Hello Everyone!
It's been over 2 years since I've written an update. I can't believe that time can go by so quickly. With this blog still live I get monthly emails that tell me how many people visit the site (it's about 250 per month) and I thought that was it. I would think "wow, people are still seeing it in their Google searches" and move on. Assume that most people poke around quickly and leave. And maybe that's what happens....but some of you have left me comments! Comments that I have to read and approve to be published on the site. And I haven't been seeing the emails notifying me of the comments.....until today! I honestly don't know how that happened, but I have comments from 2018 that I haven't even seen until today.
And I'm so sorry.
I started this blog because when I was going through my ordeal there was SO LITTLE information out there that I vowed to share my experience so that people wouldn't feel so alone.
And then I had surgery. And then I had a baby. And moved. And, and, and.....I just let it go.
Well, I'm back. I might not be here as often as I would like, but I promise to check in, give updates and answer questions. Because just because my accident/surgery/recovery is over, doesn't mean this type of injury doesn't happen to people every day.
So....how am I today?
My last post was so down. I can't believe I left this blog like that. The recovery was hard and long. At 3 months post-surgery I decided to have an embryo transfer (oh yeah, I was going through IVF while prepping for surgery...) and got pregnant. So the recovery was even harder for me since my body was dealing with a lot. I had the crowns placed on my teeth (16 of them) when I was about 3 months pregnant. Then having the baby almost 1 year exactly since surgery was definitely rough on my jaw. I was on painkillers after the birth, and they were so necessary.
To make a long story short, having procedures and recovering while pregnant was EXHAUSTING. (1 star out of 10, do not recommend). Having a newborn 1 year after surgery was also EXHAUSTING. But now that I have the benefit of hindsight, I can say that I now see just how long the recovery really is. It takes years, y'all. After 6-8 weeks you can go back to work. You can do it. But even now, 3+ years later, I'm still seeing improvements.
Using my jaw now isn't nearly as painful as it used to be. Before and after surgery it hurt to talk too much, hurt to eat too much, hurt to exercise too much. I couldn't run, because of the pounding. I couldn't sing along to the radio. Now if I eat something chewy or hard or difficult to manipulate in my mouth it's more frustrating than anything. I will often have sharp pains as I am doing it, and some pain afterward, but it goes away quicker than it used to and I don't need to take pain medication to manage it. I take pain meds so infrequently now, I'd say it's not even once per month. I feel like my muscles are stronger now. When I lift weights, I have be very careful not to engage my neck, and there are a lot exercises that I just absolutely cannot do. It makes it frustrating because I have to be very careful what I do, but I find that over the past year there are far fewer times that I'm in real pain after working out than there used to be. Running isn't an instant pain generator as it used to be. Life is just so much better than it was even a year ago in terms of my jaw.
As far as my teeth go, as I mentioned they were all capped a few months after my surgery. It felt like I was all done with procedures, and it was a false sense of security. Just one month after returning to work from my 1 year maternity leave, I got an abscess in my lower front tooth. The one right over the break site (where I lost the tooth during the accident) failed. That tooth had had 2 root canals already, and just couldn't stay. So in October 2018 the tooth was pulled by my oral/TMJ surgeon. In May 2019 he put me under again to place the implant post, and then in Oct 2019 I had the tooth placed on it. Since it was a front tooth, I spent a year wearing my retainer to keep the space and somewhat cover the hole it left, and it was terrible. I talked funny, had to take it in and out to eat, and I was so self conscious. I had a lot of breakdowns over having to have more work done. But now that the tooth is in I feel much better. Unfortunately the tooth beside it is a bit loose, and my dentist says eventually I'll need an implant for that one too, which sucks. And since I insist on implants instead of bridges, I'm paying out of pocket for the whole thing - our insurance doesn't cover implants. Argh! It never ends, my friends!!
Anyhow, that's a quick summary of how things have been. If there's still anyone out there reading this, I'd love a comment to know so I know to keep writing! And as always, ask questions. I promise I'll answer them now!
Thursday, February 6, 2020
Wednesday, April 19, 2017
Update post TMJ Replacement
Wow, it sure has been a while.
I remember reading blogs and watching videos of people who had had TMJ replacement and thinking "I'm going to write/video the most updates after surgery so everyone knows what it was like!"
And then I didn't. Oops.
And here's why. The recovery was hard. So fucking hard. It was brutal and I didn't want to scare anyone about to go through it. A lot of it was hard because the care I received in the hospital was AWFUL (no shout-outs to you, Mt Sinai) and then my post-op complications were SCARY.
So, to point #1. The hospital care.
I'll mention a few of the finer points:
The nurse who "didn't know when she'd have time" to re-insert my IV that gave me pain medication.
The nurse who told me "well everyone who has that surgery is in a lot of pain".
The doctors who told me to "set a timer on my phone" to remind myself to ASK for pain pills because they weren't giving me IV pain medications on time, or they weren't lasting long enough.
Anyways, it was horrific. I completely dissociated on the car ride home (2 hours in Toronto traffic) because the pain was so horrible. As I laid in the hospital bed, I thought to myself: take care of these joints, because I am not strong enough to go through this again!
Now, sure you can argue that this is all due to Canada's universal health care having lots of problems, and maybe that's so but I can also tell you I paid $0 out of pocket for this surgery, and I know many in the US who have been fighting to have it for years with little hope. So let's leave politics out of it.
And onto #2.
On my first night home from the hospital, I was sure that I wasn't breathing in my sleep. I woke up a few times gasping for breath, just knowing I hadn't taken a breath in a long while, and I was scared that I would just stop breathing in my sleep and die. I had been given oral Dilaudid for the pain, and knowing that it can suppress breathing, I thought it was the cause. So I was afraid to take pain medication and I was afraid to fall asleep. Finally I realized that I couldn't make it through recovery like that, so I woke my husband and told him "I'm not breathing in my sleep".
Of course, my surgical team had given me instructions to call them first, and NOT to go to a local ER since they wouldn't know what to do with my condition. So my husband called them and told them the situation. Begging to not have to a. drive all the way to downtown Toronto again and b. return to the awful, inhumane hospital, they finally gave me the ok to go to my local ER with strict instructions not to touch my face. Which is awesome because the local hospital is 1 km from my house and brand-spanking-new.
After a night in the ER and a CT scan with dye in my veins, they found out that it was fluid on my lungs that was causing them to partially collapse. Hence, being unable to breathe. The treatment was pretty benign, actually - deep breathing exercises to break up and move the fluid. This worked surprisingly well over a few days, and I could at least take pain medication without fear!
Over the past few months, the recovery has gone really well. I can eat many more foods than I used to be able to, and since the joints aren't there anymore, presto - no more joint pain! It's not all happy-happy though. The recovery from this is LONG and slow. I am still very tired a lot, and I do still have a lot of muscle pain in my face and head. There are nerve spasms - sharp, pointy pain that shoots through my face at any time as the nerves regenerate. I still see my chiropractor every week to 2 weeks for muscle release treatments that HURT and I still get occasional tension-related migraines.
On a personal note, I still feel disconnected to people a lot. I don't want people to understand anymore, I get that it is a random "illness" and that nobody wants to hear about your troubles forever. But I also just want to be alone. I find myself neglecting friendships, relationships and losing patience with situations. I feel very overloaded, trying to get back into regular life, especially since I am still going through dental work to restore my teeth. It's like this will never end.....I'm getting glimpses that it really never will - I may always be in pain after eating something crunchy/sticky/meaty/whatever.
In the end, the surgery was helpful, it was the right decision and I don't regret it. It took away a lot of pain, and from what I hear from other patients, I have more recovering to do - hopefully it continues to get better!
Thanks for reading.
I remember reading blogs and watching videos of people who had had TMJ replacement and thinking "I'm going to write/video the most updates after surgery so everyone knows what it was like!"
And then I didn't. Oops.
And here's why. The recovery was hard. So fucking hard. It was brutal and I didn't want to scare anyone about to go through it. A lot of it was hard because the care I received in the hospital was AWFUL (no shout-outs to you, Mt Sinai) and then my post-op complications were SCARY.
So, to point #1. The hospital care.
I'll mention a few of the finer points:
The nurse who "didn't know when she'd have time" to re-insert my IV that gave me pain medication.
The nurse who told me "well everyone who has that surgery is in a lot of pain".
The doctors who told me to "set a timer on my phone" to remind myself to ASK for pain pills because they weren't giving me IV pain medications on time, or they weren't lasting long enough.
Anyways, it was horrific. I completely dissociated on the car ride home (2 hours in Toronto traffic) because the pain was so horrible. As I laid in the hospital bed, I thought to myself: take care of these joints, because I am not strong enough to go through this again!
Now, sure you can argue that this is all due to Canada's universal health care having lots of problems, and maybe that's so but I can also tell you I paid $0 out of pocket for this surgery, and I know many in the US who have been fighting to have it for years with little hope. So let's leave politics out of it.
And onto #2.
On my first night home from the hospital, I was sure that I wasn't breathing in my sleep. I woke up a few times gasping for breath, just knowing I hadn't taken a breath in a long while, and I was scared that I would just stop breathing in my sleep and die. I had been given oral Dilaudid for the pain, and knowing that it can suppress breathing, I thought it was the cause. So I was afraid to take pain medication and I was afraid to fall asleep. Finally I realized that I couldn't make it through recovery like that, so I woke my husband and told him "I'm not breathing in my sleep".
Of course, my surgical team had given me instructions to call them first, and NOT to go to a local ER since they wouldn't know what to do with my condition. So my husband called them and told them the situation. Begging to not have to a. drive all the way to downtown Toronto again and b. return to the awful, inhumane hospital, they finally gave me the ok to go to my local ER with strict instructions not to touch my face. Which is awesome because the local hospital is 1 km from my house and brand-spanking-new.
After a night in the ER and a CT scan with dye in my veins, they found out that it was fluid on my lungs that was causing them to partially collapse. Hence, being unable to breathe. The treatment was pretty benign, actually - deep breathing exercises to break up and move the fluid. This worked surprisingly well over a few days, and I could at least take pain medication without fear!
Over the past few months, the recovery has gone really well. I can eat many more foods than I used to be able to, and since the joints aren't there anymore, presto - no more joint pain! It's not all happy-happy though. The recovery from this is LONG and slow. I am still very tired a lot, and I do still have a lot of muscle pain in my face and head. There are nerve spasms - sharp, pointy pain that shoots through my face at any time as the nerves regenerate. I still see my chiropractor every week to 2 weeks for muscle release treatments that HURT and I still get occasional tension-related migraines.
On a personal note, I still feel disconnected to people a lot. I don't want people to understand anymore, I get that it is a random "illness" and that nobody wants to hear about your troubles forever. But I also just want to be alone. I find myself neglecting friendships, relationships and losing patience with situations. I feel very overloaded, trying to get back into regular life, especially since I am still going through dental work to restore my teeth. It's like this will never end.....I'm getting glimpses that it really never will - I may always be in pain after eating something crunchy/sticky/meaty/whatever.
In the end, the surgery was helpful, it was the right decision and I don't regret it. It took away a lot of pain, and from what I hear from other patients, I have more recovering to do - hopefully it continues to get better!
Thanks for reading.
Thursday, September 15, 2016
1 week post-TMJ Replacement Surgery!
I'm sorry it's been a while since an update - I kinda had something big going on. I had my surgery! On Sept 6, I got my new TMJ joints implanted. I was a total psycho wreck leading up to it, which is why I didn't really post. It likely would have been jibberish. But here I am! Alive! Well!
When I woke up from surgery, it was awful. My head was totally wrapped up in dressing, and the pain was brutal. I don't really remember any time in recovery, although I do recall that the nurse was quite nice - until she yelled at me to breathe. Scary. That was a foreshadowing of what was to come. Eventually I got loaded up to my room on the 11th floor, which is where my memories start. All I remember is pain. For about 2 straight days, just pain. There was nothing else in my mind except that. My mom and husband came to visit, and my mom took pictures for my son's first day of school, hung up a poster in my hospital room that they had made together, brought flowers, but all I remember is thinking - I don't care about any of this. I just want to die. The pain was so terrible, all-consuming...I didn't care about anyone else or anything. This lasted pretty much a week.
