Chiropractic Treatment #3

Following my visit with Dr P, I went straight to Dr Nino's office for another chiropractic treatment. (Ok, that's a lie. I had buffer time in there in case Dr P was running late from surgery, and he wasn't. So I had time to hit up Winners on the way. Don't tell the hubs.)

We did the now-standard acupuncture needle placement, then head massage and ART.  Dr Nino started with the back of my head and then moved to my temples and generally upper head.  It felt so bad/good, and he said that he was using a lot more pressure this time than last, so although it still feels just as painful for me, it is getting "better".

The massage/ART on my neck/head is so painful. I can really tell that it's the back of my head that's in really bad shape, but when he gets to my temples its like I could lie there all day.  If there was a device out there that would massage my temples like that, I would pay all the money in my bank account for it.  Instead I'm going to have do a hard negotiation with the hubs to give me some TLC.

After a bit, he moved on to massaging my masseter muscles.  To remind you, the masseter is the muscle that helps you chew, and runs inside your cheek, attaching all along your jaw line (see image).

The muscle itself should feel like a soft pasta noodle, while I hear mine feels more like uncooked spaghetti.  Dr Nino must be Italian.

Anyways, it hurt like a sonofabitch.  Of course afterward all I felt like doing was sleeping.  Then the power went out and my son wanted to sleep in our bed.  Actually it wasn't so bad, I got some cuddles in and it was awesome.

Joint Replacement Consult #2

Yesterday afternoon was all about me and my damn face!  I had a visit with my therapist, my follow up consult with Dr P, followed by a chiropractic treatment.  When I finally got home in the evening, I was feeling relieved and at peace with my situation. Here's how my Dr P consult went.

I had my initial consultation with Dr. P in November, where he had reviewed my xrays, cone beam CT scan and reports from my dentist.  This visit was tough, it was in the evening and my husband and 3 year old son came with me.  I wanted my husband to be present for Dr P's thoughts and recommendations, but after our son almost broke some dental molds in his office, he ended up in the waiting room with a busy little boy.

Dr P gave me the news that day that he was recommending a total bilateral TMJ replacement with custom prosthetic joints. He obviously ran through all the reasons he was recommending this, the treatment plan, complications, costs, timeline and answered the limited number of questions I had for him at the time.  My husband didn't hear any of this, and had a really hard time accepting this as my only option.  So this time I wanted the hubs present. And he was.

Dr P reviewed my recent symptoms and took a look at my "bite".  You could loosely identify it as a bite. The thing that struck me most about him this time is his confidence and assuredness that he can help me.  He managed to say, in the most compassionate but not condescending way, "Don't worry, we're going to fix this for you." I am so pleased with his demeanor and the confidence he inspires in me that he can help.  It truly seems like no question is beneath him to answer, and that he really cares for you and your well being.  It's sad to say, but if only all doctors could convey that.

Anyways, we discussed the fact that my anterior fracture site is lacking in bone, and that I was concerned about trying to move teeth around in that area.  Again, he wasn't concerned. He said it shouldn't be a problem, and that yes, I might lose a tooth or two in that region but then implants just become part of the ultimate treatment.  Again, making me feel like I needn't worry....he's got this.

My husband wisely asked him about my tooth pain, specifically that every time one of my teeth starts to hurt I worry that it means I'm going to lose them.  He reassured me that, no, that's not the case.  My teeth have had root canals, but the nerves around them are all damaged and it could take a long time for them to settle down.  He feels good that in the long run it will subside.  He mentioned he even has one patient with persistent pain, but all the xrays of her teeth show normal pathology. Since the teeth look fine, he is keeping them in her head and managing the pain for her.  I like the sounds of that.

The MRI results that he received just confirmed what he already knew or suspected.  Both discs in my TMJ's are displaced, meaning they are no longer cushioning the bones of the joint. I don't know if they are forward or backward, but they're not where they're supposed to be.  The rest just confirmed that my joints are messed.  The report did confirm that I have a normal brain, and for some reason he just laughed when I requested a copy of the report saying so.  Weird.

