of facial numbness and/or paralysis that might be temporary or permanent. I may lose function of my eyebrows (like free Botox!!) or not be able to close my eyes. These are big risks!

The joints themselves are made similarly to those for knees and hips, but hasn't been done for near as long. The idea is that they will not last my lifetime - and will need replacement at least once. 

An alternative to prosthetic joints is to use bone from your rib. I don't know the details of this option, only that Dr P didn't think it was the best way to go. 

So contemplating this surgery is scary. It was presented to me by Dr P, and I was given some websites to read and learn about it. Now I feel very conflicted. Is this worth it? 

I'm told if I don't have it now, my joints will continue to degenerate and my jaw will sink further into my face. Eventually I won't be able to close properly, and eating will be difficult or near impossible.  But how long will that take? Can they recreate my condyles but save my TMJs? But he mentioned that in the meantime, if my pain goes down or something miraculous happens, we could discuss other options. What has to change for that to happen? 

These, plus a zillion more, are the questions I have for Dr P. 

Shiny, custom and expensive - TMJ replacement surgery

Welcome to my nightmare everyone....as of yesterday I am on the ~1-year waitlist for double total Temporomandibular Joint (TMJ) replacement surgery.

Dr. P. was fantastic. He is a truly caring, compassionate Dr. who seems really empathetic about my situation. Before I went for the consult yesterday he had already spoken with Dr. T, Dr. T2, and my orthodontist Dr. O about my case. He had reviewed all my tests and come up with the determination that I will need this very serious surgery. I also have to commend Dr. O. I only visited him for 1 initial (complimentary) consultation and he has also been consulting with both Dr. T and Dr. P. on a regular basis. Another truly caring professional. I can't wait to work with him.

The reason that I will need this surgery is that my joints are both not healed and healing badly.  The right TMJ is healed in an overlapped and shortened position. This is why my face is shorter on the left side and my teeth meet there many millimeters before my right side.  The left side is not even healed at all. The condyle may be "in" the socket, but it's not attached to my mandible (jaw). So that's not great.  On top of that, Dr. P. is sure that I have a significant amount of soft tissue damage, including the discs in the TMJs too. The joints and all my muscles are inflamed, basically nothing is right in there. He says there isn't a way to fix what has happened now, it's been too long and my joints are actually degrading. There are other procedures he can try (jaw surgery without joint replacement) but since my jaw isn't connected on one side, the results are very unpredictable and not favourable. So, here I am.

I asked Dr. P. about my previous care with Dr. M. and what was done to repair my jaw initially. While no surgeon will throw another under the bus, and I very well understand that health care is both an art and a science, he did think this is a result of improper treatment.  I should have been wired shut from the beginning (I wasn't until 1 month after the injury) and I should not have been left to heal this way for so long. I could have possibly avoided this serious replacement surgery with a less serious (but still serious!) jaw surgery to stabilize the joints for healing.  I am not feeling any animosity or anger toward Dr. M. The jury is completely out on the correct way to treat a bilateral condylar fracture, and he did the best he could. It serves me no purpose to blame him. He did what 50% of the surgeons out there would have done....he just let it "not work" for too long. I also understand that my injury and subsequent poor healing is fairly rare.

So now that I'm on the wait list, there's a new (accelerated) treatment plan. Dr. T. has to get all my root canals and temporary restorations (crowns) done as soon as possible. I need to get braces on so that they can move my teeth into the correct positions for when my jaw gets put back in the right spot. This means the braces are going to straighten my teeth relative to the bone they are attached to - but they won't line up to each other until the surgery. This will take time, obviously, but Dr. O. already consulted with Dr. P. and thinks he can get the job done in the year before the surgery.  So I need to get them on pronto, so that when surgery time arrives I'm all ready. Then I'll have the braces on afterwards too, in order to fine tune things.  I don't know how long...it's probably only an estimate now anyways.

After the braces come off, then Dr. T has to remove all the temporary crowns and put pretty new ones on. I'll also get an implant for the 33 that is coming out, plus any that I might lose between now and then as a result of the damage that was sustained. Teeth can take years to fail...so I am likely in for more implants sometime in the near or far future.

In the meantime, once I get all this dental work done and braces on, pain or no pain I have got to get back to work. I need to start living somewhat normally...this is too all-consuming right now to be healthy. I'm going to get myself into counseling. This is a bit more than I can handle on my own, or ask my friends and family to help me with. Hopefully by January 1 I will be working at least part-time.

So there you have it! I am going to request an honorary DDS after all this.  I can honestly say now that I've always been interested in working in the dental field, but now I know I would really love it.

Professing my love for Canaray

I have mentioned previously that I have been referred to Dr. P, a local world-renowned TMJ specialist and oral surgeon. Well, as part of that referral process, he requires that you visit Canaray, a private clinic that specializes only in Oral and Maxillofacial Radiology.

I visited the clinic on Friday last week (today is Wednesday, the day of my consultation with Dr. P!) and they indicated that it usually takes ~2 weeks for the report to be completed. When asked to do it by today for my visit with Dr. P, they accommodated me without any pushback. Granted, this was requested FOR me by Dr. T, but they did it no questions asked.