It certainly didn't help that the nurses were awful with their attention to my pain. They would not check on me, and I tried to be sparing with my call button, but eventually I was pressing it non-stop. They would take forever to come, and then arrive with nothing and ask what I needed, as though I was going to ask for a cup of water. "PAIN" was all I could say. By day 2 we figured out that my IV had been coming out, and the morphine was not going into my vein.....and the nurse said "Yeah, your IV is coming out and I don't know when I am going to have time to put it back in." ARE YOU KIDDING ME!?!!? I was pretty much delirious from the pain from then on. Listen, I'm not one to take all the medication until I'm loopy as fuck and can't feel anything anymore. I had surgery, sure, there's gonna be pain. But something to take the edge off. Something so I can move. Like, nothing crazy here. Anyhow, I digress.
I was released on Friday, and the drive home through rush-hour downtown Toronto traffic was....awesome. Yeah, I pretty much held ice-packs to my face until I dissociated from my body. Horrible. Friday was spent in bed, continuing to wish for death. Saturday the same. Saturday at around 2:30 am I felt like my breathing issues were getting really bad, especially when I woke up feeling distinctly like I wasn't breathing and with a terrible crushing pain in my chest. My husband called the hospital, and they told me to go to my local ER. There's a brand-new beautiful hospital less than a kilometer from my house - perfect!! I spent from 3am until around 2 the next day there, being tested with EKG, blood work, X Ray and a CT scan with dye in my veins to see what's up with my pulmonary arteries, etc. It turns out I had a pulmonary edema with some overlying passive lung collapse - awesome. So I went home with some breathing exercises to do and watching my high blood pressure. Thankfully, the exercises worked to clear the fluid out within a couple of days. I still have to go for a follow up X Ray in a couple of weeks, but my BP is down to 98/66 so I think I'll be ok.
As far as my joints go, I had a follow up with my surgeon today who is very happy with my progress. 9 days after surgery I can open to 25mm and my pain has decreased hugely in the past couple of days. He reminded me that I had major facial surgery, in case I had forgotten, since I'm looking and doing so well. It was awesome to hear, but I'm going to try not to let it go to my head since it's been 2 days of feeling good and there are bound to be some hard ones ahead. But so far, so super good!!
Wednesday, July 6, 2016
Moving right along!
I was just re-reading my last post, and I feel so bad! There have been a lot of updates that I haven't shared. I haven't been staying away intentionally...I've just been so busy at work and home, and when I am home I am far too exhausted to do much of anything. I've been falling asleep anywhere between 8-10 pm each night, and that's my "me" window of time. I'd say this is definitely because of the pain that I have been dealing with lately, I can't say that I know why it's been getting so much worse, but in any event, it has. The joint pain is intense where it has been intermittent and manageable in the past. The muscle pain and tightness has spread from the top of my head, down into my shoulders and upper back, and the regular treatments I get there are only helping to maintain status quo (or maybe not even) so there's little relief. Anything that I do outside of sleep, work, eat, family time seems to drain me of any extra energy I may have had and I end up in a deficit that I have to work to rebuild with extra sleep and rest and pain meds.
So having said all of that, I am super excited that I have a date for my TMJ replacement surgery!! I was originally given November 1, but there was a cancellation and I was offered Sept 6 instead. The company manufacturing my joints (Biomet) has confirmed that they are able to make and ship the joints to meet that date. I had my CT scan to send to the company in early May, which was so easy y'all!! I didn't have to change into any hospital gown - just walk in, lay down on the machine bed and 5 mins later I was walking back out. Dr P's office took impressions (covering my braces with wax beforehand so they slid right off) and I've been X-rayed to the moon and back, but now I'm ready to show up on Surgery Day and give'r.
In the end, I didn't end up doing the plan that I was given and outlined in my last post. My surgeon didn't feel comfortable putting any final restorations on my teeth before surgery, so I went full steam ahead with the scanning and I'm so glad I did, or I would not have been offered the cancellation when I was. Those pretty teeth with have to wait.
In fact, I just had my final appointment with my surgeon, Dr. P, yesterday. He took final x-rays and pictures of my bite and face, and answered all my questions. I got a pretty intense surgical package that I have to complete with my family doctor and send to the hospital. Then the hospital will schedule a date for me to go in for an anesthesia consult and fit me for compression stockings for the surgery (to prevent blood clots in my legs since I'll be out for so long). I have to order the Therabite for use after surgery in rehab, and visit my orthodontist to get surgical hooks attached to my braces so that the surgeon can wire me shut while he works on me. I will also need arrange for after-care with my family. I will need help from my mom, and possibly others, to help my husband look after my son and I. My son will be starting SK the day after my surgery, so someone will need to be with him that week, as well as taking me to the hospital and checking in on me as I am recovering there for a few days.
The surgery is set to start at 8am on Sept 6, so I've been told to arrive at the hospital at 6am. The hospital is downtown Toronto, and we live in a suburb so it will be a smooth ride down there. They estimate that the surgery will be over around 3:30 pm. Then it's recovery! I'm told that right away I'll be eating things like scrambled eggs and mashed potatoes - I'll be sure to stock up!! At least I won't be wired shut or eating through a syringe! I am told I might have elastics on my braces, but I'll be able to fit in a spoon. Fingers crossed.
I plan to make videos as I go along, starting soon so that you can see the before, during, and after. I really want to share this experience. Watching videos like Shea's (sheasmith.org) have been so incredibly helpful to me.
So having said all of that, I am super excited that I have a date for my TMJ replacement surgery!! I was originally given November 1, but there was a cancellation and I was offered Sept 6 instead. The company manufacturing my joints (Biomet) has confirmed that they are able to make and ship the joints to meet that date. I had my CT scan to send to the company in early May, which was so easy y'all!! I didn't have to change into any hospital gown - just walk in, lay down on the machine bed and 5 mins later I was walking back out. Dr P's office took impressions (covering my braces with wax beforehand so they slid right off) and I've been X-rayed to the moon and back, but now I'm ready to show up on Surgery Day and give'r.
In the end, I didn't end up doing the plan that I was given and outlined in my last post. My surgeon didn't feel comfortable putting any final restorations on my teeth before surgery, so I went full steam ahead with the scanning and I'm so glad I did, or I would not have been offered the cancellation when I was. Those pretty teeth with have to wait.
In fact, I just had my final appointment with my surgeon, Dr. P, yesterday. He took final x-rays and pictures of my bite and face, and answered all my questions. I got a pretty intense surgical package that I have to complete with my family doctor and send to the hospital. Then the hospital will schedule a date for me to go in for an anesthesia consult and fit me for compression stockings for the surgery (to prevent blood clots in my legs since I'll be out for so long). I have to order the Therabite for use after surgery in rehab, and visit my orthodontist to get surgical hooks attached to my braces so that the surgeon can wire me shut while he works on me. I will also need arrange for after-care with my family. I will need help from my mom, and possibly others, to help my husband look after my son and I. My son will be starting SK the day after my surgery, so someone will need to be with him that week, as well as taking me to the hospital and checking in on me as I am recovering there for a few days.
The surgery is set to start at 8am on Sept 6, so I've been told to arrive at the hospital at 6am. The hospital is downtown Toronto, and we live in a suburb so it will be a smooth ride down there. They estimate that the surgery will be over around 3:30 pm. Then it's recovery! I'm told that right away I'll be eating things like scrambled eggs and mashed potatoes - I'll be sure to stock up!! At least I won't be wired shut or eating through a syringe! I am told I might have elastics on my braces, but I'll be able to fit in a spoon. Fingers crossed.
I plan to make videos as I go along, starting soon so that you can see the before, during, and after. I really want to share this experience. Watching videos like Shea's (sheasmith.org) have been so incredibly helpful to me.
Wednesday, April 6, 2016
New plan for surgery
Gosh, I feel like it's been so long that I posted about my braces, dental work or surgery. I apologize! I know what it's like to look forward to updates about progress and I've been slacking.
To bring you up to speed, I'm at the last few wire stages with my braces before surgery. I was booked to have my CT scan for surgery at the end of April, but that, too has changed. When my surgeon booked me for the scan, we had thought it would mean (calculating forward 3-4 months from scan date to implant delivery) that put me in August for surgery. But because the hospital only gives him 1 day/month in July and August, and the # of patients ahead of me who already have had their scans done, I'm really looking at the fall to have the surgery. This means that if I have the scans done now, the implants will be ready and sitting waiting for me for a couple of months - months during which nobody can touch me because my bite can't shift one bit before surgery. So the new plan is to get a bit more work done before I schedule the scans in May or June. This should not slow down my surgery timeline, but will allow me 1-2 more months to get some work done before surgery, rather than after.
I have to tell you, when I got the date for the CT scan, I completely lost my mind. Like, LOCO crazy, for real. I had no idea it was going to affect me that way, but this journey has been so incredibly long and hard, that even the thought of another root canal is enough to send me over the edge. I'm not kidding - for someone who truly loves her dentist (and I mean real, deep love - she is one of the best people to come into my life) I get extreme anxiety going to get any work done. So - jaw replacement? I just couldn't even handle the thought. I wanted to jump off a bridge, cancel the surgery, scream out loud...howl at the moon...whatever made the anxiety go away. I'm not sure how I'll cope when the next scan is planned, but hopefully a lot better when I've got some new teeth in my head! (How I'm preparing mentally is the subject for another post.)
The work that is planned to be done is some more teeth straightening (I had another wire change on the top that wasn't supposed to happen) and my teeth are looking even better as time goes on! I can't tell you how great that feels. I also can say that, generally speaking, the wire changes are becoming a little less painful as I get further into treatment. Of course, I'm several weeks out from the last one so it's easy to say that - I do remember there being a lot pain after the last one that really stressed me out because it was in the top front 2 teeth. I'm deathly afraid of (and too close for comfort to) losing these teeth, so any pain there puts me at a constant DEFCON 3 level.
Another thing that my dentist (Dr.T) and orthodontist (Dr.O) came up with is to do the top front 8 crowns before surgery. There are a couple of reasons for this - to get them in before I potentially lose my accident insurance coverage, and to get them done now instead of after surgery when I'll be recovering. They also thought (how incredibly sweet of them) that if I could get these nice, perfectly shaped, white permanent teeth on, I'd feel a lot better about myself psychologically before going into such a hard surgery and recovery. And I have to say that I agree.
So that's the new plan for now! If you have any questions, feel free to ask.
To bring you up to speed, I'm at the last few wire stages with my braces before surgery. I was booked to have my CT scan for surgery at the end of April, but that, too has changed. When my surgeon booked me for the scan, we had thought it would mean (calculating forward 3-4 months from scan date to implant delivery) that put me in August for surgery. But because the hospital only gives him 1 day/month in July and August, and the # of patients ahead of me who already have had their scans done, I'm really looking at the fall to have the surgery. This means that if I have the scans done now, the implants will be ready and sitting waiting for me for a couple of months - months during which nobody can touch me because my bite can't shift one bit before surgery. So the new plan is to get a bit more work done before I schedule the scans in May or June. This should not slow down my surgery timeline, but will allow me 1-2 more months to get some work done before surgery, rather than after.
I have to tell you, when I got the date for the CT scan, I completely lost my mind. Like, LOCO crazy, for real. I had no idea it was going to affect me that way, but this journey has been so incredibly long and hard, that even the thought of another root canal is enough to send me over the edge. I'm not kidding - for someone who truly loves her dentist (and I mean real, deep love - she is one of the best people to come into my life) I get extreme anxiety going to get any work done. So - jaw replacement? I just couldn't even handle the thought. I wanted to jump off a bridge, cancel the surgery, scream out loud...howl at the moon...whatever made the anxiety go away. I'm not sure how I'll cope when the next scan is planned, but hopefully a lot better when I've got some new teeth in my head! (How I'm preparing mentally is the subject for another post.)
The work that is planned to be done is some more teeth straightening (I had another wire change on the top that wasn't supposed to happen) and my teeth are looking even better as time goes on! I can't tell you how great that feels. I also can say that, generally speaking, the wire changes are becoming a little less painful as I get further into treatment. Of course, I'm several weeks out from the last one so it's easy to say that - I do remember there being a lot pain after the last one that really stressed me out because it was in the top front 2 teeth. I'm deathly afraid of (and too close for comfort to) losing these teeth, so any pain there puts me at a constant DEFCON 3 level.