We discussed medication, which I have not been taking, for some personal reasons.  After being reassured by my doctor that it wouldn't be a problem to take Vimovo (an enterically-coated NSAID anti-inflammatory) and Flexeril (a muscle relaxant for bedtime) I finally relented to trying them.  Dr P thinks I'm being silly and just told me "take your pills!"  This should also help with the tooth pain, and I have to say that he's right.  I took my first Vimovo last night and one this morning (the dosage is 2 pills per day) and I can feel a difference in my overall pain level.  My joints are still quite sore, but it's not as bad as it was. 

The Flexeril is another beast altogether.  He recommended starting with 1/2 a pill at first, and I took one last night. Boy did it knock me out! I remember waking up when my husband got into bed last night and being so incredibly dopey. I also needed a strong cup of coffee before even hitting the shower this morning to wake up. It was strange. I don't know if I'll take those every night. I don't want to take anything that can cause a dependency, and I'm not sure about those guys.

We also discussed what I think is a misunderstood aspect of TJR (total joint replacement), which is ultimate pain relief.  The research I have done online (admittedly, not the most reliable source!) told me that this surgery is not primarily intended for pain relief.  The intended goal is to restore function, and patients should not expect complete pain elimination as a result.  This is concerning! I have spent months now worrying that I wasn't in enough pain to warrant this, and wondering if the surgery could cause me to be in more pain afterward with the implants than I am now. 

I now believe that I'm not a great judge of my pain levels in the moment.  I've had tremendous, debilitating and horrific pain post-accident, and any pain I feel now seems so insignificant in comparison.  However, any time I've experienced further pain reduction, I look back and see how much pain I have actually been in without acknowledging it. 

In any case, Dr P explained that no, the surgery cannot guarantee complete elimination of pain.  However, the studies that have been done show a marked decrease in pain levels for most patients.  In fact, the numbers show that 85% of patients who have undergone TJR experience pain level reductions from 8-9 on the pain scale (out of 10) to 2-3.  Interviewed about their satisfaction with their results, most say that they would choose to do the surgery all over again.  I've joined a jaw surgery support group on Facebook, and had a chance to speak directly with some ladies who have gone through it, and they say the same - their pain is way less or gone, and they're so happy they did it.  What reassurance!

What else? Dr P is just waiting for Dr O (my orthodontist) to get my teeth straightened and let him know when he might be able to schedule surgery.  I'm sure this is a long way off, considering I only get my lower braces on next week, so I'm certainly not holding my breath yet.

I will go back for another follow up visit in 4 months, and hopefully there will be some good progress toward the end goal!

The value of a good pillow

This past weekend I was traveling, and slept in 2 different beds in 2 nights.  Usually I like to travel with my own pillow, which might be one of the few high-maintenance things about me.  I'm quite tall (5'11") and have fairly wide shoulders and am a side sleeper, which means flat pillows are like having no pillow.  Everyone's pillow preferences are different, and not everyone has enough pillows in their house to accommodate your needs when you visit (plus, I'd never ask them to). Plus, I have 3 siblings from one house, and when we are all there with our partners and/or kids, there may not be enough pillows to go around. So, I just decided long ago to embrace my inner pillow diva and both invest in a good one (which turns out to be amazing for me now) and bring it everywhere with me.  Judge me. I don't care.

A few years ago, my husband and I decided to go invest in a couple of good pillows. We went to the store, tested a bunch, spoke to the sales person and each took home our favourites.  His is a memory-foam type thing, mine is a thick but very springy foam. I love my pillow. Maybe a little too much.  We never switch (we each think our pillows are superior) and I never sleep without it.  If I recall correctly, they were +$100 each, but amortized over however long we will have them, I think it's well worth it.

Well I decided that I wasn't going to bring my pillow with me this past weekend.  I'll be fine, I thought.  I'm the only one sleeping over (well, my 3 year old too, but he DOES bring his pillow everywhere....).  I was wrong. 

The pillows on night #1 were adequate in height, but much firmer than mine.  Normally this would be fine, but I've got a couple of ticking time bombs on each side of my face. And, as mentioned, I'm a side sleeper.  It was like sleeping on rocks, and my face ached the whole next day.  Night #2 was better, a thick, soft pillow, but still not mine.  Plus my lingering soreness needed some recuperating, and only my own pillow would do it.