Outside of my visit to the office, which was fast, pleasant, and efficient, the quality of their work is outstanding, in my humble opinion. Yesterday I was in Dr. T's office to have impressions taken in order to prepare a 'flipper' for me by Friday when my 2 teeth were to be extracted and bone grafts done. I was terrified, since the impression material could have pulled out one or both of my teeth prematurely. Well, Dr. T's associate, Dr.....T (ok, let's call him Dr. T2) was there and was interested in seeing my report. I logged into the Canaray website (they give you a code so you can view your own scans) and tried to find it for him. The images were up, in fact they had been there since the weekend. The report was not to be found, however. So we got ready to get the impressions done.

In the meantime, I checked the website again, and lo and behold...the report was up! A full, 7-page report, complete with multiple images from the scan and findings based on those images. It is impressive.  Well...looking at the report we found out that the tooth 14 that we were sure was vertically fractured and completely unsalvageable was only fractured in the crown!!  A whole chunk of it was fractured off, but since it went down into my gum, it hadn't come loose (lord knows how it's stayed put for 3 months). But it was squeezing the root of my tooth every time it moved. I know....I can tell you. Every. Damn. Time.  The pain was unbelievable. Just a slight knock to the tooth and I was in tears.  I can't seem to get the photos to copy here (I'll keep trying) but simply removing the broken piece, doing a root canal and then crowning the tooth is all it took to get me out of pain. And I get to keep my tooth!! Wonderful!


The rest of the report lays out my injuries in gory detail. (Well, it's not that gory). I will try to get the photos to copy into here so I can show you.

My words of advice after this experience are to advocate for a trip to Canaray for a full cone CT scan and report on your injuries. It shows so much more than any x-ray can, and informs your doctors of what's really happening in your mouth/head. It already saved me losing a tooth, having a bone graft and then an implant....anywhere from $5000-7000 worth of work, and the scan plus report cost $295. Even if it weren't covered by insurance, it would be worth it!!

State of the Union

I thought at this point it would be a good idea to explain where things are at in full...not just day by day or tooth by tooth. I also figured since I'm using tooth numbers to explain everything, it would be helpful to see the tooth numbering system that I'm talking about! 

Here is the Canadian tooth numbering sytem: 

Keep in mind there are different numbers for baby teeth. Gotta keep all those chompers straight! Pun not intended.

Also interesting to learn is the terms used to describe the sections of each tooth (although I won't be using these on this blog, I'm all for more information. Nerd Alert!

Mesial: the front of the tooth

Distal: the back of the tooth

Occlusal: the top of the tooth ("occlusion" refers to how your teeth fit together....I have "malocclusion" at the moment)

Buccal: the outside surface of the tooth (facing the cheek)

Lingual: the inside surface of the tooth (facing the tongue)

There you go - The More You Know! 

Anywho, here's what I'm dealing with in the general sense. As far as my jaw goes, it has now been set and healed in the more-or-less central position since it was wired closed Sept 9. This did resolve the gross movement it had made to the left side of my face. It's still a good 5 mm or so off to the left, which doesn't sound like a whole lot, but it is noticeable and you can imagine that makes for an abnormal occlusion. I understand that since I can physically force it to move to centre, with physiotherapy (stretching, exercises and massage) I will be able to get it back to centre. Braces with elastics will also help. 

The condyles of my jaw are also still in play. The left side has always been fractured and displaced. The right side has been fractured, then displaced, then fit back into the joint, and now these recent x-rays and CT scans will determine if that's still the case. What I can tell you is that I can open my mouth pretty well, but not as much as I could before. If I have to live with that, it's ok. But there is still quite a bit of pain and discomfort when using my jaw joints, probably because they're not in the right places. The muscles are all tight and very sore. 

The condyles of your jaw go into the sockets in the side of your skull, right around your ears. I have had some ear pain as a result, but in the grand scheme of things, it's pretty minor.  What concerns me is the sinking in that's happening to the side of my face. I have divots where my jaw used to be, back near my neck. It's pronounced when I smile, but I see it all the time.  Looking back at photos of myself pre-accident and even after, I see that there is a big difference. It's happened over time since the accident, so that might be why some people haven't noticed much. Others see it as very obvious. I'm in the latter camp, obviously. 

Here's a photo of me from July (I cropped it, but had to keep the bass in there!), and you can see a defined jaw line: 

And here's one from last week (mid root canal, how have I managed find the least flattering photos of myself for this argument!) where I think you can see the 'caving in' on the side of my face:

The aesthetics of it is obviously worrisome, but again...something I can live with if I have to. But the fact that my jaw is no longer where it is supposed to be concerns me functionally. I'd like to be as close to normal as possible. This is where my oral surgeon, Dr. M, has me a bit confused. He said that we will need to "revisit" my jaw at a later time, but mentioned bone grafts to build up the jaw for looks. I'm not sure that I'm interested in that, unless it really bothers me long-term. But is he concerned about the function of my jaw? He just isn't saying. This is where the TMJ specialist, Dr. P., should come through for me on Wednesday.