Another thing that my dentist (Dr.T) and orthodontist (Dr.O) came up with is to do the top front 8 crowns before surgery. There are a couple of reasons for this - to get them in before I potentially lose my accident insurance coverage, and to get them done now instead of after surgery when I'll be recovering. They also thought (how incredibly sweet of them) that if I could get these nice, perfectly shaped, white permanent teeth on, I'd feel a lot better about myself psychologically before going into such a hard surgery and recovery. And I have to say that I agree.
So that's the new plan for now! If you have any questions, feel free to ask.
Friday, March 18, 2016
Hey there Chronic Pain:
You suck. A lot.
At this point, I feel like that could be my entire post on this subject. But if you know me, you know I can't shut up, so it won't.
So let me just tell you (chronic pain) what else I have to say.
Thank you for being there every minute of every day. If you're one thing, it's dependable. Thanks for being there when I wake up in the morning, and for feeling like a hangover that I didn't earn. On second thought, maybe it was that can of ginger ale I had last night.... or not. Thanks for getting worse when I get tired. Thanks for making me tired. It's really fun to run out of energy at 3pm and have to pretend that you're fine for the rest of the day, because nobody wants to hear about you. And even if they did, I don't like talking about you! You're depressing!
Thanks for getting worse over time and building up a tolerance to pain medications. It's really fun to have to justify to your doctor, your friends, yourSELF why you're asking for a stronger medication. It isn't embarrassing, and it doesn't make me feel like a pill-seeker. Thanks for the mood-swings that one day make me feel like "fuck yeah, it's my pain, I'll take this if I need it! I don't need to feel bad!" and the next day make me feel like "no way, I'm not taking this pill, what if I get addicted?" even though I actually hate all of the side effects of pain medication, EXCEPT for the one that makes my pain go away.
Thanks for making me feel like an old lady. When my friends and coworkers talk about the crazy things they do like go to the gym, run a race, or go out at night, I smile and nod and pretend like I do those things too. Nope, I don't go to bed at the same time as my 4 year old son! My husband thinks it's sexy that I put my jammies on at 8 pm and pass out! What could be more 34-year old like behaviour?? I tried doing some 3 km runs a few days a week, and guess who not so subtly told me that I can't do that??? YOU did! Thanks for the reminder.
Thanks for turning some days at work into complete wastelands of productivity. I really love sitting and staring at a screen, wishing you'd go away so that I could focus. I sit there anyways, so nobody thinks I'm a slacker who goes home sick all the time. Because if there's one thing I've learned is more important than your health, it's what other people think of you.
And finally, thanks for getting a whole lot worse when supplemented by hormones. Because going through uterine surgery and IVF is a whole lot of fun on its own....I need you to be there too.
Come to think of it, it kinda seems like you have a little bit of FOMO. Or you would, if you ever just pissed off for a while.
At this point, I feel like that could be my entire post on this subject. But if you know me, you know I can't shut up, so it won't.
So let me just tell you (chronic pain) what else I have to say.
Thank you for being there every minute of every day. If you're one thing, it's dependable. Thanks for being there when I wake up in the morning, and for feeling like a hangover that I didn't earn. On second thought, maybe it was that can of ginger ale I had last night.... or not. Thanks for getting worse when I get tired. Thanks for making me tired. It's really fun to run out of energy at 3pm and have to pretend that you're fine for the rest of the day, because nobody wants to hear about you. And even if they did, I don't like talking about you! You're depressing!
Thanks for getting worse over time and building up a tolerance to pain medications. It's really fun to have to justify to your doctor, your friends, yourSELF why you're asking for a stronger medication. It isn't embarrassing, and it doesn't make me feel like a pill-seeker. Thanks for the mood-swings that one day make me feel like "fuck yeah, it's my pain, I'll take this if I need it! I don't need to feel bad!" and the next day make me feel like "no way, I'm not taking this pill, what if I get addicted?" even though I actually hate all of the side effects of pain medication, EXCEPT for the one that makes my pain go away.
Thanks for making me feel like an old lady. When my friends and coworkers talk about the crazy things they do like go to the gym, run a race, or go out at night, I smile and nod and pretend like I do those things too. Nope, I don't go to bed at the same time as my 4 year old son! My husband thinks it's sexy that I put my jammies on at 8 pm and pass out! What could be more 34-year old like behaviour?? I tried doing some 3 km runs a few days a week, and guess who not so subtly told me that I can't do that??? YOU did! Thanks for the reminder.
Thanks for turning some days at work into complete wastelands of productivity. I really love sitting and staring at a screen, wishing you'd go away so that I could focus. I sit there anyways, so nobody thinks I'm a slacker who goes home sick all the time. Because if there's one thing I've learned is more important than your health, it's what other people think of you.
And finally, thanks for getting a whole lot worse when supplemented by hormones. Because going through uterine surgery and IVF is a whole lot of fun on its own....I need you to be there too.
Come to think of it, it kinda seems like you have a little bit of FOMO. Or you would, if you ever just pissed off for a while.
Monday, February 22, 2016
Hello 2016!!
Hello everyone!
I'm back! I'm here! Did you miss me?
Sorry for the hiatus, or maybe you're welcome for the break :) It's been a really busy few months for me, particularly with work as I transitioned to a new location of our company (new building, new environment, team, boss, etc) and it has been busy. So good, but busy. I have been so exhausted at night that I just haven't felt like writing. If I'm honest, it has been kinda tough for me personally to cope with the lack of energy. Great at work, but really tiring.
Where am I with my jaw and teeth? I am scheduled to have my next, and final, wire change on my lower braces only on March 7!! I am so excited!! No more wire changes. It hardly seems real. My teeth are pretty straight now, but the bottom ones have only just started to look that way, so it does seem surreal. Since I had a lower canine removed, my front middle lower teeth are all shifted, and they don't really line up properly with the top ones, but it is something I'll just have to get used to.
That means I'm one (big!) step closer to my Jaw Replacement Surgery. Once this wire change is done, and the teeth settle in about 6 weeks, I can have the big scan done. This scan is crucial - it will be sent to the implant manufacturer and it's what they will use (along with some impressions and a lot of my surgeon's input) to design and build my custom joint implants. Once they receive the scan there's lots of work to be done, consulting with my surgeon and getting these babies just right. It will take about 3 months to make them, and only when they are about 1 month out from completion will the implant company give my doctor the ok to schedule the surgery. So if you add up all that time, I'm looking at roughly August for the whole big deal. Implants. In my face.
So it's basically starting to feel super real to me now. I'm thinking about when I should let my work know, how long I think I might be off for, what I'll need for surgery, how to prepare, all that stuff. Should I take a vacation before I go off? (I'm thinking yes). What will I need to buy? How am I going to feel?
Of course, there's a massively terrifying part of this too. What is the pain going to be like? How long will it take me to feel relatively normal again? I remember how long and how hard healing was when I just broke my face..this has to be just as hard. Most certainly, my face is going to change after this. What is it going to look like? Will I be ok with it? How will my massive scars heal? Will my son be afraid of me? Will I have facial paralysis? Will I be able close my eyes?
On the plus side, I get to get a rad new hairdo for it all. They're going to shave my hair above my ears, and I'm not just going to let the nurses do it. I'm planning to prep...embrace my inner rocker chick...let my freak flag fly! What do you think of this look??
I'm back! I'm here! Did you miss me?
Sorry for the hiatus, or maybe you're welcome for the break :) It's been a really busy few months for me, particularly with work as I transitioned to a new location of our company (new building, new environment, team, boss, etc) and it has been busy. So good, but busy. I have been so exhausted at night that I just haven't felt like writing. If I'm honest, it has been kinda tough for me personally to cope with the lack of energy. Great at work, but really tiring.
Where am I with my jaw and teeth? I am scheduled to have my next, and final, wire change on my lower braces only on March 7!! I am so excited!! No more wire changes. It hardly seems real. My teeth are pretty straight now, but the bottom ones have only just started to look that way, so it does seem surreal. Since I had a lower canine removed, my front middle lower teeth are all shifted, and they don't really line up properly with the top ones, but it is something I'll just have to get used to.
That means I'm one (big!) step closer to my Jaw Replacement Surgery. Once this wire change is done, and the teeth settle in about 6 weeks, I can have the big scan done. This scan is crucial - it will be sent to the implant manufacturer and it's what they will use (along with some impressions and a lot of my surgeon's input) to design and build my custom joint implants. Once they receive the scan there's lots of work to be done, consulting with my surgeon and getting these babies just right. It will take about 3 months to make them, and only when they are about 1 month out from completion will the implant company give my doctor the ok to schedule the surgery. So if you add up all that time, I'm looking at roughly August for the whole big deal. Implants. In my face.
So it's basically starting to feel super real to me now. I'm thinking about when I should let my work know, how long I think I might be off for, what I'll need for surgery, how to prepare, all that stuff. Should I take a vacation before I go off? (I'm thinking yes). What will I need to buy? How am I going to feel?
Of course, there's a massively terrifying part of this too. What is the pain going to be like? How long will it take me to feel relatively normal again? I remember how long and how hard healing was when I just broke my face..this has to be just as hard. Most certainly, my face is going to change after this. What is it going to look like? Will I be ok with it? How will my massive scars heal? Will my son be afraid of me? Will I have facial paralysis? Will I be able close my eyes?
On the plus side, I get to get a rad new hairdo for it all. They're going to shave my hair above my ears, and I'm not just going to let the nurses do it. I'm planning to prep...embrace my inner rocker chick...let my freak flag fly! What do you think of this look??
Monday, November 2, 2015
Pain Science on Bruxism, Jaw Clenching amd TMJS
I know that I have talked before about how I get my head massaged (and shrunk, but that's a different topic) every week or two on the reg, but I have yet to post any of the science behind it. My chiropractor focuses on my temporalis, masseter and suboccipitals during treatment. Speak English Tiffany! What do those sciency words mean?? Why do you give your chiropractor so much money to massage them?
Ah. Relax my friends. I don't have to explain all of this, because blogger Paul Ingraham (a self-described over-qualified massage therapist) at PainScience.com has published the most helpful article on Massage Therapy for Bruxism, Jaw Clenching and TMJ Syndrome. In this article, he describes the Trigger Points, or muscle knots, that can be self-massaged for TMJ pain relief. Am I just wasting my money? (Just kidding...I couldn't do all that Dr. Nino does for me).
Not only does he talk about where to push, but the article describes, in easy to read style, your masseter muscle anatomy, physiology, the areas that it can affect, symptoms and tips to help you relax your jaw muscles and how to care for them by lifestyle adjustments. In fact, there are so many links in there that are incredibly useful and relevant, I can't even describe them all.
Anyways, if you are still reading here, stop. Go to the article. It's long, but it's so incredibly useful and educating. And if you are reading this blog in support of me, but not because you're dealing with TMJ pain...check out the Pain Science blog. He has tips for all kinds of aches, pains and injuries. I highly recommend checking it out, even just to better understand what's going on inside all of us.
P.S. There's also an article linked in there called Pain Changes How Pain Works. It's a discussion about how pain itself results in more pain with less provocation, and he describes it as "Owner's Manual Stuff".
Ah. Relax my friends. I don't have to explain all of this, because blogger Paul Ingraham (a self-described over-qualified massage therapist) at PainScience.com has published the most helpful article on Massage Therapy for Bruxism, Jaw Clenching and TMJ Syndrome. In this article, he describes the Trigger Points, or muscle knots, that can be self-massaged for TMJ pain relief. Am I just wasting my money? (Just kidding...I couldn't do all that Dr. Nino does for me).
Not only does he talk about where to push, but the article describes, in easy to read style, your masseter muscle anatomy, physiology, the areas that it can affect, symptoms and tips to help you relax your jaw muscles and how to care for them by lifestyle adjustments. In fact, there are so many links in there that are incredibly useful and relevant, I can't even describe them all.
Anyways, if you are still reading here, stop. Go to the article. It's long, but it's so incredibly useful and educating. And if you are reading this blog in support of me, but not because you're dealing with TMJ pain...check out the Pain Science blog. He has tips for all kinds of aches, pains and injuries. I highly recommend checking it out, even just to better understand what's going on inside all of us.
