My 3rd Opinion

Hi Friends,

I've been trying to get up the energy to post again this week, but to be honest I didn't really have much great to say.  It's been a bit of a rough week for me, and not in terms of my health or jaw situation. But I've received my final report from Best Doctors Canada, and I thought that would be a great reason to write.

To start, I'll just talk about what's been going on.  I work for a large company in the Oil & Gas industry in Canada.  So does my husband, although at a different location.  You might be aware that oil prices have fallen sharply in the last six months, from over $100/barrel to under $45 in the first quarter of this year.  As a result of the poor short to long-term outlook for oil prices (not to be confused with gas prices!) our company announced in January that they would be reducing our workforce by 1,000 people.  While this number seems huge, consider that we also have a lot of contract workers in the upstream business (oil sands, in particular) and we didn't really know how many of those 1,000 would be from full time employees, and if so, who and where.  Well this week we lost 4 people from our relatively small team, one of which was my work husband (..not real husband).  I've been deeply affected by the unfortunate circumstances for everyone, but this loss was really personal for me, and I'm quite sad.  Another person who is leaving is my boss, who is being asked to retire at the end of April.  He's been the only one allowed to stay beyond the end of the day of hearing the news.  Our new boss is moving here from Calgary, and I don't know anything about him except for his name.  It's a sad and stressful time.

On top of that, my dog Roxy took ill last weekend and by Wednesday had to go see the vet.  I had been consulting with my best friend who actually IS a vet, but she lives out of town.  Upon her recommendation, I brought Roxy in.  It turned out that Roxy was so ill that she needed to be hospitalized, and stayed there overnight for 2 nights on IV fluids, antibiotics and anti-nausea/diarrhea medications.  Only today has she started eating again after 3 full days of not eating at all.   I am to pick her up soon, and I can't wait to get her home for some love and rest.

So...it's been a stressful week, y'all.

But in GOOD news, today I received my final report from the Best Doctors Canada service.   If you don't know about this service, it's a company that offers help finding doctors,  getting second opinions and referring you to specialists.  It's often a part of your benefits package at work, but most people don't know about it.  I had seen it on my benefits before, but it wasn't until my mom told me about someone she knew who had used it that I found out what they really do.

I engaged them, and they took my history, assigned me a nurse and a case manager and went about gathering all of my physician's notes, test results, images and the like.  They then had their internal physician review the information, and sought out a specialist (in my case an Oral MaxilloFacial Surgeon - OMFS) for their opinion on my treatment and diagnosis.

In my case, my information was sent to Dr. Bonnie Padwa at the Children's Hospital Boston.  Essentially Dr Padwa confirmed that my condyles are indeed broken and shortened.  They are not dislocated, but they are shortened which has resulted in a downwards and backwards rotation of my jaw, and an open bite. The limitation in opening of my jaw could be due to muscle spasming, and could be improved with aggressive physical therapy (PT).

Dr Padwa did agree that my condyles should have been treated with internal fixation (surgically fixing the broken condyles with pins/plates), and that it is too late for that now that so much time has passed.  She thinks that I should get a new CT scan to confirm if there is ankylosis in my joints and to confirm that my mandibular fracture has healed.  Ankylosis basically means joint stiffness. If there is ankylosis, she recommends the joint replacement surgery.  

If there's no ankylosis, she suggests that PT could improve my mouth opening and that a less complicated LeFort 1 osteotomy surgery could be performed to move my upper jaw into alignment with my lower jaw.   Um, how about no thanks??

So my feelings about this report are essentially that Dr P (my original Dr P) is correct in his diagnosis and treatment plan.  Even if there is no ankylosis in my joints, I'm not really interested in surgically moving my upper teeth to a screwed up position to match the already F'd up lower jaw.  (Pardon my language, I just don't see this as an actual option).  I'd still end up with a messed up jaw, but I'd be able to bite.  Great, but I'm not interested in creating more deformity. 