As far as my teeth go, I've explained a lot of it, but I've had 3 pulpotomies (root canals, teeth 11, 21, 45) and they've relieved a great deal of my tooth pain. The 35 and the 45 are very questionable whether they can be saved, but Dr. T. is trying her hardest. So far the 45 has been crowned with a Cerec crown (awesome procedure...so fast and easy!) and we're hoping it holds up over time. The 35 is due for the same procedure later this week. These 2 teeth were very badly damaged, losing most of the bulk of the structure and leaving the pulp exposed. Thankfully it retreated somewhat during the 3 months they were left alone and the pain level went down. 

There are a whole slew of teeth in there that need pulpotomies (all the lower fronts) and many were cracked and lost chunks off the crowns. These will need restorations, I'm not sure exactly that means but I'm guessing a few more Cerecs.  The 14 and 33 will be extracted this week, and bone grafts done at the same time to prepare the sites for implants later. The 33 especially needs the bone grafting as that was the site of one of the fractures. The 14 was vertically fractured and is damaging the bone underneath. 

My bite is not great..."malocclusion", and I also have an open bite, meaning my front teeth no longer touch each other. This is a result of, obviously, the jaw fracture, and because my jaw still isn't all that great functionally I don't even really know where to put it when I close my mouth. Then there's the fact that all my lower teeth basically collapsed inwards during my healing. This was totally unexpected, and is a major reason for requiring braces. Removing any teeth down there, and at least 1 will be, will just help my teeth to collapse even more. So once the pulpotomies and restorations (crowns) are complete, I will get braces. These will straighten my teeth and help restore my occlusion. They will also help to make room for implants to the teeth that I will lose. Unfortunately, since implants cannot be moved, the orthodontics have to be complete before I can have a full set of chicklets. Until then, its a flipper.  I also can only have temporary crowns on for the braces, and when they come off all the crowns will be redone with permanent ones.  Of course, there might be another jaw surgery sooner or later to repair what's still wrong. 

So I guess the long and short of it is, things are incredibly better pain-wise. I'm getting out of pain slowly and steadily, which is fantastic. Dr T is restoring my teeth and I feel so much better for that too (no more tiny shards of teeth, now they are looking a bit more normal, and my mouth looks more "full"). But I still have a long way to go....and it's a bit daunting to think about. 

Music has always been a big part of my life, and I've found it can be an incredibly powerful tool to change your mood. So lately I've been listening to the song "Tough People Do" by Brett Kissel.  I'll leave you with some lyrics: 

That's the thing about life

The rain's gonna fall on us all

Your heart's gonna break some times

But there's no way around it, life is full of mountains you're gonna have to climb

But there ain't no crime in cryin'

You've just gotta keep on trying'

So remember, no matter what you're going through

Tough times don't last.....tough people do!

Just listening to this song can take my mood from a 2 to an 8 :)

Thanks for reading!

Yesterday I made the decision to share the fact that I'm blogging like this on Facebook.  Judging by the amount of traffic I've gotten since then, I'm guessing that all you readers are my friends and family...and maybe a few 'Facebook friends', folks I've met along the way but who don't know me all that well.

Anyways, thanks for your interest in what I'm doing. I know I was making some pretty funny posts on Facebook, and I haven't gotten there with this blog yet. It doesn't mean I'm not taking it all as lightly as I can, but blogging is a much more personal thing, and so I am doing it with some solemnity for now. Once I get more comfortable, I hope to be a little more lighthearted here!

A few of you have reached out to me to share your support and let me know that you have confidence in my inner strength to handle all this. For this, I cannot say a big enough THANK YOU!!!! This is both a serious thing to go through, and also only a minor blip in time....and I acknowledge that.  I know that my mind has a huge degree of control over which one of those things it is, but sometimes it's hard to exercise that control.  So your words are invaluable to me in those times.

If you have any comments or suggestions for me in this, please feel free to share! And again...thanks for checking out what I'm doing here :)

My CT Scan and plans for next week

So I'm almost ready to see the TMJ specialist on Wednesday.  I went to Canaray yesterday morning for my cone CT scan, which took no time at all. It was a beautiful facility with a very-well run system. They specialize in dental imaging only and it's clear they know what they're doing.

The cone CT scan was actually completely indistinguishable from a panoramic x-ray. They do strap your head into place pretty tightly so that you don't move (they don't do that with the x-rays) but otherwise you'd have no idea which one was happening to you.  They have assured me that the results will be sent to my doctors by Wednesday, and in fact I've already seen some of my images in the online portal that they provide you with. It's all pretty cool...except for the fact that I have no idea what you're supposed to see in these pictures!

So now on Tuesday I'm going to be back in Sarnia at Dr. T.'s office to see her associate (he's actually the one who referred me to the TMJ guy) and have impressions made so that I can have fake teeth Friday after the 14 and the 33 come out. It's a long way to go for that, but it is also Christmas party time and I really would feel better having the flippers in while I am supposed to be socializing and enjoying the holiday celebrations. There's also a chance that taking the impressions for the flippers could pull one or both of the teeth out prematurely (lovely thought) and Dr T's associate (also Dr T...how confusing) is equipped to deal with that. So I've downloaded some podcasts to listen to on the long drive and am hoping for good weather.