So there you have it. I'm writing a blog post about my damn pillow.  The old me would be embarrassed, but the new me (post injury) gives zero F's, so I'm cool with this.  Plus, my experience this past weekend has made me realize that a lot of my lack of intense TMJ pain might be related the fact that I have a great pillow for my condition.   So the real reason for this post is to tell you that if you're in the same boat as me, go and find yourself a great pillow.   I wish that I could remember what mine was so that I could recommend it (if I find a label on it I'll update my post) but I'd say go out and buy the best pillow that you can easily afford.  There's no need to break the bank but I'm confident saying that it will help your pain levels, especially if you're a side sleeper and can't give it up. 

Like I said, my pillow is great for me being a side sleeper.  You'll have to choose your own type based on your sleep preferences, but I'd say one of the key things is something really soft and springy, as little firmness as possible so that it cradles your face without pressure.  To me, it's like how a cloud might feel if you rested your head on it. (How's that for a sleep analogy).

It's just like my mom always says....there are 2 things you should spend good money on: shoes and mattresses.  And by extension of that - your pillow.

ART/Acupuncture Treatment #2

Yesterday afternoon I went for my second ART/acupuncture treatment with Dr. Nino.  I was feeling pretty excited, since the results from the first visit were so dramatic! It was definitely another good experience.

During my first visit, he took my history and asked a lot of questions, including whether or not I was working out again.  Actually, he assumed I was NOT, since pretty much every exercise involves clenching your jaw (consciously or not).  I said, no...I WAS working out, and not finding it a problem.

Well....I was treated on Thursday afternoon (after a workout) and didn't get another chance to hit the gym until the following Wednesday. And when I did return, boy, did I ever start feeling the muscle pain and tension in my jaw. I did a bit of rowing on the ergometer (my cardio of choice, or running) and I don't think that has been helping me.  So I'm going to have re-think my exercise strategy.  Maybe I'll try to hit more yoga classes....I think it's going to be a lot of trial and error.

That being said, I went in yesterday with some pretty tight muscles, but still not horrible pain considering where I had been prior to the first visit.  Dr Nino was pretty happy with 6 days of relief.  He put in a few additional needles, choosing to do a point on my feet (between big and second toe), one on my chin just below my knee (for muscle/tendon pain), one on my hand (between thumb and index finger), 2 in my TMJ's and one on the top of my head (apparently for mental well-being). I don't know all the details of the points, so I won't pretend to be able to recommend them to you).  Then he did a lot of massage/ART on my head, which felt AMAZING(ly painful). Actually, it felt great at times and awful at times.  He also discovered 2 huge knots in my shoulders (between trapezius and levator scapulae).  These are still very painful as well, and could be a result of being at a desk most of the time during the day.

I can't say that I felt any immediate relief afterward, but last night I was just exhausted. I made and cleaned up from dinner, took a shower and got right into bed, lights out by 8:45pm. I slept like a baby, and this morning I feel pretty good, with some soreness in my shoulders. 

I will say that my jaw feels more sore than usual, in the joints themselves.  I have found in the course of my healing that I have so many different types of pain that when one subsides, it's like my body gets a chance to feel another that may have been there all along. Not sure if this is normal in pain management, and it's weirdly not that stressful, as long as the pain is manageable. Nix this if it's tooth pain.  Internally I lose my shit whenever I feel tooth pain....and constantly until it goes away.  It's not cool.

I also feel a bit like the left side of my mouth is getting shorter - which I'm sure is totally unrelated to this treatment, although who knows. I can feel the gums behind my molars almost touching, or touching but lightly. I am sure this wasn't the case before. 

My worries

This post is about all the worries that run through my head during my situation, and how I am learning to deal with them. I might note that it took me a few hours to write about my problems, and several days to write the rest of it. This stuff is hard!
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Last week was a breaking point for me. I didn't even realize that it was happening until I found myself saying (out loud) "I don't want to be here anymore". I didn't mean that in the literal sense, but those were the words that came out of my mouth, and I know that what I really meant was that I just wanted to step off this crazy roller coaster ride that this situation has brought to me.  