To be honest, though I might sound upset in this post, I'm not.  I was deeply convinced that this 2nd (or 3rd) opinion was going to confirm the TJR (total joint replacement) and I was right! (Who doesn't love saying that?!)

Feeding the Courage Wolf

Native American folklore says that we all have 2 sides to us, one that is "good" and one that is "bad".   These 2 sides are represented by wolves and the good is called the "Courage Wolf", while the bad is called the "Fear Wolf". This is oversimplifying things, of course, but is a metaphor that can be powerful in helping to remind us what to do in times of challenge and stress.

I've decided to take on the challenge of developing what's referred to as an "Unbeatable Mind", a concept and program developed by former Navy SEAL Mark Divine. Mark has a few programs, most notably "SEALfit", which is also a whole-person training program.  Both programs are geared toward this holistic approach, it's just that SEALfit has a much stronger physical component to it than Unbeatable Mind.

And so I'm working through both at the moment, at a basic level, which means I'm reading both books and trying to implement the actions into my life.  Here's what I've learned so far.

Your mind is the most powerful tool that you have.  Regardless of your physical condition (they believe, as I do, that stronger is always better), you can achieve great things by harnessing the power of your mind.  This isn't as simple as it seems, but for me it is boiled down to one idea: To win at anything, you must first win in your mind.  Better said, "Victorious warriors win first and then go to war.  Defeated warriors go to war first, then seek to win."  - Sun Tzu.

The first 2 big steps in this process are to change my belief system, and begin the steps to visualize my own success in my mind.  Practically speaking, this means that I wrote down the 4 guiding emotions in my life.  They are as follows:
1. Fear (fearing failure) 
2. Jealousy (wishing for what others have achieved)
3. Love (I believe that all things must begin with love)
4. Despair (giving up hope when things get hard).
I am proud that one of my dominant emotions is Love, however...the other 3 are directly at odds with this and so I don't believe that I'm truly acting out of love all the time. 

I am working to replace these emotions with
1. Courage
2. Acceptance
3. Love
4. Hope
 I reflect on these daily until they become virtues - founding principles on which my character is built.  This will not happen overnight, and it will take a lot of time and effort on my part. 

The visualization part is also a ways off.  To start this process, first I am practicing meditation daily.  Finding even 5-10 minutes of quiet at the beginning or end of my day to just clear my mind is my goal.  I use  the fishbowl technique, which is where you imagine your mind as a cloudy, dirty fishbowl that slowly clears to pristine waters.  Anytime thoughts creep in, the fishbowl clouds again.  From here, once I have a clear mind, then I can imagine my own success.  For me, this is being a calm, courageous force.  Someone who truly begins all things with love.

I am also beginning the physical component, which is to push myself in workouts that are quite difficult.  The difference here is that although they are very physically demanding, the purpose is to both strengthen myself physically, but more importantly, to strengthen my mind.  By believing that I can complete a tough physical challenge (by first visualizing myself doing, and completing, the workout) and then proving it out, I gain strength of mind.  However, I also am tuning into my body much more.  If I feel tired or worn out, I take a rest day.  You must nurture your body with sleep and nutrition so that it can be powerful.

Will you try one of these techniques with me?  Nothing ventured, nothing gained! And if you feel this is all to "new agey" or hokey, remember....these are techniques employed by Navy SEALs - the toughest of the tough.

If you have any questions, please feel free to comment.   And remember to starve the Fear Wolf and feed the Courage Wolf inside of you.

Gathering Strength

Recently I've been giving a great deal of thought to my psychological well-being.  I think this is evidenced by my previous posts!  But going further than that, I'm specifically interested in developing my mental and emotional resilience.  I've always felt fairly strong in this area, or at least not weak, but since my accident my resilience has been tested, and I'm determined to emerge stronger and better after it's all said and done. 