Then I'm back to Mississauga on Wednesday to see the TMJ expert (Dr. P) for a consult. I'm looking forward to getting his opinion on what to do with my jaw. I can say that I'm not in a great amount of pain...but it is a lot of discomfort and I still get tired very easily. Sometimes my mouth just won't open very much, and there's a lot of discomfort with all the muscles of my face and head. I don't know if I'm hoping he says that Dr. M's plan for me is good, or that he says he has other things in mind. I'm just grateful to be getting a second opinion, and one that I can trust. Both Dr. T's associate and my orthodontist say that Dr. P is THE guy to work with, so I think I can trust him too.

After that, Friday I'm back to Sarnia at Dr T's to have some more root canals (pulpotomies), crowns and then over to her periodontist for the 2 tooth extractions and bone grafts.

I'm almost wishing I hadn't written this post....I'm tired already just thinking about it!

Dental Marathon #1

Today I spent my day in my dentist's chair from 8 am to 2 pm, starting to get done all the work that now lays ahead. Obviously there were breaks in there, but it wasn't nearly as bad as I had anticipated, pain-wise.

My jaws held up pretty well (of course some valium helped) through 3 root canals and 2 crowns. There were a ton of X-rays for each tooth, and a Panorex too. My fears of losing teeth weren't unfounded, as it was discovered that 2 teeth have to come out - and I'm scheduled for those next Friday, plus bone grafts to help heal and prepare the bone for implants. I'm going to lose the 14, which was vertically fractured and in really bad shape. The other one that comes out is the 33, the lower left canine that was avulsed in the accident. I'm told this is a very important tooth for mouth structure, so it's going to be interesting how an implant might hold up there. Here's a gorgeous picture of me mid-pulpotomy:

My worst fear was that I would lose my top front teeth, and only one of them is looking poor long-term. Maybe in a couple of years I will lose it to an implant. The bottom teeth that were knocked out of place (but still in the bone) are also at risk of degenerating within a few years. So that's kind of bleak.

The disconcerting part was the results seen on the Panorex Xray. I don't have a copy...sure wish I did and maybe I can try to get one. It is showing that both of my condyles are in very poor position, and Dr. T. was concerned enough to contact 3 different specialists right away, send them my x-rays and get their opinions.  Two of them got right back to her with the opinion that things are not in good shape, and in fact  the function of my joints is poor. So I'm being referred to a specialist next Wednesday who is apparently a world-renowned TMJ specialist with a very long waiting list to be seen. Unfortunately, he requires a CT scan prior to being seen and they usually take 2 weeks. So I'm rushing to the clinic to get one done first thing tomorrow morning and they're promising to rush the results to him. I am really hoping all that goes well so that I can get his informed opinion on what should be happening.

Of all the things that I thought I would hear at the dentist today, that wasn't one of them. Now there's a real possibility that I could be having another surgery..and I wonder if it will involve being wired shut again. I so hope not. It was torture last time!

I also have learned a lot today about my insurance coverage. It turns out that most of this should be covered under a dental accident clause in our medical coverage, which has a lifetime maximum of $500K. I'm truly hoping that most of this is covered - I'm wondering if even braces might be covered. I'm being told by my doctors that they're not for cosmetics, they're actually truly required for function. So we'll see what claims are accepted and which are denied.

I'll post more about my CT scan experience (I've already had one when I was in the ER but this might be different.) and then of course what the new specialist says about my jaw. Fingers crossed!! For what, I'm not sure....

Anxiety overload

Well blog readers ( all 5 of you, whoever you are) you're about to get a taste of a low point tonight. It's the night before my first real day of dental work, and I've driven 3 hours through a snow storm to get to my dentists house. Oh right, I might have forgotten to mention that one of my best friends in the world is my dentist. How incredibly convenient!

Anyways her mom made me a meal of all soft and delicious foods to eat, and now I'm stuffed to the gills and camped out in her guest bedroom. I will make my way to her office first thing in the morning with her to spend all day (with breaks) in her oh so comfortable office. No really...it's beautiful. I'll post pics later. 

Since there is SO much work to be done, the treatment possibilities are incredibly complicated. I won't even go into trying to explain it all, since there are a zillion factors and it would be pointless to lay out all the permutations now, only to get more information tmrw during my visit...which I will obviously share. 

However, we did discuss the very real possibility that I will be losing a major portion of my front teeth sooner rather than later. And how we proceed will be determined largely on insurance coverage. A lot of the details that we discussed tonight were rather upsetting, so I've taken a Valium to relax. Here's hoping that I rest up for tomorrow's dental marathon. 

I'll be sharing the news about the state of my teeth as soon as I can. Please wish me luck. 

(Not) Eating with your jaw wired shut

This is an incredibly important topic to cover, and I thought it deserved it's own post. Having your mouth wired shut means that you will be eating a liquid only diet the entire time.  No breaks, obviously. This simple fact is bad enough, but I took it much more personally, unfortunately, and this is because of the reason you are eating liquids: because everything you injest has to fit either through your teeth or around and in behind your molars! and that, my friends, is ACTUALLY the worst part of the liquid diet.