I felt very much that the perfect storm had converged on my life, but nobody knew it except for me. I don't want to write it all out in detail, and it feels funny putting it into a bullet-point list, but for brevity's sake, I will:

- I was on my 3rd week back at work, and supposed to go from working 4 hour days to 8 hour days
- I was feeling exhausted from just getting up to go to work for the past 2 weeks
- I had a braces wire change that caused a lot of tooth pain (in one tooth, the pain extended into my sinuses)
- My teeth moved after the wire change, causing my jaw to reposition
- The jaw repositioning caused a lot of jaw pain to come back, and the muscles in my head to seize up again
- I learned that the tooth beside my extraction/bone graft site might not be able to stay in due to bone loss (the tooth is otherwise healthy and wasn't on the 'list' of ones to worry about)
- The insurance company processed my dental claims so far, and either messed up or purposely denied paying half of them.
- And finally....all that was going on with my head (physically and mentally) was unseen by everyone around me, so they all thought I was doing fine. I did NOT want to put my hand up and tell everyone that I was sinking.

...Except, that's exactly what I had to do.  The night I found out about the tooth, I think I hit my breaking point. I was just done. Done with it all. This road has been long and hard, and I have been handling it pretty well, but I just want it to be over. And it's so so so far from over.

I say that it was a breaking point for me because I truly felt that I couldn't continue even going to work, and emotionally I felt completely depleted.  I really had nothing left to give, and it felt terrible.

So, what am I going to do about it?  Well for starters I made sure to visit my counselor/therapist for our scheduled meeting. Here I was able to lay it all out with pure honesty, because I didn't have to worry about upsetting her by being honest. And also because I don't have to feel guilty for talking about myself...she's paid to listen. That helps too.

There were a lot of things we discussed, but she made a few suggestions that really hit home with me. First, she suggested I try a specialized form of therapy that helps you deal with trauma, specifically letting it go so that it doesn't continue to affect your life on a daily basis. I'm super interested in that! I'm sick of thinking about my injury and reliving the moment that it happened.  If you've ever had a traumatic event happen to you, you know what I mean. If you haven't, you probably think I'm crazy and should 'just don't think about it'. Hopefully you're being open-minded with me here.

Another thing we talked about is that this whole situation is starting to become most of who I am, and is beginning to 'define me', if you will.  This goes along with the whole letting go of the trauma bit, but goes further to try and let go of what's happening to me. I'm fully on board with this.  I wanted to return to work to move on in my life, gain some perspective and introduce more areas of focus in my life. It hasn't worked thus far, but I hope I'm on the other side of that with better pain-management strategies (to remind you, I refuse to take any medication stronger than Tylenol and the occasional Robax for now).

So the thing I'm working on now is to gather up all of my worries and concerns, package them into a nice little bubble*, and blow them away (*Friends reference....I am not losing it!)  I need to acknowledge that I might lose a bunch of my teeth, accept it and be grateful for what I end up keeping.  I might not know for sure what surgery is right for me, but I need to trust that I've sought out enough expertise that I'm making the best decision I can, and move on from it.

I think this 'letting go' is going to be critically important to me over the next several months and maybe even years. I can't continue to let the doubt and worry consume my thoughts on a weekly or even daily basis. I can't live my life fully if I am paralyzed with fear.  And so I'm going to make the choice every day to trust my future to whatever it is that is leading me...be it God, fate or chance.

Pain Relief through acupuncture and ART

Yesterday afternoon I had my first acupuncture treatment for my TMJ/head pain, and I want to share what my experience was like, and encourage you to seek out this treatment if you are having any TMJ issues or even chronic headaches or head/neck pain.

I have my husband to thank for this post, since it was he who encouraged me to actually make an appointment to go for acupuncture. As I mentioned, I've had acupuncture in the past for other issues and found it to be enormously helpful, so he thought it would be worth a shot. I researched it a bit prior to making the appointment and found that it does show strong correlation with TMJ/TMD pain relief so I was really encouraged. It turns out that he was right.  I was treated at 3:30 yesterday and I am feeling enormous relief today.

In trying to find the closest practitioner in the area, I found a chiropractic office that offered it. Turns out their chiropractors actually use it in combination with other therapies. I wasn't sure if this would be a good thing or bad, since I was looking for purely acupuncture and no adjusting, etc but it worked out great.