I have been broken a few times along the way, and I certainly find it easy to start to feel myself slipping toward hopelessness.  My bite is getting worse with orthodontics, and I often get frustrated trying to eat, when I hear myself speak with a lisp or am asked to repeat myself and generally feeling deformed, even if it isn't super-obvious to look at me.  I get tired easily, and I'm truly afraid of pushing myself physically.  I've always enjoyed exercise, and challenging myself when I can.  I'm not the best at much of anything (although I'm a pretty good rower), not the strongest in a fitness class, or the fastest runner.  But I generally don't back down from trying.  And I feel my best when challenging myself this way.

Well I'm now left feeling very deeply afraid of pushing myself, both out of fear of seriously injuring myself again, or just the current pain that might escalate as a result.  I don't like this.  I want to get out and go for a long run to relieve my stress.  I want to go lift some weights, or do a hard class at the gym.  But I'm afraid. 

I know that this is temporary.  My whole life won't be like this.  I will have surgery, I will get the braces off, someday I will be a new normal person.  This is what the doctors tell me.  I will be able to do everything I used to do again, without pain.  But getting to someday is hard.  Yes, it helps to know that this will pass....but getting through it is another thing.   The only easy day was yesterday.  Today is a new day. 

So I'm working on my mental toughness.  Tackling some inner demons, taking control of my inner dialog.  I've been doing some meditation, focussed breathing, yoga and learning about training your mind to overcome the obstacles it sets for itself.  I'm feeling a shift start to happen.  I need to turn these things into practice.  Turn them into every day things, habits that feed my mind and soul.

What I'm hoping for through my journey and pursuit of mental resiliency, I will better prepare myself for what lies ahead, both the known and unknown challenges.  I want this to be a life-long skill, to live a more mindful existence, gaining better control over my actions, reactions and working more toward my purpose than just living this life as a passenger.  For too long I've been a product of what has happened to me, and not in control of where I was going.  In truth, my ultimate goal is to seek out what truly makes me happy in this life, and have the courage and ability to continue to pursue it long after this whole journey is over. 

In the meantime, becoming a stronger person will help me to steer myself through this whole experience.  Forging mental toughness will allow me to handle the pain with control, and come out of the surgery stronger, and ready to recover fully.  If you're interested in the same things, or any of this resonates with you, please comment and let me know!

Coping with Facial Trauma

Living with changes to your facial appearance as a result of trauma can be incredibly difficult. In fact, studies have shown that people who acquire facial changes as a result of trauma have more difficulty coping than those with congenital disfigurement, or even that resulting from treatment of a disease, like cancers of the face or head. There have not been enough studies on the effects of these changes, and in this post I’m attempting to summarize some of the risk factors, symptoms to look for and strategies to cope.

 

People with oral and/or facial trauma are up to 70 % more likely report symptoms of depression, anxiety and hostility. Injuries to critical facial structures like eyes, ears and dental structures will increase these odds, and these psychological issues can impede your recovery. Being aware of the symptoms and risk factors is critically important to your health.

Key Facts:

 

• There is no correlation between the degree of disfigurement and type, extent or severity of psychological symptoms
• Your satisfaction with your facial appearance is a more important predictor than the objective severity of facial changes
• Women are more susceptible than men
• Depression puts you at increased risk for suicide, poor compliance with treatment and a poor rehabilitation outcome.
• Your surgeon may not recognize these symptoms - so be aware for yourself or loved ones.
• Attributing blame for your trauma to others puts you at higher risk for both anxiety and depression (vs. self-blame, or accepting of it as an accident).

Facial changes and/or disfigurement can result in depression, anxiety and even Post Traumatic Stress Disorder, or PTSD. The symptoms of PTSD are:

1. Re-experiencing the trauma (via intrusive thoughts and/or distressing images and dreams);
2. Avoidance of thoughts, emotions or situations related to the trauma; and
3. Autonomic nervous system hyperarousal, including difficulties sleeping, having an exaggerated startle response and experiencing increased irritability and tension. 