Dr M gave me this horrific looking system for eating: 

And, might I add, he gave me just 1 of these setups. Note the tube attached to the already sad-looking syringe. The tube is made of rubber, and tastes like it. I think it was supposed to thread around behind my molars for direct injection into my mouth, but it wouldn't fit, and believe me, I tried.  I just found it incredibly sad to have to physically inject food into my mouth, and combine that with the taste of latex with my already sad soups and smoothies.....well, I actually tried to scream at the top of my lungs out of frustration. I think I loosened some wires by accident.  I wish I could have just quit eating for the duration of my wiring.

Well, after about 2 days, this thing was not cooperating, being that it's designed for a single use. It became incredibly hard to suck up food with it, and then one day my hubs was wrestling some soup into it out of a mug and the whole contraption just seized. The mug went flying onto the floor, spraying soup and broken ceramic everywhere. 

So my word of advice: go get more, ASAP. I found this brand to be the best -
Terumo 60 cc/mL Catheter Tip syringe.

So here is a list of what sustained me over the time. 

- Puréed and watered-down soups

- Smoothies with no fruits with seeds of any kind (they get stuck in your teeth/wires and aren't worth the struggle) 

- Cream of wheat, with lots of cream 

- Yogurt

- Pudding (made with cream, for the calories)

- And, at one point, a peice of cake in the blender with ice cream and milk.

Here's a picture of an attempted meal:

Spaghetti through the blender and mashed potatoes (packaged, watered down). The spaghetti didn't work so well....it got stuck both in the syringe AND the wires in my mouth. The disappointment was epic. Much more than it should have been, but I was both chronically starved and starving at this meal time. There are a lot of mountains to be made of molehills when you're going through this process. 

You can see that I was not creative at all with my food selections. I wish I could say that I was being positive at this point, but truthfully I got so sick of liquid food that I really just gave up. It is a perpetual cycle - you're starving, so you're miserable and lack all motivation to feed yourself, and then you're miserably hungry. I cried from hunger more than once. On liquids you really can't ever feel full. So, more advice: plan ahead if you can, and stay open to trying different things.  But be prepared for disappointments. One thing that really got to me was a pumpkin who up that a lovely coworker of the hubs made for me...I tried to eat it, but even though it was thoroughly puréed, the fibres from the pumpkin (no matter how small) all got stuck through my teeth and wires and it took me forever to pick/brush/rinse them all out. And then there's the picture above - my mom put spaghetti through the blender, but loaded it with cheese for calories. The same thing happened, but worse, with the cheese.

All of these frustrations are bad enough, but here's where it again differs from elective jaw surgery: because my teeth were all badly damaged, brushing and cleaning them is EXTREMELY painful. So knowingly getting them full of food debris to be painstakingly removed later? NO THANKS.  

Accepting Reality

It's taken me a long time to get to the point where I could write this post, because the revelation of how bad my injuries were came to me slowly, and in fact I'm still discovering in new and interesting ways how this is going to affect me for some time.

After I fell, it was obviously really hard to know what the situation was.  I knew I hit my chin on the ground, and that there was a pretty nasty gash.  I also knew, from feeling around with my tongue and spitting out bits of teeth, that there was a lot of damage to my teeth. My husband texted photos of the inside of my mouth to my dentist Dr. T, and she indicated that it was a bad situation. And even when the oral surgeon, Dr. M, visited me in the hospital and told me that my jaw was broken I still sort of thought "Well, you set a bone and it heals. That might be really tough if it's your face, but it will heal." What I didn't know was how different a jaw break can be.

In those early days the pain was so bad that I was given a lot of really strong painkillers that I had to take constantly to manage. And even then the pain was incredible. So the first month was pretty foggy, and it was hard to follow a lot of what I was being told. Dr. M purposely kept information from me, for this reason and also because it was all so traumatic that he didn't want to bombard me with bad news. It was a lot wait and see. Not to mention the fact that only my dentist could tell me what was going to happen to my teeth, and she hasn't even been able to determine that yet. And it's been 3 months! If you can't open your mouth, though, it's impossible to tell. I have to say though, Dr. T has been the voice of reality for me. While Dr. M. withheld information, Dr. T. was as honest as she could be with what had happened. She kept telling me that it would be a very long and sometimes very painful road ahead. That sort of helped me come to terms with it all. She's remained a constant source of support to me that I can't even express my gratitude.

I kept saying to people that the only way I could tell how badly I'd been hurt was the number of floral arrangements that kept arriving, and the strength and quantity of painkillers I was prescribed. It was really just day-to-day and week-to-week in the beginning, and like I said the timeline of healing wasn't really laid out all at once. I received over a dozen beautiful arrangements and my house began to look like a funeral home! And the drugs....I'll write a whole other post on them.