The chiro that saw me (Dr. Nino) isn't that well-versed in TMJ issues, but has treated many severe headache patients and knew a fair amount about that.  He has been in practice for 20+ years and is very experienced, which I think is critical for me since my case is so rare and extreme.  He admits that he's no expert in this, and that he is playing just a supporting role to my other doctors, and I think it's good that he is thinking along those lines. He knows that my problem will only be resolved surgically and he's going to help me manage the pain in the long-term while I wait for surgery, and likely during recovery too. He agreed that chiropractic adjustments are too aggressive for my situation, considering all the bony issues I'm having..and anyways TMJ adjustments are sort of discouraged in the chiropractic community since they may provide immediate relief, but contribute to joint damage in the long run.

So how did he help me? He used a combination of ART - active release therapy, massage and acupuncture.  Active release is not that well known, but if you've had a massage, you've probably experienced it without knowing it exactly.  It's where the hold onto the muscle by pressure and then either manipulate it for you or you move it yourself. It can be intense and painful.

I told him my main problem was temporalis muscle pain (see image below), where it feels like either a vice squeezing my temples or screwdrivers being pushed into them - depending on the level of pain, and it's pretty constant. Surprisingly, he found that the back of my head was causing me most of the issues, with 3 nerves underlying them that wrap up over the back of your head toward your temples and eyebrows. Putting in needles at 3 points - the hands and feet (for overall pain relief) and only 1 TMJ point (it got too intense for more at this visit), he then used active release and massage on the muscles at the back of my head, some in my jaw and a little at the temples.  I'd say he spent 80% of the time on the back of my head, but said that all the muscles in my head are very tight. It was intense and pretty painful, in that sort of "so good it hurts" way.

Before I left he gave some stretches for my platisma muscle - this goes from the front of your chin all the way down the front of your neck to your clavicle (collar bone). Mine is very tight, and as a result is pulling my jaw backward, causing a lot of pain.

I really felt great after I left, despite the soreness in my head from the massaging. Last night I felt a lot of relief, and this morning I feel so much better. It really helped, and I have booked another appointment for next week.....and I bet every week thereafter.

If you are having chronic headaches, TMJ issues, head/neck pain, I would strongly urge you to try ART or acupuncture. Just visit with a practitioner to see what they think they can do, and consider it. So far I am so happy with the results.

Time to get real

Hi Friends, I feel like today is a day when I should warn you that I want to get real. I hesitate to make these posts, because...well, I think we've all become accustomed to the social-media world where we don't really share anything unless it's to humble-brag our way to some compliments or share our best-lit, filtered and perfectly-angled selves to the world.  I've always been a fan of those who are honest and tell things the way they are.  Isn't that the truest way to connect, to share our real experiences, thoughts and emotions so that we can hold a mirror up to each other and say "Hey. I thought I was the only one who felt that way. Let's help each other out here!" It's sometimes easier said than done. 

Sharing your real feelings can have that effect, but it can also open you up to a few negative reactions.  It's possible that your feelings won't be validated, or you'll be seen as whining, complaining or just plain annoying. And maybe people will do what they think is helpful: feel sorry for you. Get stressed out for you. But this only adds to the issue. 

In sharing, I think we all just want to be heard, and hopefully understood. Just getting it out is half of the point!

So having said all that, I'm into my third week back at work, this week I'm adding an hour to my day, so a total of 5 hours a day every day of the week.  And I'm tired.  Truthfully, I had no idea that it would be this hard.  If this had never happened to me, I'd probably think that I had it good. Working in the morning, afternoon off, man...she must have time to do everything!  Well, I might have the time, but certainly not the energy.

My jaw is re-adjusting to my new bite almost constantly it seems. Since having the braces put on my top teeth, the gap between my front teeth has gotten much bigger. I was warned that this would happen by my doctors, since the braces aren't in there to make things fit together, just to straighten the bone. This makes talking and eating difficult, and this movement has translated to jaw movement. Any time that happens, the muscles all seem to seize up and the effects go all around my head. There is significant muscle pain up to my temples and around behind my ears.  Touching any of the muscles in my head is incredibly painful, and just sitting doing nothing my temples feel as though they are in a vice.  Unfortunately, muscle relaxants are all that seem to help this, and I certainly can't take them at work or if I have to drive so I don't get any relief during the day.
Here's a photo of my "bite". (Apologies for the quality, it's a cropped cellphone pic):

