Complications

The decision made to get an MMA, there are still two complicating factors for me--other conditions I have which have some bearing on my surgery. The first is TMJ issues. The second is Rheumatoid Arthritis.


I got the TMJ following an upper endoscopy to look at some ulcers I had, courtesy of the job I had before this one. I was stressed and in pain at the time, and apparently my jaw was tense even when they put me partially under. The result was that my TMJs got dislocated forward when they put the tube in and have remained that way ever since. Physical therapy restored most but not all of my jaw mobility, I'm happy to say, but I think the only reason it doesn't lock up again is because of the steady stream of anti-inflammatories I'm on for my RA.

The RA I picked up three summers ago, out of the blue. Still don't know what the trigger was, and it's doubly unfair as I tested negative for the genetic factor that gives you susceptibility to it. However... I'm lucky in that it's well-controlled; I respond well to the drugs I'm on and haven't had to use the hard-core immunosuppressants. But that's a story for another time.

What the TMJ combined with RA essentially means is that one major treatment option was eliminated for me--a mandibular positioning device; i.e., an oral appliance that keeps your jaw shifted forward at night and your tongue with it. Too much inflammation, too much potential for additional damage. How the surgery will affect the TMJ is a question yet to be answered; Dr. Jelic says it could help my TMJ issues by simple virtue of the fact that I won't be chewing or using my jaw at all for a couple months, giving the joint discs an opportunity to pull back. A potential side bonus if true, though I'm somewhat skeptical. I'm worried I may have to go through the physical therapy all over again once my jaw has healed enough to get it reopened..

The main problem with the RA is keeping on my medication while I'm unable to open my mouth. My current ones don't exist in liquid form; that means crushed-up pills in my shakes, presumably. One more thing to plan for.

I have to be honest, though... in some ways, I'm grateful for all this. These conditions mean that surgery becomes my only real option, and insurance has no choice but to pay. Not that they didn't fight, though. More on that later.