A big source of information for me was the very place you're NOT supposed to look when you have symptoms - the internet. But I needed to know...more information was better, taken with the knowledge that I couldn't take what I read as absolute.  I kind of understood that when I found very little information about my particular break. (And of course that's the reason I'm writing this blog). When it comes to "broken jaw blogs" (my preferred search term, as I was looking for accounts of what it was like, not really medical information), I found there are 2 camps of people who "break" their jaws. The first are people undergoing jaw surgery to correct bites, as part of a planned treatment. I don't discount the difficulty of doing this, but they were doing it to get better or perfect their smiles. In my case, I'm not going to to heal in a better position - my bite will probably never be right, and I'm going to be losing teeth and undergoing hours of dental work, not just the surgery once and then braces and then yay! my teeth line up like they always should and I'msohappywiththeresultsOMG! The other camp are folks like me - they've had their jaws broken through an incident, but I found that usually meant they'd broken one side of their face as a result of being hit with an object or by someone. Not a whole lot of folks have broken their jaws clear of the joints. Yay me! I've always been an overachiever. *insert sarcasm

One thing that I was strangely comforted by was the number of articles about hockey players having broken their jaws - yet even they usually sustain it as a result of a hit, either from another player or, more often, a puck to the face. (Horrific in it's own right). My sort of injury would more likely happen as a result of falling face-first onto the ice and hitting your chin. It's safe to say an NHLer would have to be knocked unconscious before falling like that....their skating skills are pretty solid. Now, as a true hockey-loving Canadian, I'm sickly comforted to be in their ranks - except I never played hockey and wouldn't put myself on the ice with anyone completing a slapshot with such force.

The part that really made me feel better was the all the accounts from said NHLers indicating that this  was the worst injury they've ever had to recover from. Of course, it all depends on the severity of your injuries, but anyone having to have their jaws wired shut were highly affected by it.  Even players who have undergone multiple surgeries say the jaw was the hardest recovery by far. So I feel better. #BadAssBitchAlert. I even found an article (about hockey) titled "Want sympathy? Break your jaw!!" Not to mention my hockey crush since was in the minors, Sid the Kid, had his jaw broken last year, and lost a whack of teeth. I'll just fake a hockey injury if anyone asks. But I digress. My point is that these accounts from tough mothers helped me to see just how serious this recovery would be.

One thing that surprised me once I was with it enough was the fear I would have of riding in cars. I remember hiding a panic attack I was having one day when my husband was driving on the highway. I just could not stop imagining getting into an accident, and what would happen to my damaged and fragile face if the airbag went off. It wasn't fun.

I'd say that at this point I've come to the acceptance that my face won't be the same as it was before. Even if I get braces and a bunch of pretty crowns, my jaw may not put the teeth in the right spot. If I can just get through losing teeth and being without them for a while, I think I might just survive this thing.

Weather Changes

As the snow gently fell all day for the Toronto Santa Claus parade today, it is clear that we are entering that most feared of seasons: Winter. Not that I mind winter all that much. Toward the end of August I seem to start getting really sad at the thought of the end of summer, but then by the time Halloween rolls around I find myself looking forward the change of season. Maybe it's just a natural resilience in the face of something I can't change - some family of ours just moved to Arizona and are experiencing their first non-Canadian winter. I bet they'll miss the cold and show for about 1 day - Christmas. Then it's back to "hey, wanna hang out by the pool?"

Well this year I might have just found my first legit reason to dread the cold.  My teeth are now incredibly sensitive to temperature changes, but mostly cold. Anything below lukewarm and I'm wincing in pain. Hot, however, doesn't seem to be nearly as much of a problem. In fact, I love warm drinks even more now than I did before - and that was a lot. The warmth seems to soothe my teeth.

Inhaling that cold winter air was pretty painful today, not to mention the effects on my jaws too, from sitting out on the street for a couple of hours. Even my wrists were starting to ache (since one was broken and the other had soft tissue damage in the accident).  Thankfully the tooth pain will go away with the root canals that are coming...not soon enough now apparently!

My jaw still hasn't fully recovered from the day, but I'm not surprised.  Once those facial and neck muscles lock up, it usually takes a nap or some good heat on them (usually combined with a muscle relaxant) to loosen them up.  I am always hopeful when I wake up in the morning that I will start out nice and loose, and it's great when it happens.  Sometimes it doesn't, and it can really set me off for the day, or at least the morning. It doesn't help the situation that I'm not a morning person....something I am working on.

If you're recovering from a jaw surgery/injury in the winter months, make sure you keep the area warm as much as possible, and make sure to heat it up afterwards. I was wearing my husbands trapper hat tied up under my chin and it really helped! I started out with a heating pad, but it's really a pain in the ass to use for your face.  I plan to pick up a Magic Bag this week - smaller, more mouldable and portable!!! Nothing is going to be ideal to keep on your face, but anything that makes it a little easier is worth it in my books.

On the other hand, if you are recovering from this in the summer (my accident happened August 12), keep in mind that winter's coming (depending on where you live, of course!) and you'll probably need to deal with the effects of cold eventually. This is a long healing process. Some may say indefinite....

Attitude: How important it is to stay positive..and how hard that can be

"Your attitude determines your altitude."

How many times have we heard this, yet when your attitude is in the dumps, it's almost impossible to bring it up to cruising altitude.

