3rd Post-Op Appointment

The third post-op appointment actually happened two days ago now, coinciding with the two-week mark post-surgery.

The main purpose of this appointment...

Aside from the usual examination, was to teach me to take on and off my rubber bands so I could give my mouth a thorough cleaning at night and let me spend at least a couple minutes moving my jaw a bit. They gave me this diagram of how my rubber bands should be:

So by actual count, there are eight rubber bands, one of which goes from the 'cleat' on the inside of my back top molar to the outside of two lower molars (the partially dotted black line at L5&6). These are meant to not only hold the jaw shut, but correct post-surgical bite disparities. For example, there's a 'long pull' designed to correct a crossbite (the blue line going from my top left canine to the lower left molar), two 'boxes' (the green lines around the back top and bottom two molars) and two 'triangles' (hard to see, but the light yellow lines around the 3 and 4 molars). The ensemble is completed with two rubber bands that go between two implanted hooks above and below my front teeth (the red line). Those hooks were put in at surgery and are embedded right into the bone; you can see them in the x-ray I posted some days back. The topmost one started bleeding yesterday when I took those rubber bands in and out. The hooks come out at the very end of the recovery period, when you don't need the rubber bands any longer.

They give you special plastic hooks to put the rubber bands on and off, but even with them, it's not easy. Took me ten minutes just to take off/replace the front bands and the two 'triangles' the first time I tried to solo yesterday, and I decided to stop there, master those before proceeding to the next. Taking those off made taking pills much easier, at least.

Also caused my TMJ pain to flare.

Speaking of which...

I asked Dr. Jelic about the TMJ pain I was experiencing, and the answer I got back was basically 'give it time' and use some warm compresses for relief. I found that slightly cold comfort, especially given how bad the pain was flaring on the drive home after having had my mouth open like that. Dr. Jelic did, however, find a small area of infection at my lower left suture line, where the line had apparently ruptured between two stitches and was oozing slightly. That could have something to do with the pain, he noted, and gave me a renewed antibiotic prescription. He was also dissatisfied with the rate the sutures were dissolving, so he pulled several of them himself.

I've been avoiding things that I know cause the TMJ pain, which for whatever reason includes playing one of my favorite first-person-shooters. I'm guessing stress makes it hurt. I know from previous treatment of my TMJ that we do tend to hold tension in our jaw joints, which is one of things that makes TMJ issues so difficult to treat. Other things that seem to set it off are working my jaw too much, and laying on that side. So just things to avoid for the time being while the infection clears and the muscles settle back down. I do wonder if I'm going to have to go back in for physical therapy to help it, though. Did that once before for nearly a year. It worked--got most of my mobility back, but I can't help but think it was only the steady stream of anti-inflammatories I was on for RA that kept it that way. The question here will be, will there be improvements and will they be dependent on continued use of Celebrex?

Sleep update...

 

I had a good night last night after a couple shaky ones due to the pain. I started off with 10ml hydrocodone, went to bed around 11:15. Fell asleep fairly quickly and didn't wake up until around 6:30 or so. Used the bathroom, then returned to bed, falling *back* asleep and didn't wake up again until after 9. Now, most of this time was spent on my left side to minimize the TMJ pain. There was still some when I woke up, but it was just low-level and not twinging. When the pain goes away, I'll be able to sleep on my back and opposite side more, I would think. But for now, I'll take this. No apnea, no snoring either.

This would have been unheard of for me before surgery. This is what I wanted--a full night's sleep and the ability to sleep in. I'm ironically feeling more tired for it, which I've noticed can happen when you sleep more than you're used to, but that will go away after an hour or so.