The symptoms of depression, anxiety and PTSD might be at the subclinical level (meaning that they don’t meet all of the diagnostic criteria) and so might be missed, but are serious nonetheless, and can still have adverse effects on quality of life.

 

The biggest challenge is the social aspect of life after an appearance-altering trauma. The response that people have to your appearance can be painful, even if not intended to be. For many, constant worry about reactions their appearance can cause social withdrawal. Just remember that curiosity is a natural human reaction when faced with something we don't understand.  Most people who may be staring at you, or even asking you inappropriate questions, are not doing so to hurt you.  They are simply curious and interested.  There are ways to deflect this unwanted attention. My favourite is: "You seem to find me very interesting!".

 

Another known effect of facial changes due to trauma is that it can ignite negative body image issues and body dysphoria in social situations that can significantly affect your life. Still others can have no body image issues despite disfigurement. It seems that predictor for this response is your self-image prior to the accident. The more value you place on your looks in general, the more likely you are to suffer from a negative body image after trauma.

 

 

Pre-Trauma Personality Traits that Affect Recovery

 

• Presence or absence of psychiatric illness
• Financial and social status
• Family history of psychiatric problems
• Having a family member involved in the trauma
• Family approach to the trauma and recovery
• General resilience
• Response to major life events in the past
• Survivor guilt (if relevant)
• If the trauma was the result of an accident or a workplace/industrial incident
• Presence of compensation and litigation issues

 

 

It can often be hard to know when it’s time to reach out and seek professional help. This is especially hard for loved ones, as we don’t often admit to all the symptoms we are feeling. I urge you to review the list below and be honest about how many apply to you. I bet if you have one symptom, you have at least a few more. Please reach out if even one of these symptoms applies to you.

 

 

Telltale signs that a referral to mental health professional is needed:

• Anger
• Irritability
• Poor support network present
• Crying spells
• Loss of hope for recovery
• Long in-patient stay
• Multiple surgeries
• Depressed mood
• Poor financial support
• Loss of loved ones in the same traumatic event
• Loss of job
• Flashbacks or recurring dreams
• Sleep problems
• Chronic pain
• Family or personal history of psychological illness
• Preoccupation with facial appearance after recovery

 

 

Ways to Cope

 

 

The human mind is a remarkable thing, and the beauty of it is that we are often capable of so much more than we give ourselves credit for. Remember this, and use it to your advantage when you’re feeling low. Actually...keep it in mind all the time. As Winnie the Pooh once said: “You’re braver than you believe, stronger than you seem and smarter than you think.”

There are many ways to care for yourself and improve your resiliency, and it all starts with self-care. The crux of it is to be kind to yourself.

 

 

1. Set yourself up for success. This means taking care of your basic needs - get enough sleep, nourish your body with good food and make your well-being a priority. Don’t take on more than you can handle, and learn to say no.
2. Be active. Don’t worry about how fit you are, or pushing yourself through a difficult workout if that’s not your thing. Go for a walk, or cycle. Just get up and move.
3. Focus on developing your inner self. True beauty comes from confidence, and the best way to feel confident is to feel good about the person that you are on the inside. Take time to develop that. Things you can try are immersing yourself in a non-stressful hobby, meditation, social events.
4. Talk to someone you trust.
5. Try to view your situation as a positive challenge, rather than a threat.
6. Remember that you are a warrior. You have been through challenges that nobody but you can understand. There is power in that. Gather strength from your successes.

 

 

Changing Faces UK is an excellent resource for all people coping with facial disfigurement for any reason. I stumbled across it in my research and found it to be very informative. They have an excellent online learning program (for free!) that teaches you how to handle social reactions to your appearance. There are 5 techniques that they teach:

 

 

1. Explain in a way you’re comfortable with.
2. Make a big effort to reassure people.
3. Distract people away from your condition.
4. Use your sense of humour.
5. Be assertive.