Let's continue with the airplane analogy.  In order to take off, an aircraft has to first overcome inertia to move at all before bringing itself up to enough speed for take off. The force required to overcome inertia is calculated based on the mass of the object and the frictional resistance against that object. Sometimes the weight of what's happening to you can be a lot, not to mention the internal resistance to change, which I think is sometimes something you don't even notice, and if you can't acknowledge it, how can you ever change it?

All this said differently is the very definition of inertia itself.  The word inertia itself is derived from the latin iners, meaning idle or sluggish.
Simply put, and for the intent of my discussion, inertia is the property of matter by which it retains its state of rest (or its velocity) so long as it is not acted upon by an external force.

So I guess what I'm trying to say here is that an important part of maintaining your positive attitude, or trying to change your attitude for the better, is to first acknowledge that your mind wants to stay the current course that it is on and second, know that it is going to take some effort (or force) to change.  

I can say with certainty that I have been both up and down the emotional roller coaster (some times from bottom to top in one day...hell, one hour) and it's exhausting. It really is. I've tried really hard to maintain a positive attitude throughout this journey, and here are some of my tried-and-true tips that can help set you up for success: 

1. Get enough rest. This can be really hard to do when you're recovering, and especially hard if you still have to work, balance family life and keeping your home together. I was fortunate to have lots of help from my husband, mom and hired help (because of the accident, not that I have hired help all the time) to help me be able to rest as much as possible. Being tired, for me, is the surest way to lose all mental resilience. 
2. Get enough to eat, and often. Another toughie when you're dealing with an oral issue, and being wired shut can make this impossible. However, it is critically important to both your mental and physical healing that you stay nourished as much as possible. 
3. Let it out once in a while!  Your loved ones will be there for you when you break down, and they will still love you just as much as ever. And if that isn't enough, seek counselling.  This is something that I considered carefully all along my journey so far, and I have managed to go without it. Does that mean it wouldn't have benefitted me? No. Does that mean I won't continue to carefully consider reaching out for help? Absolutely not. When my bad days outnumber the good, or if I end up having to lose any major teeth (like the top fronts) or a large number of them, I very well may reach out. And there is absolutely no shame in doing it. 
3. Find distractions. Read a book, binge-watch a show, take up knitting....something, and hopefully a combination of things that you can use when you just need a distraction.  All of these things have helped me. 
4. Don't isolate yourself. Go out in public. Talk to people, visit, be social. Act as if.  Act as if life is normal, this is something you can handle, even if you don't feel like it sometimes. This can be a strategy...but not the only one. Sometimes it can help...but it won't always. 
5. Don't look back, try not to relive the moment, don't try to find a reason for it all. At first I would ask myself, 'Am I really not a good person?' 'Why did this happen to me?' 'Is this karma? Have I done something to earn this, or am I putting a deposit into the karma bank now that I can withdraw later?'  The answer is that life just isn't fair sometimes.  Really bad things can happen to really good people, through no fault of their own. Trying to find a reason for it will drive you crazy because I can tell you - there's no reason for it at all. 

These are just some ways I've found that I can help bring my attitude up when it's starting to sink. And I really believe that your attitude can help with your healing. So stay strong, and if you don't feel strong, lean on someone. Do something to get your strength back. Nourish your body, and then your mind. Your body is the foundation, your mind is place where you dwell. 

The "Waiting Place"

If you've ever read the Dr. Seuss book "Oh, The Places You'll Go", you might remember the Waiting Place. As the good Dr. says, it's the most useless place. This is where I've found myself.  I've had the hardware removed, and I have an appointment next Thursday to begin with my dental work. I've been so looking forward to this part (root canals, oh my!) because it means the beginning of the end of the ongoing pain I am experiencing with my teeth.  Once the root canals are complete on some teeth, the pain should go away.

However, when the arch bars (or "grillz", as I prefer to call them) came off, Dr. M found that the lower left canine, the 33 tooth that came out during the accident, was not re-attaching as well as he had hoped. In fact, it's very loose. It's also being squeezed by the teeth beside it, so whenever I yawn, chew or touch it I can feel it grinding on the adjacent teeth. It's not pleasant to imagine it moving so much, and it's also incredibly painful. So, Dr. T (my dentist) will pulp it (root canal it) and bond it to the adjacent teeth in a last gasp effort to get it to stay put, but the prognosis isn't good and so I'm preparing myself to lose it.  It's a pretty important tooth for mouth structure and is also located right above one of the fracture sites, so may require a bone graft to be able to place an implant. It also needs room to exist so I will likely be without it for a while if it does come out. Braces will help to make room. The other tooth I'm likely to lose is the 14, which is the 4th tooth from the back on the right side. Not a "front" tooth, but also not really a "back" tooth. It's likely vertically fractured to the root, which is completely unsalvageable if that's the case.

I'm most concerned, however, about my top front teeth. They were moved with the block of bone they sit in, which is the part that was actually damaged. They need pulpotomies at minimum, but they have also both changed colour. It's not obvious because I had them both capped in a previous dental life, but if you look at the back of them (which I can with a makeup mirror) they look ghastly. The right one in particular is quite painful, and if they are broken at the roots, they will need to go as well. Just the very thought of this is horrific to me. This, in combination with a couple of others being gone, just breaks my spirit. There are a couple of others that might go too - the 35 and the 45 are broken very badly, and may or may not be salvageable. So in total, I stand to realistically lose any combination of 6 teeth. We won't know until Dr. T gets in there and takes a look.