P.S. There's also an article linked in there called Pain Changes How Pain Works. It's a discussion about how pain itself results in more pain with less provocation, and he describes it as "Owner's Manual Stuff".
Tuesday, October 20, 2015
Are your limitations really limiting you?
One thing I certainly didn't expect from this injury is the limitations that have been placed on me physically. It makes me uncomfortable to say it, but I don't feel like I'm one to accept limitations without pushing them a little bit first. I wouldn't say that I'm someone who pushes through anything super human to achieve a goal, but I'm not one to say "I can't do that" without trying it first. Maybe I'll try it secretly...without announcing the results...but I'll give it a go.
This injury has been a source of almost constant discomfort. I say almost because there are good drugs and bottles of wine (not to be combined!) that can take it away but neither of these are perfect. Hangovers and side effects need to be managed! Whether it's neck, shoulder, head, jaw or tooth pain, it always seems to be something. I find that often times I'm taken aback by how unrelenting it is, and how places that I thought could never hurt, do. Like your head muscles. How many of you have asked to have your head muscles massaged? Did you even know you HAD head muscles? The ones that cover your skull and barely move? I get them massaged every other week....and it never makes the pain go away completely. (Actually, if you're reading this you probably have TMJ and totally get it. Sorry.)
Anyways, I'm not writing this to whine about my aches (ok, maybe a little bit), but to talk about accepting, and sometimes pushing, your limitations.
There are a lot of things that I want to be able to do without ending up in a pain crisis, or fully exhausted for a week, or without crying because I've over done it. Like go out for a night on the town. Or train for a competition. Or stay up past 10 pm on a weeknight. Or deal with a cold. Or go out in the cold for a day. Or make multiple plans on a weekend (with associated eating/drinking) and function like normal the following week.
You get it.
I'm whiny.
But really, all of these things end up sort of crushing me at some point. And I don't mean like "oh boy, I'm extra tired on Monday." This past weekend I went out to a late dinner Friday night, cleaned my house on Saturday, went to a friends house in the afternoon and then walked around Toronto watching my sister run a marathon on Sunday. By Monday I was exhausted, had a splitting headache and a nasty sore throat, which I really felt was set off by my lack of energy and ability to bounce back after some busy times. My jaw muscles were aching and I felt the vice-like grip around my temples that comes after a lot of talking, eating socially and maneuvering my jaw around trying to make my braces presentable after just taking a bite. Maybe it's just cold/flu season, but I'm really tired of this!
I used to just push through busy things, over-schedule myself and rebound alright....now I'm like a ticking time bomb. I have another late night, busy weekend coming up and I'm already dreading the "recovery time" from that. My sister went to work the day after the marathon, damn it!! Why can't I??
If this whole situation has taught me anything, it's got to be patience. The funny thing is, there's patience with life and then patience with yourself. Having patience with yourself (and self-care) is the hardest thing to practice. I would rather just push through my plans and obligations and deal with the tiredness later. It's just that now, it's not just being tired. It's pain, it's exhaustion, and it's the "me" that I put forth and give to my family that I have to be concerned with. Sigh.
Or here is this question to ponder....
How bad is this situation? You know when you hear about people doing incredible things, like, oh...say EVERY paralympian, EVER? Who am I to whine?
Time to feed that courage wolf...
This injury has been a source of almost constant discomfort. I say almost because there are good drugs and bottles of wine (not to be combined!) that can take it away but neither of these are perfect. Hangovers and side effects need to be managed! Whether it's neck, shoulder, head, jaw or tooth pain, it always seems to be something. I find that often times I'm taken aback by how unrelenting it is, and how places that I thought could never hurt, do. Like your head muscles. How many of you have asked to have your head muscles massaged? Did you even know you HAD head muscles? The ones that cover your skull and barely move? I get them massaged every other week....and it never makes the pain go away completely. (Actually, if you're reading this you probably have TMJ and totally get it. Sorry.)
Anyways, I'm not writing this to whine about my aches (ok, maybe a little bit), but to talk about accepting, and sometimes pushing, your limitations.
There are a lot of things that I want to be able to do without ending up in a pain crisis, or fully exhausted for a week, or without crying because I've over done it. Like go out for a night on the town. Or train for a competition. Or stay up past 10 pm on a weeknight. Or deal with a cold. Or go out in the cold for a day. Or make multiple plans on a weekend (with associated eating/drinking) and function like normal the following week.
You get it.
I'm whiny.
But really, all of these things end up sort of crushing me at some point. And I don't mean like "oh boy, I'm extra tired on Monday." This past weekend I went out to a late dinner Friday night, cleaned my house on Saturday, went to a friends house in the afternoon and then walked around Toronto watching my sister run a marathon on Sunday. By Monday I was exhausted, had a splitting headache and a nasty sore throat, which I really felt was set off by my lack of energy and ability to bounce back after some busy times. My jaw muscles were aching and I felt the vice-like grip around my temples that comes after a lot of talking, eating socially and maneuvering my jaw around trying to make my braces presentable after just taking a bite. Maybe it's just cold/flu season, but I'm really tired of this!
I used to just push through busy things, over-schedule myself and rebound alright....now I'm like a ticking time bomb. I have another late night, busy weekend coming up and I'm already dreading the "recovery time" from that. My sister went to work the day after the marathon, damn it!! Why can't I??
If this whole situation has taught me anything, it's got to be patience. The funny thing is, there's patience with life and then patience with yourself. Having patience with yourself (and self-care) is the hardest thing to practice. I would rather just push through my plans and obligations and deal with the tiredness later. It's just that now, it's not just being tired. It's pain, it's exhaustion, and it's the "me" that I put forth and give to my family that I have to be concerned with. Sigh.
Or here is this question to ponder....
How bad is this situation? You know when you hear about people doing incredible things, like, oh...say EVERY paralympian, EVER? Who am I to whine?
Time to feed that courage wolf...
Current TMJ Implant Options
The world of alloplastic implant options is small you might say. There are three options on the market for your surgeon to choose from:
1. TMJ Implants
2. TMJ Concepts
3. Biomet/Lorenz
To start, there are several criteria that are considered when designing an implant for use in the TMJ. This is done to ensure that a situation like the Vitek implant disaster does not happen again, and takes into account what was learned with that experience, as well as what can be applied from hip and knee replacement implants that have been around for decades. I found an excellent review article in the McGill Journal of Medicine that explains implant design in detail.
(Sinno H, Youssef T, Giladino M, Bobyn D. Engineering Alloplastic Temporomandibular Joint Replacements. MJM 2010 13(1): 63-72.
The following is a summary of the key factors in implant design.
1. Biocompatibility.
The implant has to affix well to the bone to which it is attached, while causing the least amount of damage to the surrounding tissues as possible.
2. Modulus, or stiffness of the material.
The more flexible the implant material, the more it can share the load with the bone it is affixed to. When bone is stressed with a load, the more bone density and strength are preserved in the long run.
3. Stiffness.
This depends on both the flexibility of the material and the shape and thickness of the implant. The thicker the implant, even if it is made of a flexible material, the stiffer it will be. This is the reason why, when you look at pictures of the implants, they show little notches in the metal parts. Putting these notches in, or making it hollow, or very porous, helps to reduce the stiffness of the implant.
4. Stress Shielding.
Similar to, and perhaps a summary of modulus and stiffness, when 2 materials have a uniform load applied to both, the stiffer material will absorb most of that load. So when an implant is attached to bone, it will absorb the loading and shield bone from the stress. As mentioned above, this will cause the bone to lose density and strength in the long term.
5. Notch Sensitivity.
This was the hardest for to me to understand, but when an implant is made with notches in it to reduce it's stiffness, or perhaps to encourage the bone to grow into the notches and rigidly fix the implant, those notches are a point of weakness. So notch sensitivity is is how sensitive the material is to fracture due to the presence of the notches.
6. Modularity.
This enables the use of different materials for different parts of the implant. Materials that are best for wear resistance can be used for bearing components. Materials that are less stiff can be used for load carrying and fixation to reduce the stress shielding and bone resorption that results.
7. Materials.
The same materials that are used in hip/knee replacements are what are used in TMJ implants. Cobalt-Chromium (Co-Cr) and titanium alloys are useful in the stems and bodies of the implants. There are also a variety of options for porous fixation surfaces. A new development is the use of highly cross-linked polyethylene, which is a very wear resistant plastic - ultra high molecular weight polyethylene (UHMWPE) that is also being used widely in hip and knee replacements.
Stainless steel is not used, because it can corrode - so it's not biocompatible for the TMJ.
A few notes on Co-Cr, titanium alloys and UHMWPE:
Co-Cr is very hard and abrasion resistant, but can cause significant stress sheilding.
Titanium alloys are more flexible than Co-Cr, but does not have good wear properties. It is also notch sensitive, so it can't be impregnated with beads or wire to promote bony ingrowth. It can, however, be roughened at the surface, or coated.
UHMWPE has had long term success in orthopaedic surgery, but is subject to wear after repeated loading.
Comparison of current implants:
The condylar portion of all implants is made with Co-Cr alloy. The Biomet/Lorenz implants have a plasma spray titanium coating on the bone-contacting surface to help bone fixation. The Co-Cr bearing has high hardness and strength.
Attached to the condyle is the ramus (below the condyle on the jaw). In TMJ Implant and Biomet, the ramus is made of Co-Cr alloy. TMJ concepts uses titanium alloy. The authors of the study thought that since the ramus is a thinner bone, using a titanium alloy would distribute the load better, and reduce stress sheilding.
The ball and socket portion of the implant is the fossa. The TMJ implants uses metal-on-metal bearings made of Co-Cr. Both TMJ Concepts and Biomet use UHMWPE.
Overall, the study suggests that Alloplastic TMJ reconstruction devices have shown a lot of predictability and reliability. Choosing Alloplastic over Autogenous reconstruction provides a few benefits, including custom made implants that allow for immediate jaw function (in most cases, no wiring shut) after surgery.
Of course, everyone in this "business" knows that these implants are not meant to last forever, and will need replacement at some point in time. The current suggestion is about 20 years of life, since they are relatively new and every year that goes by, another one lasts another year longer.
It's sure no picnic to sift through all of this information...so I hope it's somewhat helpful in learning more about TMJ implants!
1. TMJ Implants
2. TMJ Concepts
3. Biomet/Lorenz
To start, there are several criteria that are considered when designing an implant for use in the TMJ. This is done to ensure that a situation like the Vitek implant disaster does not happen again, and takes into account what was learned with that experience, as well as what can be applied from hip and knee replacement implants that have been around for decades. I found an excellent review article in the McGill Journal of Medicine that explains implant design in detail.
(Sinno H, Youssef T, Giladino M, Bobyn D. Engineering Alloplastic Temporomandibular Joint Replacements. MJM 2010 13(1): 63-72.
The following is a summary of the key factors in implant design.
1. Biocompatibility.
The implant has to affix well to the bone to which it is attached, while causing the least amount of damage to the surrounding tissues as possible.
2. Modulus, or stiffness of the material.
The more flexible the implant material, the more it can share the load with the bone it is affixed to. When bone is stressed with a load, the more bone density and strength are preserved in the long run.
3. Stiffness.
This depends on both the flexibility of the material and the shape and thickness of the implant. The thicker the implant, even if it is made of a flexible material, the stiffer it will be. This is the reason why, when you look at pictures of the implants, they show little notches in the metal parts. Putting these notches in, or making it hollow, or very porous, helps to reduce the stiffness of the implant.
4. Stress Shielding.
Similar to, and perhaps a summary of modulus and stiffness, when 2 materials have a uniform load applied to both, the stiffer material will absorb most of that load. So when an implant is attached to bone, it will absorb the loading and shield bone from the stress. As mentioned above, this will cause the bone to lose density and strength in the long term.
5. Notch Sensitivity.
This was the hardest for to me to understand, but when an implant is made with notches in it to reduce it's stiffness, or perhaps to encourage the bone to grow into the notches and rigidly fix the implant, those notches are a point of weakness. So notch sensitivity is is how sensitive the material is to fracture due to the presence of the notches.