 

 

These bullet points are not enough - I encourage you to review the course for a detailed explanation on how to employ these techniques. The course is built for teenagers, but that’s just in the way it’s presented and in fact I think that only targeting this age group is a mistake on their part. The information within is completely appropriate for all ages. It can be found here: http://learn.happyelearning.co.uk/clients/changingfaces/home.html

 

 

I hope this provides some help and support to you. Please feel free to comment, or message me personally if you need to talk to someone and don’t know who.

And take care of yourself.

Full-On Braceface

Good morning friends!

Do I sound happy? I hope so.  Despite having gotten my lower braces on yesterday and my top wire change, and being in enormous pain in my mouth, I took today off so that I wouldn't have to deal with this pain while trying to work.  So, today I choose to be happy that I'm not at work.

I'm a full brace-face now, it's official. Woo! What a move up in status, lol.  Man, does it hurt!! My teeth are all so sensitive, which I'm sure makes the pain worse, but holy cow!  When they're putting the braces brackets on your teeth, they put this awful device in your mouth that holds your lips wide open and off your teeth.  It really stretches your muscles, and phew am I glad I don't have to see that thing again until the braces come off (I think hope).  It took about an hour to get the brackets all on my lower teeth, a little longer for me because of the special adhesive they have to use on my crowns. The regular stuff doesn't stick so well - when they used it on my upper teeth 8 brackets popped off within 24 hours of putting them on. On a Friday night.  Yeah, it wasn't awesome.

Dr O has someone who puts the brackets on for you before he puts the wire in.  He had quite a hard time getting my wire in, I have a tooth (the 35) that's really broken, in fact it's not even crowned, it's only built up with dental composite because it's also so angled in my mouth that Dr T couldn't crown it.  That will be done once Dr O uprights and turns it.  That's right..it's both rotated and on a severe angle.  He couldn't even get the wire into the bracket yesterday, he had to sort of jury-rig something to attach it using an elastic or wire.

Whenever I go in there, we always discuss what's going on, and I use all kinds of dental speak.  I've learned it, it makes sense and is the most efficient way of discussing things.  For example, yesterday I said something like "do you have the right adhesive for the crowns in there? I know the 45 is crowned, and the 35 is built up with composite, so is the 47.  I'm just not sure if it's on the lingual or buccal side."  Dr O always gets a kick out of how much I know, and one of his assistants thought I was studying to be a dentist.  What a compliment!  Dr O said, "No she isn't, but I want to bestow upon her an honorary doctorate in something!"  It was a long, painful but fun visit.  I found it very encouraging, since Dr O told me that he's proud of me for what I'm going through and loves my attitude about it.  He also said I'm his favourite patient, although I'm sure that's just an honorary title too :)

After my visit I made a video on my phone to summarize my feelings right after.  I know I found it really helpful to watch people's vlogs when I was learning about what it's like to have braces, BUT as usual I still can't figure out how to upload the thing!! Once I do (I *am* working on it...) I'll update this post to include the video.

Oh, and one tip for you if you are having braces put on soon - put the wax on soon after they go on.  The real pain doesn't peak until a few hours later, and if you're putting wax on (or silicone ear plugs like I much prefer) it will hurt WAY more if you wait until it really hurts.  :)

Have a great day everyone!

Facial Trauma and Mental Health

Hey friends.

So it's no surprise to anyone that I'm seeing a counselor through our work family assistance program. Mostly because I talk about it all the time.  As I've said before, this is uncomfortable for me, but is important to my beliefs because I think it's important that we remove the stigma from discussing mental health.  Nobody should be ashamed to admit that they need help sometimes, and in many cases it can either save a life, or save the quality of your life, and isn't that almost the very same thing?  [Stepping down from my soapbox now.]

I was recently inspired to do some research on mental health after facial trauma, and I was surprised to learn some interesting facts.