So waiting to find all this out is, in the least, very nerve racking. I've been oscillating between feeling like it's all not so bad, I'm not critically ill, I will survive this and it will all be ok in the end, and then feeling like it's all so traumatic and awful and preparing a bunker in my basement to hide in until it's all over. I can't tell if it's one or the other, or maybe it's both just at different times, or somewhere in the middle all the time. I mean, let's get real here.....

I'm a 33 year old woman, who fancies herself at least somewhat attractive. I've lost bone in the sides of my face, making it even skinnier and longer than before and it's really not very pretty. This can be fixed with bone grafts in the future - BONE GRAFTS!  Come on!  Then, possibly losing a bunch of teeth, including the front ones....and having to wear a "flipper" until I get permanent replacements put in. Or braces with hopefully some fake teeth attached to look somewhat normal. I want to have another baby sooner or later, but how do I even manage to feel attractive enough to smile in front my husband, let alone feel sexy. I love him, but if he lost a bunch of teeth, let's be honest. I wouldn't look at him the same way either. At least not until they were replaced. And all this because what? I went to a gym class?? I wasn't in a car accident, I wasn't sky diving or doing a extreme sport, or in a street fight. I was trying to do something good for my body. I know several people who've made the risky decision to engage in street fighting and THEY have all their teeth! Why did I deserve this??

So there you have it. I'm trying to stay sane in the meantime....hopefully I can keep  my head (and teeth) above water.

Freedom from the torture device

This Halloween marked a full 11 weeks of wearing the arch bars and accompanying wires, and also the day that they came off.  Here's my experience with that procedure and what it's like to finally be free! 

The whole apparatus itself, if you've ever had to wear one, is just pure evil in your mouth.  The bars themselves aren't so bad, but the way they stay on is by wrapping wires around each one of your teeth and then securing them as you would any wires - twisting the loose ends tightly together and snipping them with wire cutters.  Pretty standard, except when they're inside your oh-so tender mouth.  The wires are really very primitively cut, leaving sharp edges, and some are wound up near your gums, while some are just bent into little hooks. Without a lifetime supply of wax, your mouth will be shredded in no time...and sometimes the wax just isn't enough. 

So you would think that I would have been pretty excited to get these babies off. 

And don't get me wrong....I was. But the purpose of the arch bars was to hold my bone in place - the chunks holding my top front and bottom front teeth were both broken and pushed back/forward respectively, so the thought of being without protection was scary. Not to mention my canine that was avulsed and that I am still at risk of losing. Anyhow....I digress. 

The plan conceived between my oral surgeon (Dr M) and my dentist (Dr T) was to put me under with general anesthesia because my teeth are still all broken and so tender, and also so that if he took off the bars and found any teeth that were in worse shape than could be judged with the bars on (excessively loose, etc) Dr M would be able to remove them then and there. I'm happy to say that I woke up with all my chiclets in tact, though I know I won't be keeping them all. 

The night prior to the procedure I was so nervous, but not for any reason you might think.  The last time they knocked me out, I had the IV in my hand, which I hate because I am pretty thin and I dehydrate easily. Once I follow the instructions not to eat or drink for 6 hours before, my veins are pretty tiny. So when Dr M pushed the anesthesia into my tiny dried up vein, it burned like a sonofagun. So THAT'S what I was afraid of. Well, I shouldn't have been, because as soon as I told his nurse that, she put the IV in my arm instead, which is a bigger vein and it barely burned at all. Relief! 

Waking up without the bars on was great, don't get me wrong, but I was totally frozen. Even though I was put under, Dr M froze my mouth, so I couldn't tell.  Apparently I did the customary professing my love to them while waking up from the anesthetic, which makes me happy. My brothers girlfriend had come with me too, who I am quite fond of....apparently I told her so as well.  Good thing I'm a happy drunk! 

A couple of days out now, my mouth feels much better. The tears inside my cheeks have started to heal up, and I don't feel as nervous about not being "protected" in there. My teeth, however, all still hurt, and maybe more so than they did before. This might be because I don't have the pain of the wires distracting me from the pain in my teeth.  The canine that came out is very loose, although it hasn't turned colour yet to indicate that it's dying. It is very painful....so much so that I am taking painkillers on the reg. I have to go in to see Dr M on Tuesday and get a splint made up for it to hold it in place...apparently it's an important tooth for mouth structure and Dr M is trying desperately to save it. 

He told me that I'm free to pretty much eat whatever I want, but that is in theory only. The tooth pain is too intense to actually chew much of anything, so I am on soft foods unless there's something truly delicious that I'm willing to stand the pain for.  My jaw is somewhat fitting together right, unless the muscles tighten up or go into spasm, which pulls it downward and out of place. It's painful, and also strangely feels like when a knuckle needs to be cracked. I guess that's because the joint isn't quite sitting right, or that's my best guess. 

I will leave you with an after photo. This is right after surgery.