6. Modularity.
This enables the use of different materials for different parts of the implant. Materials that are best for wear resistance can be used for bearing components. Materials that are less stiff can be used for load carrying and fixation to reduce the stress shielding and bone resorption that results.
7. Materials.
The same materials that are used in hip/knee replacements are what are used in TMJ implants. Cobalt-Chromium (Co-Cr) and titanium alloys are useful in the stems and bodies of the implants. There are also a variety of options for porous fixation surfaces. A new development is the use of highly cross-linked polyethylene, which is a very wear resistant plastic - ultra high molecular weight polyethylene (UHMWPE) that is also being used widely in hip and knee replacements.
Stainless steel is not used, because it can corrode - so it's not biocompatible for the TMJ.
A few notes on Co-Cr, titanium alloys and UHMWPE:
Co-Cr is very hard and abrasion resistant, but can cause significant stress sheilding.
Titanium alloys are more flexible than Co-Cr, but does not have good wear properties. It is also notch sensitive, so it can't be impregnated with beads or wire to promote bony ingrowth. It can, however, be roughened at the surface, or coated.
UHMWPE has had long term success in orthopaedic surgery, but is subject to wear after repeated loading.
Comparison of current implants:
The condylar portion of all implants is made with Co-Cr alloy. The Biomet/Lorenz implants have a plasma spray titanium coating on the bone-contacting surface to help bone fixation. The Co-Cr bearing has high hardness and strength.
Attached to the condyle is the ramus (below the condyle on the jaw). In TMJ Implant and Biomet, the ramus is made of Co-Cr alloy. TMJ concepts uses titanium alloy. The authors of the study thought that since the ramus is a thinner bone, using a titanium alloy would distribute the load better, and reduce stress sheilding.
The ball and socket portion of the implant is the fossa. The TMJ implants uses metal-on-metal bearings made of Co-Cr. Both TMJ Concepts and Biomet use UHMWPE.
Overall, the study suggests that Alloplastic TMJ reconstruction devices have shown a lot of predictability and reliability. Choosing Alloplastic over Autogenous reconstruction provides a few benefits, including custom made implants that allow for immediate jaw function (in most cases, no wiring shut) after surgery.
Of course, everyone in this "business" knows that these implants are not meant to last forever, and will need replacement at some point in time. The current suggestion is about 20 years of life, since they are relatively new and every year that goes by, another one lasts another year longer.
It's sure no picnic to sift through all of this information...so I hope it's somewhat helpful in learning more about TMJ implants!
Saturday, October 10, 2015
TMJ Replacement Options
I was recently asked the question: are you getting TMJ Concepts custom made implant or Biomet custom implant? Do you know by any chance what is the difference and which one may be a better one?
This is a question that I've thought a lot about myself, but just sort of trusted my surgeon to recommend what's best. And I still feel that way - whatever he is most comfortable "installing" in my face has got to give the best outcome. Some might feel differently, but allow me to explain myself. This is a very uncommon and relatively new surgery. There are fewer surgeons who actually perform the TMJ replacements, so they are on the leading edge of what is being developed and seeing the results of themselves with their patients. However, having a solid Biology background (as in, an undergrad degree), I am keenly interested in the implants that I'm getting and why.
Without disrespecting anyone who has dealt with this longer than I have, and certainly that's almost anyone who is facing this as a result of a systemic issue rather than a recent trauma (like me), I'm writing this from the perspective that your surgeon has recommended a TJR (total jaw replacement) and a certain type of implant and you're wondering why they might be recommending that type and the history behind it. In my particular case, I know that this is my only option going forward - foregoing TJR of any type is not an option. I know that there are some folks out there who believe surgery should be avoided at all costs, and certainly there are cases where this should not be jumped into. However, I've done enough research and know my own situation well enough to know that this is something that I need and there is no other option.
That being said, here are the options for complete TMJ reconstruction surgery:
Pros:
Alloplastic Replacement is the replacement of the whole joint (fossa/"socket", condyle/"ball" and ramus - what you think of as the jaw bone) with a manufactured joint. These implants can be conceptualized as the same as a hip or a knee replacement implant.
The reasons you might get an alloplastic implant are:
Some of the benefits of alloplastic joints over autogenous grafting are:
This is a question that I've thought a lot about myself, but just sort of trusted my surgeon to recommend what's best. And I still feel that way - whatever he is most comfortable "installing" in my face has got to give the best outcome. Some might feel differently, but allow me to explain myself. This is a very uncommon and relatively new surgery. There are fewer surgeons who actually perform the TMJ replacements, so they are on the leading edge of what is being developed and seeing the results of themselves with their patients. However, having a solid Biology background (as in, an undergrad degree), I am keenly interested in the implants that I'm getting and why.
Without disrespecting anyone who has dealt with this longer than I have, and certainly that's almost anyone who is facing this as a result of a systemic issue rather than a recent trauma (like me), I'm writing this from the perspective that your surgeon has recommended a TJR (total jaw replacement) and a certain type of implant and you're wondering why they might be recommending that type and the history behind it. In my particular case, I know that this is my only option going forward - foregoing TJR of any type is not an option. I know that there are some folks out there who believe surgery should be avoided at all costs, and certainly there are cases where this should not be jumped into. However, I've done enough research and know my own situation well enough to know that this is something that I need and there is no other option.
That being said, here are the options for complete TMJ reconstruction surgery:
- Autogenous Replacement (rib graft most often)
- Alloplastic Replacement (manufactured implant)
- TMJ Implant
- TMJ Concepts
- Biomet/Lorenz
Pros:
- Cost - since no manufactured parts are required, the cost is lower for this surgery. However, since there is another surgical site and associated pain, the hospital stay is longer, and the recovery may be longer. This may offset the cost savings to the patient.
- Growth potential - in children, this is the only option for reconstruction, since they will continue growing and a manufactured implant will not.
- Recovery time is long
- Only reconstructs the "ball" and not the "socket" part of the joint
- Often requires re-operation, which may ultimately include a manufactured implant
Alloplastic Replacement is the replacement of the whole joint (fossa/"socket", condyle/"ball" and ramus - what you think of as the jaw bone) with a manufactured joint. These implants can be conceptualized as the same as a hip or a knee replacement implant.
The reasons you might get an alloplastic implant are:
- Ankylosis of the TMJ with severe anatomic abnormalities
- Failure of autogenous grafts
- Failure of Proplast-Teflon or Vitek-Kent or partial joint implants
- Severe inflammatory joint disease resulting in joint mutilation and functional disability
Some of the benefits of alloplastic joints over autogenous grafting are:
- Immediate jaw function, allowing for physiotherapy to begin on Day 1 of recovery
- No need for a secondary donor site (rib sectioning, etc)
- Custom implant availability
Surgeons seem to see that immediate movement of the joints contributes to a much shorter healing time, and better outcomes. Of course, one of the deciding factors in the relative success of the surgery is dependant on how many prior surgeries a patient has had. The more surgeries, the lesser the degree of success.
I hope that this helps to understand the differences between grafting-type TMJ reconstruction and manufactured implants. In my next post, I will share what I've learned are the subtle differences between TMJ Concepts and Biomet/Lorenz manufactured implants.
Keep feeding the courage wolf!!
Monday, September 28, 2015
Surgery Upate
Someone commented (OMG I love you!) and asked if I had a date for surgery yet. Sadly, I have to say no, but I did I see my surgeon last week, which is now a 3 month standing "date". He's so reassuring, that Dr. P!
Just to refresh anyone new, if you're having your jaws replaced with TMJ concepts implants, they must take scans of your face to create the joints. If you have braces, after the scans are taken your orthodontist can't touch your mouth again...so the scans can't be done until your ortho has done their job. Then it takes 3 months to make the joints, so scheduling a date for surgery isn't as simple as picking a date.
So Dr. P was very pleasantly surprised at how my teeth are coming along. I must say, the top teeth are looking pretty darn good! The lowers are getting there....definitely in the general 'arch' position, with final touching-up needed. It felt nice to hear him say, rather surprisedly "You look good! Really good!!" This guy fucks with faces for a living. Yeah!
So throughout this whole process (and LONG before) my goal was to have another baby. Given the timeframe that was imposed on me since the accident, we accelerated our attempts (also because 3 years is a long time to try with no success) and saw a fertility clinic. We decided to say to hell with the face surgery and just go gung-ho with IVF. I was in the middle of stimulation hormone injections when I saw Dr. P, with the goal of freezing embryos until next cycle (or one after face surgery....ahh that old time-worn debate....). Then Dr. P said he thought we could be getting close to planning for surgery, and that the sooner we 'fix' my joints, the sooner I can get out of pain. He talked about chronic pain theory - whereby the longer you're in pain, your nerves can permanently change and you can end up with chronic pain even after the joints are fixed. So it's better to have surgery sooner than later. Well damn. That sure changes things.
In any case, even without all the IVF complications, I wouldn't yet have a surgery date. What Dr P. did offer me though, was to tighten up all the timelines to get the TJR surgery completed as quickly as possible - get started on planning for the scans and even a surgery date. That way, when it's over with I'd be able to implant one of those frozen littlescience experiments embryos blastocysts only about 2 months after TJR.
So there you have it... still hurry up and wait. If I don't come out of this a more patient person, then I'm just going to give up!!
Just to refresh anyone new, if you're having your jaws replaced with TMJ concepts implants, they must take scans of your face to create the joints. If you have braces, after the scans are taken your orthodontist can't touch your mouth again...so the scans can't be done until your ortho has done their job. Then it takes 3 months to make the joints, so scheduling a date for surgery isn't as simple as picking a date.
So Dr. P was very pleasantly surprised at how my teeth are coming along. I must say, the top teeth are looking pretty darn good! The lowers are getting there....definitely in the general 'arch' position, with final touching-up needed. It felt nice to hear him say, rather surprisedly "You look good! Really good!!" This guy fucks with faces for a living. Yeah!
So throughout this whole process (and LONG before) my goal was to have another baby. Given the timeframe that was imposed on me since the accident, we accelerated our attempts (also because 3 years is a long time to try with no success) and saw a fertility clinic. We decided to say to hell with the face surgery and just go gung-ho with IVF. I was in the middle of stimulation hormone injections when I saw Dr. P, with the goal of freezing embryos until next cycle (or one after face surgery....ahh that old time-worn debate....). Then Dr. P said he thought we could be getting close to planning for surgery, and that the sooner we 'fix' my joints, the sooner I can get out of pain. He talked about chronic pain theory - whereby the longer you're in pain, your nerves can permanently change and you can end up with chronic pain even after the joints are fixed. So it's better to have surgery sooner than later. Well damn. That sure changes things.
In any case, even without all the IVF complications, I wouldn't yet have a surgery date. What Dr P. did offer me though, was to tighten up all the timelines to get the TJR surgery completed as quickly as possible - get started on planning for the scans and even a surgery date. That way, when it's over with I'd be able to implant one of those frozen little
So there you have it... still hurry up and wait. If I don't come out of this a more patient person, then I'm just going to give up!!
Thursday, September 24, 2015
The Zone of Tolerance
Do you ever feel like some days the smallest things just set you off? You're short-tempered, angry, just not capable of handling your life? ("Like...I just CAN'T right now!! UGH!") Or perhaps you just feel exhausted, like you don't want to leave your bed and have no energy to even listen. You're probably outside your zone of tolerance.
Today's post is about a phenomenon that's new to me in theory and description, but I know from...well...life in general. It wasn't much of a persistent problem before my accident, but since then I've noticed big fluctuations in what I'm capable of handling at any given moment. I described this to my therapist, and she showed me the diagram and literature that explains it. It's called the Zone of Tolerance. Here's the diagram:
We all have one. The "zone"is the area within with you are operating at any given time. If your life is relatively stable (event-wise, emotionally, physically..) then your zone is probably sort of fixed in it's size. You probably can pretty reliably predict what you're capable of handling. If however, your world is shaken up by something (in my case, chronic pain and stress) your zone might shrink. Some days (high pain levels, lack of sleep, emotional turmoil) your zone is so small that the smallest things can set you off. Other days, everything is going well, you feel good - your zone is bigger and you feel like you can take on the world. These are great days!