My bite also has no "home", so my jaw is constantly moving around. It seems to recess backward during the night, so that during the day it's sore from having been in the wrong spot for so long. I actively move it forward during the day.  I used to wear my bite splint to keep things where they should be, but I can't seem to use it anymore. My front lower teeth now have a lot more room than they used to with the canine being gone, so they move. When I put the splint back in, it forces them where they used to be, and it hurts.  Not to mention, I don't really want to be moving my teeth around down there constantly.  The fracture site is still in rough shape, the bone graft is healing and my doctors are worried that the fracture site may not be able to hold the teeth in place.  So that's scary. I am now at risk of losing a tooth that was never in jeopardy before, and am still at risk of losing any of the others that were damaged.  I'm surprisingly fine with missing my canine, but any more and I think it will really start to affect my coping. This might sound dramatic to you, but imagine losing some teeth.

I've made an appointment (a "Doptor's Appoint", as my 3 year old calls them) to see an acupuncturist in two days for the pain in my TMJ region.  I have had acupuncture before and found it tremendously helpful, although it was for a totally unrelated issue. I can't wait to go...I am sure it's going to feel wonderful(ly awful), just like a good massage. I'll certainly share my experience and any benefits that I experience from it.

Beyond the physical pain, we've received some feedback on the insurance claims that is causing a lot of stress.  It seems that even though we called and spoke with the company twice while going through all the medical procedures, they failed to share that I have a 90-day window to submit claims after treatment as well as a 12-month time frame to complete my treatment.  Perfect, since a lot of procedures were done before then and my treatment will certainly not be completed within a year.  I just can't wait to try and fight them on this.  Thankfully my doctors seem willing to help, which I suppose is in their best interests!

I said to my hubs last night that.....I really wish that I could just take a break from my life. It seems like this constant emotional roller-coaster where I think everything is fine, pretend that it is and forget about the seriousness of the situation. Daily pain is what it is, I'm kinder to myself, more gentle and understanding. Then I get tired, not so resilient and I remember all that I am still going through and what the worst case scenarios might be.  How misunderstood I feel sometimes. How I just want to be normal again. It all comes crashing in...and I mean everything. I feel useless, both at work and at home. I am too tired to go to the gym, so I feel guilty when I skip it.  I make poor food choices so I beat myself up about it.  Is this how it is? Or is it possible to live with a more balanced perspective?

My thoughts in braces thus far

I wanted to write a post about what it's been like having braces so far, and that combined with my jaw limitations as well. Seeing that I only have braces on the top right now, this might be a little bit of jumping the gun, but why the hell not.

I opted to have clear brackets put on the front 6 teeth, for aesthetic reasons, obviously.  Dr. O. let me have them, which I am grateful for, since they aren't quite as "good" as the typical metal ones.  The reason is because they're made of ceramic and so are pretty strong but not as strong as the typical metal ones. This means if your teeth have a long way to move, they're not the best option since you need all the leverage you can get.   They're also more fragile, since if they break, they will shatter. In yo' mouth! No thanks! This is why some folks can have them put on the bottom fronts too, and some can't - if your teeth overlap enough to touch the brackets there, you can't really have them because the forces of your teeth hitting will damage and likely break the clear brackets.  There are of course little appliances your ortho can put in to stop your teeth from hitting like that, but I'm assuming in some cases it won't work or isn't worth it.  I'm assuming that since my front teeth don't overlap at all (or even think about touching) that I could technically get them for this reason, but I think it's safe to guess that there are other reasons why I can't have them. For starters, my bottom teeth need to move quite a bit. I haven't discussed clear brackets for the bottom with Dr. O, but to be honest I don't really care if I get them. I am not smiling as big now as I did before, so my lower teeth aren't really showing as much. They used to show a lot, since I'm a pretty expressive person and tend to smile big and try to laugh often.

So that being said, I can really only speak about what it's like to have top braces on.  It is definitely very hard to get used to having them at first. They're big and bulky in your mouth, and they can be really uncomfortable against your lips and cheeks. Your top lip doesn't really know what to do with itself with all the hardware now in there, but it eventually sorts itself out. One bonus is that the braces are giving much fuller-looking lips! It's like having lip injections that don't go away. I don't mind at all, I've always thought my lips were on the small side. I'll take any advantage I can get!