First, people who acquire a facial change after trauma are actually more likely to suffer from psychological issues than people who are born with congenital differences or people who acquire the facial changes due to treatment of a disease.  I think this may actually mean the symptoms are different, or they happen rapidly over a shorter period of time than those born with congenital differences.  It only makes sense that after a trauma you'd feel everything more or less 'all at once', while if you were born that way you'd go through these feelings staged over time as you mature. Second, it doesn't matter how severe the actual change or deformity is; what matters is how severe the person perceives it to be. 

This is not to diminish either those with congenital differences, nor those with severe trauma...but to give credence to those with minor changes that feel they are psychologically affected just as deeply, or more deeply than they feel they should be allowed to.

The main predictor for how severely you will be affected psychologically is how much value you placed on your appearance prior to the trauma occurring. Interestingly, this can also cause issues with body image and body dysmorphia.  I know personally that this is affecting me - I lost a significant amount of weight after my accident due to both pain and being wired/banded shut, and I put a lot of pressure on myself to try and maintain that weight...even though it was miserable not being able to eat properly that whole time and I was starving.  Whatever my desire to be thin, I have NEVER been one to willingly go hungry.  It's just not something I do, or am capable of. (And this may be my saving grace).  I make better food choices, but I never starve. (Although denying cravings is sometimes just as miserable!!!)

I'm working on putting together a more detailed summary of my research into this topic, as well as the signs that you need to seek professional counseling yourself, and ways that you can help yourself to cope.  If you are affected by this, and would like to see something like that, would you please comment?  I'd like to know if putting effort into this would be beneficial to anyone who is reading. 

Thanks!

About the meds

Last week I mentioned that I had been given a new Rx and instructions from my surgeon to take the meds he prescribed to me 3 months ago.  (I can be a bit stubborn on occasion).  I can now say I've had a few days of them under my belt and I'm so glad I (finally) listened to him.

This is another case of not knowing the pain I was in until it was relieved.  I have a prescription for Vimovo (a prescription strength NSAID, or anti-inflammatory) and nighttime Flexeril (a muscle relaxant).  I've been taking them since Thursday night when they were prescribed to me.

The Vimovo is definitely taking a big edge off the constant pain. I had been feeling like this pain was pretty manageable, but looking back now it certainly wasn't welcome. I can't say that it's gone completely, but it's a big improvement.  When it's nearing the end of the day, I can tell that it's wearing off and time for the evening dose.  The pain in my joints is less, and when it flares, as it tends to do seemingly without cause randomly throughout the day, it's also less and seems to happen more infrequently.  I occasionally was getting ear pain, almost like the feeling of a pin being pushed through your eardrum, and that's less severe and less frequent too.  Dr P also  mentioned that it would probably help my tooth pain, and it certainly has.  I would take it for that reason alone, since not only is it painful, but I get very anxious about my teeth when I can feel them aching all the time.

At first I wasn't sure if the Flexeril was helpful, I am cutting the pills in half and I still feel like it knocks me out pretty strongly at night.  I have woken a couple of mornings with shoulder/neck pain, which feels as if I've slept in a poor position. I thought perhaps that could be because I was so relaxed and knocked out that I actually was sleeping in an awkward position. I wasn't feeling a big change in muscle pain in my head, so this just seemed to add to my pain....no thanks.  But I've persisted for a few nights (3 now) and I do think that despite the neck stiffness, my head muscles are more relaxed in the day and therefore not as vice-like.  Of course, if I touch my temples at all they are very sensitive but I'm going to keep trying it and see if it helps to keep the tension headaches at bay.

I do get my upper braces wire changed and lower braces put on Thursday afternoon, so I really hope that this helps to keep the pain to a minimum.  In any case, I've booked Friday off of work so that I can just stay home, not have to worry about going to work in pain, and rest up.  I'll obviously be writing a post about the first day with a full-on set of metal mouth!