When your zone is constantly widening and then narrowing again, it's hard to feel emotionally stable. You can get really down on yourself for even the fluctuations - let alone the reasons why it's fluctuating. So what's really important is this:
Today's post is about a phenomenon that's new to me in theory and description, but I know from...well...life in general. It wasn't much of a persistent problem before my accident, but since then I've noticed big fluctuations in what I'm capable of handling at any given moment. I described this to my therapist, and she showed me the diagram and literature that explains it. It's called the Zone of Tolerance. Here's the diagram:
We all have one. The "zone"is the area within with you are operating at any given time. If your life is relatively stable (event-wise, emotionally, physically..) then your zone is probably sort of fixed in it's size. You probably can pretty reliably predict what you're capable of handling. If however, your world is shaken up by something (in my case, chronic pain and stress) your zone might shrink. Some days (high pain levels, lack of sleep, emotional turmoil) your zone is so small that the smallest things can set you off. Other days, everything is going well, you feel good - your zone is bigger and you feel like you can take on the world. These are great days!
When your zone is constantly widening and then narrowing again, it's hard to feel emotionally stable. You can get really down on yourself for even the fluctuations - let alone the reasons why it's fluctuating. So what's really important is this:
- Recognize that you HAVE a zone! Understand that it's normal to feel super strong some days, and incapable of getting out of bed on other days.
- Scan where you are in the zone at this very moment. If you feel that you are starting to slip outside of it (however big or small it may be today), try to ground yourself. Do some deep breathing through your nose (in for a count of 4, out for a count of 4) and touch something real in your vicinity. This will take you out of your head, and back into the present.
- If you're nearing the upper limit of your zone, or are slipping out of it, do something CALMING. If you're nearing or slipping below the lower limit of your zone, do something ENERGIZING.
Tuesday, September 1, 2015
Braces Update
Last week I had another wire change on my braces. I went back through my appointment history to figure out how many different wires I've had on since I started. (For someone blogging their experience, I'm not keeping very good track of what's going on!) I figured out that I've had 8 different wires on my top teeth and 6 different ones on the bottom. The reason for the difference is that the top braces went on at the end of December 2014, while the bottom ones only went on the first week of March 2015. I can't believe I've had this many wire changes already...time sure flies!
It certainly explains why I am beginning to notice a pattern in my pain levels. The wire change happened Tuesday last week (one week ago today) and the pain has migrated from my teeth, through my facial bones, and now it is at my TMJ's. It's strange how that happens. I don't know anything scientific about why this happens, but I imagine it to be the knock-on effect of the force on my teeth when the new wire goes on, then it starts the bone-forming part of moving them a few days later, and that affects my bite, jaw position, and my TMJ's get flared up. It's so great!
Not.
Dr O moved me to a thicker rectangular-shaped wire on the top, and a thinner rectangular-shaped one on the bottom. Note: the "rectangular-shape refers to the diameter of the wire, not the overall bend to it. It's still a horse-shoe shaped wire overall. When the bottom wire went on it actually was so much force that it popped the bracket off one of my molars. Whoops. The assistant told me that she would put it on at my next visit in October. If she re-attached it now, if it stayed on it would cause me too much pain. Thanks!
As for the pain, it sucks. The TMJ pain is the worst. It's not acute when I eat, oh no...that would make me change what I eat to avoid it. Nope it happens afterwards, starting as a dull ache and then moving to a sharp pain just in front of my ears. So I still eat things like pizza crust, chips, nuts (don't judge me) and pay for it later. Clearly I'm either a slow learner or a glutton for punishment. Hopefully it will subside sooner than later.
My top front teeth hurt so badly for so long (long after the rest of my teeth have stopped aching) and since they were moved ("subluxated") during the accident, one has turned grey underneath the crown, that I get so anxious that I'm going to lose them. The anxiety hangs on for as long as the pain does. Thankfully it's gone now, but it is a lot to deal with. On a side note, I've learned so much about how chronic and acute pain affect a person's mental health. They are so related.
My teeth are moving well, the top ones look so straight that it's hard to imagine needing to move them more, but we're going for perfection here. I've decided that when I get the braces off and permanent crowns put on, I'm not going to go for the "perfectly imperfect" smile that I went for when I first had my front 6 crowns put on 5 years ago (for vanity...of course). This time, give 'em to me as white as is realistic and as straight as possible! After everything I've gone through, I want a perfect smile!
It certainly explains why I am beginning to notice a pattern in my pain levels. The wire change happened Tuesday last week (one week ago today) and the pain has migrated from my teeth, through my facial bones, and now it is at my TMJ's. It's strange how that happens. I don't know anything scientific about why this happens, but I imagine it to be the knock-on effect of the force on my teeth when the new wire goes on, then it starts the bone-forming part of moving them a few days later, and that affects my bite, jaw position, and my TMJ's get flared up. It's so great!
Not.
Dr O moved me to a thicker rectangular-shaped wire on the top, and a thinner rectangular-shaped one on the bottom. Note: the "rectangular-shape refers to the diameter of the wire, not the overall bend to it. It's still a horse-shoe shaped wire overall. When the bottom wire went on it actually was so much force that it popped the bracket off one of my molars. Whoops. The assistant told me that she would put it on at my next visit in October. If she re-attached it now, if it stayed on it would cause me too much pain. Thanks!
As for the pain, it sucks. The TMJ pain is the worst. It's not acute when I eat, oh no...that would make me change what I eat to avoid it. Nope it happens afterwards, starting as a dull ache and then moving to a sharp pain just in front of my ears. So I still eat things like pizza crust, chips, nuts (don't judge me) and pay for it later. Clearly I'm either a slow learner or a glutton for punishment. Hopefully it will subside sooner than later.
My top front teeth hurt so badly for so long (long after the rest of my teeth have stopped aching) and since they were moved ("subluxated") during the accident, one has turned grey underneath the crown, that I get so anxious that I'm going to lose them. The anxiety hangs on for as long as the pain does. Thankfully it's gone now, but it is a lot to deal with. On a side note, I've learned so much about how chronic and acute pain affect a person's mental health. They are so related.
My teeth are moving well, the top ones look so straight that it's hard to imagine needing to move them more, but we're going for perfection here. I've decided that when I get the braces off and permanent crowns put on, I'm not going to go for the "perfectly imperfect" smile that I went for when I first had my front 6 crowns put on 5 years ago (for vanity...of course). This time, give 'em to me as white as is realistic and as straight as possible! After everything I've gone through, I want a perfect smile!
Wednesday, August 26, 2015
Just when you give up...
That's when you get the motivation to keep going.
I had begun to wonder whether I should continue to write on here. I've been doing all kinds of work, processing my situation, coping, learning, and just putting one foot in front of the other, but never really knowing if I had anything more to say. You see, I feel like I may be learning so much, so quickly, that I am having trouble assimilating it.
In fact, I met with my therapist today, and my head was just swimming. It just seems like there is always something going on in my head that I'm processing, and I'm reading all these books, attending sessions, trying different therapies, that it's all up in there, but the end product isn't clear yet. What HAVE I learned? What could I share? At the end of our session today, I asked: "Is this normal? Am I being over dramatic about it all? Why do I feel so isolated?" And here's what she explained to me:
1. It's normal. (Aren't all therapists supposed to tell you that?) My situation is pretty unique, yes it's been going on for a year now (yesterday was the anniversary) and people don't understand it. But most of all - they probably don't know what the right thing to say is. And I understand that...I really do. I don't place blame on anyone for not knowing what to say. How could they? In fact, this whole situation has given me many gifts, one of which is that I now really understand how people can be walking around with some really big struggles, but functioning normally and even seeming happy.
2. I'm a processor. (Not the computer kind). Some people go through traumatic events and just keep on going, without dealing with the trauma. It seemingly is not affecting them - until it does. These people delay processing their "stuff". I don't. I want to deal with it all right away, while I am going through it, and when it's all over (for me, there will be a natural end to the big stuff, God willing), I will likely be done processing it.
Whether you are someone who processes right away or sometime later is not something you can choose or change about yourself. It's as hard-wired into you as your eye colour. I'm just dealing with this all at once. And hopefully, that's the easier way.
3. I am in the middle....the "waiting place"....the most awful place (if you've read Oh! The Places You'll Go! by Dr. Seuss, you know what I mean). It feels like not much is happening and I don't have much control of everything. I'm tired of it, and I don't really want to deal with it anymore.
I had begun to wonder whether I should continue to write on here. I've been doing all kinds of work, processing my situation, coping, learning, and just putting one foot in front of the other, but never really knowing if I had anything more to say. You see, I feel like I may be learning so much, so quickly, that I am having trouble assimilating it.
In fact, I met with my therapist today, and my head was just swimming. It just seems like there is always something going on in my head that I'm processing, and I'm reading all these books, attending sessions, trying different therapies, that it's all up in there, but the end product isn't clear yet. What HAVE I learned? What could I share? At the end of our session today, I asked: "Is this normal? Am I being over dramatic about it all? Why do I feel so isolated?" And here's what she explained to me:
1. It's normal. (Aren't all therapists supposed to tell you that?) My situation is pretty unique, yes it's been going on for a year now (yesterday was the anniversary) and people don't understand it. But most of all - they probably don't know what the right thing to say is. And I understand that...I really do. I don't place blame on anyone for not knowing what to say. How could they? In fact, this whole situation has given me many gifts, one of which is that I now really understand how people can be walking around with some really big struggles, but functioning normally and even seeming happy.
2. I'm a processor. (Not the computer kind). Some people go through traumatic events and just keep on going, without dealing with the trauma. It seemingly is not affecting them - until it does. These people delay processing their "stuff". I don't. I want to deal with it all right away, while I am going through it, and when it's all over (for me, there will be a natural end to the big stuff, God willing), I will likely be done processing it.
Whether you are someone who processes right away or sometime later is not something you can choose or change about yourself. It's as hard-wired into you as your eye colour. I'm just dealing with this all at once. And hopefully, that's the easier way.
3. I am in the middle....the "waiting place"....the most awful place (if you've read Oh! The Places You'll Go! by Dr. Seuss, you know what I mean). It feels like not much is happening and I don't have much control of everything. I'm tired of it, and I don't really want to deal with it anymore.
Thursday, July 16, 2015
Potential surgery date & other stuff
Well Hallo there friends,
It's been a while since I have posted. Sorry! Life is just so damn busy.
So what's been happening in my mouth....well, the braces are in there, doin' their thang. Teeth are moving and it's all pretty positive. I saw the orthodontist last week for a wire change, and after the power chain on the lowers my teeth were still really sore. He took it easy on me this month, putting only a slightly-higher tension wire in there and was understanding that I'm in pain. The first 2 days were still pretty awful, but I was able to eat solid-ish food, which is an improvement. He said that he's happy with the progress, the top is almost where he wants it, and the bottom is catching up nicely. Keep in mind that the lower braces didn't go on until a few months after the uppers.
The 45 tooth that was wildly twisted and tipped has really come around (I know, I could feel it!), enough so that my dentist would now be able to put a temporary crown on it and make me look more normal! Now I just have to actually schedule time to make the 2.5 hour drive to get it done.
My oral surgeon began trying to coordinate my jaw replacement surgery with my orthodontist, but is jumping the gun just a bit. It sounds like my teeth won't be done moving until around January, and I can't get the special CT scans done to fabricate the joints until then. The ortho knows that the more notice he can give of when he will be done his work, the better it is to schedule everything, so hopefully it will all go as planned and I will get a surgery date in January. I don't know how the oral surgeon's office manages that, but I suppose I'm not the first one he's done. It takes around 4 months to fabricate the joints, so I guess I'd be looking at surgery sometime in the spring. Maybe for my birthday in May? Woot.
In other, very exciting, very excellent news, the insurance company has reviewed my case and decided to extend my coverage for accident insurance from 12 months to 24 months. So if everything goes according to plan, we will be able to submit most claims for all this work before they close it forever. What a relief!!! I'd heard that it's very hard to get them to make exceptions to this policy, so they must have reviewed my case and understood that it's all very extensive and complicated. Never give up hope!!