On my back teeth I have the regular Damon system metal brackets. The difference with the Damon brackets is that instead of having ligatures around the brackets, they have little doors on them that the wire threads through. They literally open the doors (like suicide doors, not a massive coupe door) and put the wire in. This also means that the wire is free to slide through brackets, although it doesn't move around freely. You don't have to get your wires "tightened" for this reason - as your teeth move, the wire moves too. Then 4-6 weeks later, they just take the whole wire out and put a new one in, and they increase in strength each time.  The metal brackets are pretty comfortable, they're smaller (or at least don't stick out as much as the front clear ones do) but I have hooks on every single one of them, and even on a couple of the front clear ones too. They really do a number on your mouth.  I don't actually know if I have the normal number of hooks in my mouth, or if I have them on every bracket because my mouth will need to be wired shut eventually. I should ask.

The soreness in your lips/cheeks does go away, but I'd say it's very wise to stock up on wax and use it whenever you need to.  It really helps to calm down any sore spots, and it's a welcome relief when you're talking and moving your mouth a lot. I found that it helps to accelerate your mouth becoming adjusted to the braces actually.  You're trying to build up some toughness in your tissues so that they get used to the braces and you DON'T have to wear wax all the time, but sometimes they get so roughed up that they are like sores and need time to heal themselves and when they do they seem to get....calloused if you will. (Trust me, you won't have calluses in your mouth - ew! - but I'm not sure how else to describe it).

One thing I've found to be an awesome product for this is......get ready for it....silicone ear plugs!  I actually found this tip from trolling the internet doing research on what it's like to have braces, and I can say it's SO TRUE.  Your ortho should provide you with dental wax, and you can certainly buy it at drugstores.  Mine even keeps packs of it in his mailbox so you can come get some for free any time, any day! (He's awesome) But I prefer this stuff, even though it's $10/box at my drugstore! So why is it so great?  It's much softer than wax, so when you break off a piece and roll it up it's much easier to manipulate, and is easier to form it. I like to make little discs with my fingers and then lay them on top of the brackets. It covers very well, and is so pliable that it just sort of fits into the little bracket spaces.  The wax is harder, so harder to press onto your teeth, and it's sort of an opaque whitish colour, where the silicone is more clear, so I feel like it's more discreet when it's in your mouth. And it stays better...the wax sort of melts if you drink or eat anything warm, where the silicone stays in place. I was even using it to coat the front brackets and prevent food/drinks from touching the clear elastics and staining them. It worked! Now that I have the wires instead of clear elastics, and my mouth is a little tougher, I'm not using it. So even though it's expensive, you don't need it 24/7. And you'll need to use it less and less as time goes on. Here's what my box looks like: 

So what else? Eating. Let me start by saying that my eating experience will be very different from a regular braces-wearer. It's a lot more limited by the fact that my jaw is uneven and barely any of my teeth touch each other.  On the flip side, since I was wired shut and in a ton of pain when I wasn't wired shut, eating with braces is just another challenge.  Yes, they get food stuck in them constantly. Yes, they make biting into things difficult (or even impossible) and yes, you do have restrictions on what you can eat. (No popcorn, no gum, no chewy candies, no hard candies, no hard crusty bread...the list goes on). I have more issues with what my jaw can handle than what my braces limit me to.  Chewing anything really crunchy or chewy (steak, I'm looking at you) is tough. I do it, but it's not comfortable and it's probably not good for my jaws. (They're being replaced anyways).  As for gum, I've replaced it with mints and Listerine pocket packs. The worst part about eating for me is worrying about staining my front brackets/ligatures. Coffee, tea, curry and chocolate are the WORST.  It made me so sad, and almost wish that I'd gone with all metal brackets just so that I could enjoy eating as much as I could, particularly those things that didn't hurt my jaw!  With this new Teflon wire, I feel much more liberated.  Who needs to burn a bra?? Just get a wire ligature on your clear braces! Duh.