On the mental/emotional side, I've definitely been struggling with a lot of things lately. I think that I'm still in the process of learning how best to manage my pain, and how it affects me day to day. I don't talk about the pain that I have for many reasons...mainly because it's not pleasant to talk about, and the more you talk about it, the bigger a "thing" it becomes in your life. Saying that, there are definitely times when just touching my head muscles can cause me to be nauseous, and times when the chronic tension headaches really affect my mood, patience, focus, etc. I definitely am learning that prescription medication is given to you for a reason, and that it helps when you take it as prescribed and not just when you feel like it, and it is not to be feared (especially when it's pretty innocuous, I'm not talking painkillers here).
I'm also accepting this whole situation for what it is. It seems so obvious to write it, but it's just my lot to deal with this. Everyone gets their challenges, and this is the one that was handed to me. It's not the best, but it's not the worst either. "Why me?" is such a pointless question to ask in this life...there's no answer, and there never will be.
And I keep on feeding that courage wolf!!
It's been a while since I have posted. Sorry! Life is just so damn busy.
So what's been happening in my mouth....well, the braces are in there, doin' their thang. Teeth are moving and it's all pretty positive. I saw the orthodontist last week for a wire change, and after the power chain on the lowers my teeth were still really sore. He took it easy on me this month, putting only a slightly-higher tension wire in there and was understanding that I'm in pain. The first 2 days were still pretty awful, but I was able to eat solid-ish food, which is an improvement. He said that he's happy with the progress, the top is almost where he wants it, and the bottom is catching up nicely. Keep in mind that the lower braces didn't go on until a few months after the uppers.
The 45 tooth that was wildly twisted and tipped has really come around (I know, I could feel it!), enough so that my dentist would now be able to put a temporary crown on it and make me look more normal! Now I just have to actually schedule time to make the 2.5 hour drive to get it done.
My oral surgeon began trying to coordinate my jaw replacement surgery with my orthodontist, but is jumping the gun just a bit. It sounds like my teeth won't be done moving until around January, and I can't get the special CT scans done to fabricate the joints until then. The ortho knows that the more notice he can give of when he will be done his work, the better it is to schedule everything, so hopefully it will all go as planned and I will get a surgery date in January. I don't know how the oral surgeon's office manages that, but I suppose I'm not the first one he's done. It takes around 4 months to fabricate the joints, so I guess I'd be looking at surgery sometime in the spring. Maybe for my birthday in May? Woot.
In other, very exciting, very excellent news, the insurance company has reviewed my case and decided to extend my coverage for accident insurance from 12 months to 24 months. So if everything goes according to plan, we will be able to submit most claims for all this work before they close it forever. What a relief!!! I'd heard that it's very hard to get them to make exceptions to this policy, so they must have reviewed my case and understood that it's all very extensive and complicated. Never give up hope!!
On the mental/emotional side, I've definitely been struggling with a lot of things lately. I think that I'm still in the process of learning how best to manage my pain, and how it affects me day to day. I don't talk about the pain that I have for many reasons...mainly because it's not pleasant to talk about, and the more you talk about it, the bigger a "thing" it becomes in your life. Saying that, there are definitely times when just touching my head muscles can cause me to be nauseous, and times when the chronic tension headaches really affect my mood, patience, focus, etc. I definitely am learning that prescription medication is given to you for a reason, and that it helps when you take it as prescribed and not just when you feel like it, and it is not to be feared (especially when it's pretty innocuous, I'm not talking painkillers here).
I'm also accepting this whole situation for what it is. It seems so obvious to write it, but it's just my lot to deal with this. Everyone gets their challenges, and this is the one that was handed to me. It's not the best, but it's not the worst either. "Why me?" is such a pointless question to ask in this life...there's no answer, and there never will be.
And I keep on feeding that courage wolf!!
Tuesday, June 9, 2015
Muscle pain, again!
Morning Y'all
Ok I've got to get something off my chest. WHY on earth would Kaitlyn bring Nick into the house with all those great guys? Doesn't she see that he's a total douche? Amirite???
Ok, that's over with.
I figured it was time for another update, since it's been a couple of weeks now since my wire change and the addition of thetorture device powerchain on my lower braces. It's been a rough couple of weeks to be honest. The pain from the powerchain lasted a few days, longer than I had anticipated. While I can't really bite into anything very well, there was a time when I couldn't even touch those teeth. On the other hand, the gaps are closed now. It happened so quickly, which shouldn't be surprising since it hurt so damn much!
I notice that in terms of my jaw and teeth fitting together, things are (as anticipated) getting worse. When I bite together now, the gap between my front teeth and all along the right side of my mouth is getting bigger. It also feels like my jaw is moving backward in my mouth, but that could just be mental.
I'm also noticing in pictures of myself that the asymmetry in my lower face is more pronounced, which is troubling. I know people say they don't "notice" it, but it definitely doesn't look right, and in my mind it makes me look a little.....slow, if you will. Maybe a little too "jolly", and not in the good sense of the word.
The worst part is the muscle pain. It is getting so tight and painful that I find myself short-tempered and tired lately. Last night I was trying to massage it out, and I found myself crying and saying "why did this happen to me?" to the hubs. No fun. He suggested I take a muscle relaxer before bed, and so I did. It definitely helped me to get out of the house this morning and go to work - I had thought I'd be needing to rest up today. And I might still need that day later this week, it all depends. I'm definitely still feeling it today.
I don't think that it's any secret to the people who know me that I've been trying to get pregnant before I have the big surgery. Since I'm 34 years old, and my son's turning 4 in September, I don't really have the time to wait until it's all over and done with so I'm trying to just sneak a pregnancy and childbirth into the wait time for TJR. No biggie. But that's left me wondering what I'll do if I find out that I am preggo and can't take my anti-inflamatories/muscle relaxants anymore? I don't take the latter all that often, but I need the AI's to stay out of day-to-day pain. And the MR's are huge to get me out of a pain crisis. I'm pretty terrified of the idea....not enough to give up on having a #2, but pretty scared. We'll have to up the acupuncture/massage budget significantly in that case.
Well that's it for today folks. As always, keep on feeding the courage wolf. Mine's getting more fierce everyday.
Ok I've got to get something off my chest. WHY on earth would Kaitlyn bring Nick into the house with all those great guys? Doesn't she see that he's a total douche? Amirite???
Ok, that's over with.
I figured it was time for another update, since it's been a couple of weeks now since my wire change and the addition of the
I notice that in terms of my jaw and teeth fitting together, things are (as anticipated) getting worse. When I bite together now, the gap between my front teeth and all along the right side of my mouth is getting bigger. It also feels like my jaw is moving backward in my mouth, but that could just be mental.
I'm also noticing in pictures of myself that the asymmetry in my lower face is more pronounced, which is troubling. I know people say they don't "notice" it, but it definitely doesn't look right, and in my mind it makes me look a little.....slow, if you will. Maybe a little too "jolly", and not in the good sense of the word.
The worst part is the muscle pain. It is getting so tight and painful that I find myself short-tempered and tired lately. Last night I was trying to massage it out, and I found myself crying and saying "why did this happen to me?" to the hubs. No fun. He suggested I take a muscle relaxer before bed, and so I did. It definitely helped me to get out of the house this morning and go to work - I had thought I'd be needing to rest up today. And I might still need that day later this week, it all depends. I'm definitely still feeling it today.
I don't think that it's any secret to the people who know me that I've been trying to get pregnant before I have the big surgery. Since I'm 34 years old, and my son's turning 4 in September, I don't really have the time to wait until it's all over and done with so I'm trying to just sneak a pregnancy and childbirth into the wait time for TJR. No biggie. But that's left me wondering what I'll do if I find out that I am preggo and can't take my anti-inflamatories/muscle relaxants anymore? I don't take the latter all that often, but I need the AI's to stay out of day-to-day pain. And the MR's are huge to get me out of a pain crisis. I'm pretty terrified of the idea....not enough to give up on having a #2, but pretty scared. We'll have to up the acupuncture/massage budget significantly in that case.
Well that's it for today folks. As always, keep on feeding the courage wolf. Mine's getting more fierce everyday.
Thursday, May 21, 2015
New Wires and a Powerchain
Hi Friends!
I know it's been a while since I've written. I read a lot of blogs about braces, and it always seems that people slack off posting updates when the hardware's been on for a few months, and now I know why. There's not a lot say! I have tried to share other aspects of my life here, and I plan to continue doing so. It's just that when you're doing a lot of introspective work, it's time consuming and doesn't leave a ton of writing time.
Anyways, today's post is about my wire change today. I had both top and bottom wires changed (for those not wearing the Damon braces system, this is the same as a braces "tightening") and all I can say is Fuck Fuck Fuck. Pardon my language. My mother in law and I agree that when something is really bad or frustrating, the only real way to feel better is to say a triple Fuck out loud.
The last wires were on for 6 weeks, and the bottom one partially closed the gap where my 33 was pulled from, and created a bit of a gap between another 2 bottom fronts. There's still the nasty 35 that's twisted and angled needing space to move. It has really come along, but it needs more room to straighten out, so now Dr. O put a powerchain on the bottom fronts to close the gaps and make more room for the 35. And holy triple F it hurts!!!
Part of me really wonders if I am just a really big wuss about the pain, or if it's extra bad for me because of all the trauma to my teeth. Since the absolute worst of it, what I would unequivocally call PAIN is in my front teeth, while the back are more extremely uncomfortable, I would guess that yes...braces hurt more for me than the average person. I'm going with that. It was so unbearable yesterday I considered going home from work (instead I took a painkiller and relegated myself to clearing out my inbox, no complicated tasks for me) and then had to take a muscle relaxer to sleep last night. I still don't understand why a braces adjustment causes my temporal muscle to tighten up like a vice. I'm so thankful that I have an acupuncture/massage appointment tonight.
So now it's another 6 weeks until the next wire change. This pain should subside in the coming days, and hopefully it's smooth sailing from there. In the meantime, I'm continuing to work on meditation, focused breathing and now I have a couple of mantras that I say to maintain my focus.
When I am in pain, it's "Easy Day. I breathe out pain with every breath."
When I want to calm myself and let go, I say "Life itself supports me. I trust in the universe."
So as always: Feed the courage wolf and starve the fear wolf inside you. Which wolf are you feeding?
I know it's been a while since I've written. I read a lot of blogs about braces, and it always seems that people slack off posting updates when the hardware's been on for a few months, and now I know why. There's not a lot say! I have tried to share other aspects of my life here, and I plan to continue doing so. It's just that when you're doing a lot of introspective work, it's time consuming and doesn't leave a ton of writing time.
Anyways, today's post is about my wire change today. I had both top and bottom wires changed (for those not wearing the Damon braces system, this is the same as a braces "tightening") and all I can say is Fuck Fuck Fuck. Pardon my language. My mother in law and I agree that when something is really bad or frustrating, the only real way to feel better is to say a triple Fuck out loud.
The last wires were on for 6 weeks, and the bottom one partially closed the gap where my 33 was pulled from, and created a bit of a gap between another 2 bottom fronts. There's still the nasty 35 that's twisted and angled needing space to move. It has really come along, but it needs more room to straighten out, so now Dr. O put a powerchain on the bottom fronts to close the gaps and make more room for the 35. And holy triple F it hurts!!!
Part of me really wonders if I am just a really big wuss about the pain, or if it's extra bad for me because of all the trauma to my teeth. Since the absolute worst of it, what I would unequivocally call PAIN is in my front teeth, while the back are more extremely uncomfortable, I would guess that yes...braces hurt more for me than the average person. I'm going with that. It was so unbearable yesterday I considered going home from work (instead I took a painkiller and relegated myself to clearing out my inbox, no complicated tasks for me) and then had to take a muscle relaxer to sleep last night. I still don't understand why a braces adjustment causes my temporal muscle to tighten up like a vice. I'm so thankful that I have an acupuncture/massage appointment tonight.
So now it's another 6 weeks until the next wire change. This pain should subside in the coming days, and hopefully it's smooth sailing from there. In the meantime, I'm continuing to work on meditation, focused breathing and now I have a couple of mantras that I say to maintain my focus.
When I am in pain, it's "Easy Day. I breathe out pain with every breath."
When I want to calm myself and let go, I say "Life itself supports me. I trust in the universe."
So as always: Feed the courage wolf and starve the fear wolf inside you. Which wolf are you feeding?
Thursday, April 16, 2015
Mindful Breathing
Guys, it's been 3 weeks since I've posted!! Things have gotten a little busy lately, so I haven't had the time to write, nor have I had as much time to dig deeper into what I'm learning enough to write about it. Until now.
This week I'm starting a Stress Response course, and one of the first things we are doing is mindful, focussed breathing. I've found it to be relaxing, yes, but it's also another factor of the SealFit and Unbeatable Mind programs, and so it must be pretty critical. The fact that they all practice almost the exact same breathing techniques says something about it.
So a bit about breathing.
There are a couple of mechanical aspects to breathing that need to be addressed right away. First, we should be breathing diaphragmatically. This means belly breathing, or breathing so that your belly and diaphragm are expanding. This is the type of breathing babies and children do, and it's the breathing of relaxation. When we are fully relaxed, this is the way we breathe. When we are responding to stress (good, bad, acute, chronic) we breathe shallowly and into our chests only. This doesn't allow for full lung capacity usage, and keeps us in the stress-aroused state, even after the stressor is gone. So to enable our bodies to relax, it helps to concentrate on breathing into your belly.
The second critical part is that you must breathe in through your nose. Breathing in through your nose helps to humidify the air, and most importantly, enhancing the air with secreted nitric oxide (NO). NO is a potent vasodilator, which dramatically enhances the uptake of oxygen in the lungs. This is why it's most important to breathe in through your nose, but not as critical to breathe out that way.
There's a pretty simple breathing exercise that works (with practice) to calm down your sympathetic nervous system and counteract all the panicky, fight-or-flight stress reactions in your body. It can be done almost anywhere, anytime, and nobody would know that you're doing it (even during a presentation or performance!) To start, breathe in through your nose, expanding and filling your belly with air. Then move to your upper chest and fill it. Do this slowly, for a count of 4 or more (whatever is comfortable to you) and then hold it in for that same count of time. Then, slowly exhale for the same count of time, and finally (if you can) hold your lungs empty for the same count. Do this for 3-4 minutes (or longer, if you can) and with practice, this technique will help to both keep you calm, and calm you down in times of stress.
The key to this is practice. I'm working now on implementing this technique every day so that my body becomes accustomed to the calming effect. Over time, it should take no more than a couple of breaths to start the calming effect, and will also train your body to belly breathe all the time, without having to focus on it.
A final benefit to this practice is that it increases your mental focus. First, for all the reasons you might think (more oxygen to your brain, etc), but also the focus required to practice this breathing spills over and secondarily serves to get your mind used to focusing - on anything.
I've been feeling more pain in my jaw joints and teeth recently, and I do find that this practice has helped me to manage that better.
Try this technique for a few days and see how it helps you. And remember to feed the courage wolf inside you, and starve the fear wolf.
This week I'm starting a Stress Response course, and one of the first things we are doing is mindful, focussed breathing. I've found it to be relaxing, yes, but it's also another factor of the SealFit and Unbeatable Mind programs, and so it must be pretty critical. The fact that they all practice almost the exact same breathing techniques says something about it.
So a bit about breathing.
There are a couple of mechanical aspects to breathing that need to be addressed right away. First, we should be breathing diaphragmatically. This means belly breathing, or breathing so that your belly and diaphragm are expanding. This is the type of breathing babies and children do, and it's the breathing of relaxation. When we are fully relaxed, this is the way we breathe. When we are responding to stress (good, bad, acute, chronic) we breathe shallowly and into our chests only. This doesn't allow for full lung capacity usage, and keeps us in the stress-aroused state, even after the stressor is gone. So to enable our bodies to relax, it helps to concentrate on breathing into your belly.
The second critical part is that you must breathe in through your nose. Breathing in through your nose helps to humidify the air, and most importantly, enhancing the air with secreted nitric oxide (NO). NO is a potent vasodilator, which dramatically enhances the uptake of oxygen in the lungs. This is why it's most important to breathe in through your nose, but not as critical to breathe out that way.
There's a pretty simple breathing exercise that works (with practice) to calm down your sympathetic nervous system and counteract all the panicky, fight-or-flight stress reactions in your body. It can be done almost anywhere, anytime, and nobody would know that you're doing it (even during a presentation or performance!) To start, breathe in through your nose, expanding and filling your belly with air. Then move to your upper chest and fill it. Do this slowly, for a count of 4 or more (whatever is comfortable to you) and then hold it in for that same count of time. Then, slowly exhale for the same count of time, and finally (if you can) hold your lungs empty for the same count. Do this for 3-4 minutes (or longer, if you can) and with practice, this technique will help to both keep you calm, and calm you down in times of stress.
The key to this is practice. I'm working now on implementing this technique every day so that my body becomes accustomed to the calming effect. Over time, it should take no more than a couple of breaths to start the calming effect, and will also train your body to belly breathe all the time, without having to focus on it.
A final benefit to this practice is that it increases your mental focus. First, for all the reasons you might think (more oxygen to your brain, etc), but also the focus required to practice this breathing spills over and secondarily serves to get your mind used to focusing - on anything.
I've been feeling more pain in my jaw joints and teeth recently, and I do find that this practice has helped me to manage that better.
Try this technique for a few days and see how it helps you. And remember to feed the courage wolf inside you, and starve the fear wolf.
Thursday, April 2, 2015
Mental Toughness = Emotional Resiliency
Hello Friends!
As I continue this journey I am on, I want to share some tidbits of learning with you. Today's revelation is the secrets of mental toughness and emotional resiliency.
In his book Unbeatable Mind, Mark Divine shares his top 3 secrets of mental toughness. The first is that Mental Toughness is a choice. You must first choose to control your mind, then you can turn it toward success and hone your skills. Seemingly a simple concept, it goes much deeper than that. By accepting that it is a choice, you are experiencing a paradigm shift that will change the way you view yourself, your life and the things that happen along the way. This change in mindset means that now you understand that you are not a product of what happens to you in life; you are a product of your reactions. No longer are you blown around randomly by the events in your life, seeming to be out of control of the things happening to and around you. You are choosing where to put your energy, your time and your thoughts. When you change the story you tell yourself about your life, you can change the way that stress affects you.
Second, Stress Kills Mental Toughness. This simple fact was, in a way, freeing to me. I have found that while I try to work my way through these steps on my journey to inner strength, when stress (or exhaustion) sets in, it's almost impossible to maintain the consistency of meditation, reflection and to focus on the tough things to be tackled inside. Now that I understand the effect of stress on my mind, I can stop, seek to understand what is stressing me out and why, then harness it and redirect that energy to something positive to counteract it. Giving yourself permission to feel the stress, rather than ignore it, is powerful.
The process to do this is simple, and again it involves choice. I've used this and I can tell you that it's a powerful way to control your mind and your reactions. First you must witness the stress happening and how it is affecting you in the moment. This goes as far as both your mental reactions, and your physical ones. Shortened breath, a feeling of loss of control and that panicked feeling are all very unpleasant. Allow yourself to feel them, experience the reaction. A good tool to use when trying to interdict your stress response is deep breathing. Taking just 5 deep breaths through your nose, filling your lungs and expanding your belly, then letting it all out will serve as a moment of pause while it changes your physiology. Deep breathing through your nose activates your parasympathetic nervous system, which turns off all the negative fear responses of your sympathetic nervous system. Then, interdict that experience. Choose to stop it in the moment and acknowledge that you are not going to let it continue. Then, redirect that energy to something positive.
Finally, most of what we consider Mental Toughness is actually Emotional Resilience. This means that you are able to easily and quickly bounce back from a setback. This is also a skill that can be trained, and needs to be exercised to be maintained.
The process of training emotional resiliency is much like that of reacting to stress. First, witness your negative reaction, then interdict it to stop it and observe the underlying emotion that is causing that reaction; why do I feel this way? What is making me react the way I am? Second, change your initial reaction to whatever the opposite emotion is. If it's fear, change it to courage. If it's jealousy, change it to acceptance. Then, engage this new emotion and all of the actions and feelings that go along with it and continue on with whatever you were doing.
I can tell you that I used this exact technique when I was having a negative reaction to something positive that was happening in my life. Instead of feeling joy and appreciation for what was happening, I was feeling guilt for being so fortunate. I was berating myself for making a choice that supported my own happiness and focusing on all the ways that I could have made a different choice that would have seemed less selfish. Once I recognized what I was doing, I physically took myself to a room where I could be alone and stopped myself from continuing down that rabbit hole. I looked at how I was feeling and why; then I chose to give myself permission to do this for myself. It is what I had been told several times to do. It is something that will bring me peace and joy and I deserve it. I appreciated my good fortune and felt the joy of looking forward to it. Once I had calmed my mind and stopped beating myself up, the stress went away and I was able to continue my day without those negative thoughts and self-talk in my mind.
Please try these techniques today - and remember to feed the courage wolf inside you!
As I continue this journey I am on, I want to share some tidbits of learning with you. Today's revelation is the secrets of mental toughness and emotional resiliency.
In his book Unbeatable Mind, Mark Divine shares his top 3 secrets of mental toughness. The first is that Mental Toughness is a choice. You must first choose to control your mind, then you can turn it toward success and hone your skills. Seemingly a simple concept, it goes much deeper than that. By accepting that it is a choice, you are experiencing a paradigm shift that will change the way you view yourself, your life and the things that happen along the way. This change in mindset means that now you understand that you are not a product of what happens to you in life; you are a product of your reactions. No longer are you blown around randomly by the events in your life, seeming to be out of control of the things happening to and around you. You are choosing where to put your energy, your time and your thoughts. When you change the story you tell yourself about your life, you can change the way that stress affects you.
Second, Stress Kills Mental Toughness. This simple fact was, in a way, freeing to me. I have found that while I try to work my way through these steps on my journey to inner strength, when stress (or exhaustion) sets in, it's almost impossible to maintain the consistency of meditation, reflection and to focus on the tough things to be tackled inside. Now that I understand the effect of stress on my mind, I can stop, seek to understand what is stressing me out and why, then harness it and redirect that energy to something positive to counteract it. Giving yourself permission to feel the stress, rather than ignore it, is powerful.
The process to do this is simple, and again it involves choice. I've used this and I can tell you that it's a powerful way to control your mind and your reactions. First you must witness the stress happening and how it is affecting you in the moment. This goes as far as both your mental reactions, and your physical ones. Shortened breath, a feeling of loss of control and that panicked feeling are all very unpleasant. Allow yourself to feel them, experience the reaction. A good tool to use when trying to interdict your stress response is deep breathing. Taking just 5 deep breaths through your nose, filling your lungs and expanding your belly, then letting it all out will serve as a moment of pause while it changes your physiology. Deep breathing through your nose activates your parasympathetic nervous system, which turns off all the negative fear responses of your sympathetic nervous system. Then, interdict that experience. Choose to stop it in the moment and acknowledge that you are not going to let it continue. Then, redirect that energy to something positive.
Finally, most of what we consider Mental Toughness is actually Emotional Resilience. This means that you are able to easily and quickly bounce back from a setback. This is also a skill that can be trained, and needs to be exercised to be maintained.
The process of training emotional resiliency is much like that of reacting to stress. First, witness your negative reaction, then interdict it to stop it and observe the underlying emotion that is causing that reaction; why do I feel this way? What is making me react the way I am? Second, change your initial reaction to whatever the opposite emotion is. If it's fear, change it to courage. If it's jealousy, change it to acceptance. Then, engage this new emotion and all of the actions and feelings that go along with it and continue on with whatever you were doing.
I can tell you that I used this exact technique when I was having a negative reaction to something positive that was happening in my life. Instead of feeling joy and appreciation for what was happening, I was feeling guilt for being so fortunate. I was berating myself for making a choice that supported my own happiness and focusing on all the ways that I could have made a different choice that would have seemed less selfish. Once I recognized what I was doing, I physically took myself to a room where I could be alone and stopped myself from continuing down that rabbit hole. I looked at how I was feeling and why; then I chose to give myself permission to do this for myself. It is what I had been told several times to do. It is something that will bring me peace and joy and I deserve it. I appreciated my good fortune and felt the joy of looking forward to it. Once I had calmed my mind and stopped beating myself up, the stress went away and I was able to continue my day without those negative thoughts and self-talk in my mind.
Please try these techniques today - and remember to feed the courage wolf inside you!
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