Cleaning your braces. Ugh. Get ready to carry a toothbrush with you everywhere you go. It's a PITA. It makes you stop and think: Do I want to eat that and then go brush? Or maybe just not eat it. I tend to use a knife and fork to eat everything. Even sandwiches, because who wants half a sandwich stuck in their front teeth? And it's not like having food stuck in your teeth - you can't necessarily feel that it's there.  My ortho gave me a Toob toothbrush (pictured below) and it's awesome. It's got a little tube for your toothpaste in the handle, and it's refillable! You can put whatever toothpaste you want in it. The only downside is that the bristles are pretty stiff, so to get under the wires you have to push pretty hard. Using it constantly is painful for the gums, but it's good for the occasional use when you're out. Here's their website: http://www.yourhealthysmile.com/toob.html

One thing I've found to be totally amazing for braces is a Waterpik. I got the WP100 and I love it. The only bad thing about it is that it's not portable - when I'm away from it for a day or two, I miss it so much! It's not that flossing is actually all that hard, I do floss still (but not as much) with my usual Oral B Glide Pro Health, and I don't even need to use the floss threaders.  Because it's a tape, it's narrow and just slides right between the wire and my teeth and doesn't take that much longer than regular flossing.  If you can thread a needle, you can definitely floss with braces.  It's just that the Waterpik is so thorough! Even when I think my teeth are clean, embarrassingly it always flushes out stuff I didn't know was there! My mouth feels so amazing afterwards, and for $60 it's not too pricey an investment.

So there you have it! What I've learned about having braces thus far.  If you have any questions or comments on what you've found helpful, please let me know.

First wire change and no elastics..

So I just got home from my first wire change, and I'm not sure if I mentioned it previously, but the old wire didn't go all the way to my back molars.  This new one does. I'm told it's because the previous wire wasn't strong enough and would have just snapped off from the pressure.  Interesting! Well, now all the top teeth are engaged and I'm happy to have them all be invited to the party.

The other thing is that I asked if they had any different coloured ligatures for my front clear braces rather than clear ones, since the clear ones stain so quickly, and when they do they turn a yellowy colour that's really unattractive. Well, I was thinking grey ligatures, but instead they wrapped a wire around them and between each tooth (just on the front clear brackets. The metal ones have doors on them and no elastic ligatures).  Here's a picture:

I'm not sure if you can really see the difference, but it's there.  Just a note about the terminology: although the elastics that go around your brackets to hold the wire in place ARE technically elastics (the ones people are usually referring to when they talk about "changing the colours of your elastics") I am calling them ligatures. There are other elastics used with braces, there are ones that go across all your teeth along the wire (these are called "power chains", meant to help close or prevent gaps) and there are the ones that go from hooks on the top braces to the bottom braces, in various arrangements.  These I call elastics, and they don't typically come in different colours. (At least I don't think so. Since I don't have bottom braces, I haven't had any of those and don't know much about them yet.)

Anyways, my new "ligatures" (actually wires) are an off-white colour and are apparently Teflon-coated so hopefully they won't stain with all the coffee I like to drink and curry and chocolate I like to eat. If they work, I'll be sticking with this new situation in the long run.  I love me some coffee!!!

Dr. O also set me up for a bottom braces date - March 5! I'm pretty excited.  Not to have more braces in my mouth, but to get this show on the road!! He did tell me he's giving the bone grafting time to take in the fractured/extracted area, and that he's nervous about moving the bottom teeth too soon considering the bone damage in the area and that the teeth are at risk. (This is normal for any teeth that have had trauma). It never feels good to hear that he's nervous about causing damage by putting on braces, but my dentist was nervous working on my mouth at times too, so I understand that I'm an extreme case for them. Anyhow, I think that date will also be another wire change for the top too. Exciting!

I also mentioned to him that there should be MRI results available soon, and he was definitely interested in seeing them. He also thought he would be sharing them with my dentist, Dr. T. as she would want to know what was happening too.  It's so nice to have such caring professionals looking after me!

In looking at the photo above, I can really see the unevenness in my chin and you can kind of tell that my jaw is off to one side.  I now see why Dr. P said he might do a little genioplasty (chin plastic surgery...I believe an implant) to even things out. He said that moving my jaw back to centre might fix that and I may not need it, but we won't know until surgery time.  I've come to realize that while this asymmetry is true, and it is there, it's not something people are looking at me and noticing.  I think that throughout this experience I'm truly learning to accept myself (although this is coming very slowly for me!) and to nit-pick less about my appearance.  Which is like huge weight slowly lifting off my shoulders. Sometimes it's a feather at a time lifting off, but hey. --- Progress is a process. ---