Peanuts & Cracker Jacks - NOT

At the ball park, there's an overly abundant supply of peanuts, Cracker Jacks, hot dogs, and just about every other unfriendly food for us mush/mash diet folks. Fortunately, they had chili too.

The home team won in eleven innings with an unusual finish when the catcher let a wild pitch pass on the third strike and the third base runner scored.

The recovery improves, in particular the chin. The pain is now shifting to a very strong tingle pain. In addition my gum sensitivity improves as well.

I tried to use a "flosser" to floss, but the teeth felt too tight, and I didn't want to floss aggressively -it 's back to the water pick.

6 Weeks

It's been six weeks and a day since the surgery. Being back to work full time and speaking for a good part of the day exhausts me by the time I get home. Not a surprise. The doctor said that many of his patients find the same thing.

The chin pain has improved again. It's not bad in the morning and sometimes goes away. By the end of the day, it's worked its way up to being quite uncomfortable.

Other recovery stuff of note:

1. More feeling in a few back teeth
2. More feeling on the upper inside gums. The outer gums are still numb on the top
3. More feeling on the outer lower gums
4. Speaking is still a challenge. It's hard to enunciate words, and it sounds to me like I slur most of my speech. In addition, like many others, I've developed a slight drooling problem when speaking. As my jaw mobility improves, all these should clear up

Sleep:

I'm getting about 8.5 hours a night. Although I still wake up tired and usually without a headache, I think that I'm better off than before the surgery. Until the pain is gone and my sleep patterns are reestablished, I'm making no judgements on whether or not the surgery "worked." The way I look at it, it's worked either way.

Powerless

Or less power?

Sunday was a good day. I made it back on the bike - twice. The first ride was a regular route with a long sustained climb of 3.3 miles and 1300 feet of elevation gain. Riding about as hard as I could, I was about 10% slower than riding at a comfortable pace prior to the MMA. It's amazing how quickly my power and aerobic capacity dropped in only 6 weeks. My heart averaged 171 beats per minute for 33 minutes. At the top of the hill, with about a five minute rest, I felt like I recovered quickly, and was able to ride home at a good clip.

Later in the day, my wife and I enjoyed a date ride. The company was much better for the second ride!!!

I returned to the surgeon this morning - he's closely monitoring my chin pain and has me returning for weekly follow-up. We've increased the Neurontin dosage, and either time or the medication has improved the pain. It's still strong, but seems to "go away" more often during the day.

Better Than Yesterday

Today I feel better than yesterday. Perhaps it's syrup an chocolate chips in my pancakes spiking my blood sugar, but perhaps I'm sleeping a bit longer and starting to pay-off the sleep debt.

The chin pain continues to be strong, but slightly improved from yesterday as well.

We had a very busy day yesterday, and doing normal things and being so busy felt good. We attended a Bat Mitzvah (she was GREAT!), luncheon, and dinner party. Even with a nap between the luncheon and dinner, I was completely worn out by the end of the evening.

With a so much of the activity centered around food, I found that eating was actually harder than talking. Although I had very soft food (mashed potatoes, egg salad, tuna salad, babbaganoush , and humus), after about 10 minutes of eating, my jaw was exhausted and it was very hard to open it enough to eat. As time goes on, the jaw will get stronger and eating will get better.

Slow Changes

One of the challenges when recovering from a major procedure is that you tend not to notice the day to day improvement. Looking at things week to week or month to month, the changes are more dramatic. So when I try to evaluate how I felt today over yesterday, there's not much difference. In reading this blog, however, it appears that I've come a long way.

By the end of the work day, I'm pretty cooked and the chin pain is worse. Contrast that to the mornings, I'm not as tired and the chin tends not to bother me as much.

The biggest improvement I've noticed over the past few days is that my upper teeth don't have the "braces tightened" feeling. Occasionally, a few of the teeth feel like they are being squeezed.

On to the important update - the bike. I was able to sneak in one quick ride this week. If all goes well, I'll get back on the bike both Saturday and Sunday. I'm convinced that cycling will speed the recovery.

Almost 5 Weeks

Hard to believe that at this time five weeks ago, I was gnawing on a turkey leg and munching on peanut M&Ms. But that was the old me. Now it's strictly mush & mash.

Just a quick update on the recovery:

1. Numbness receding on the roof of my mouth
2. Sensation returning to a few of the lower back teeth
3. Chin pain about the same
4. Major tingles on lower lip and chin - a sign of nerve regeneration
5. Sleep (the magic question): no major changes although I woke up today without a headache for the first time since the surgery
6. Speech feels impaired as jaw mobility is limited
7. Mush diet easiest to manage
8. Back to work full time

Medium Soup

I'm back at work full-time. For lunch I ordered the medium soup and a tuna salad sandwich. When I picked up the meal, (I pre-order on the web and pick up my brown bag to eat at my desk), I noticed they gave me a small soup. Life's like that.

Saw the surgeon today as well. He said that the jaw alignment is exactly what it should be and all other signs of recovery are progressing as expected. We're going to increase the Neurontin dose to help with the chin pain. From last week to this week, the chin pain has improved, but it's still there.

"Don't You Have A Better 'Before' Picture?"

That was one of the questions asked by certain family members when I showed them the side by side comparisons. What could that mean????

Ultimately, the family generally agreed that after is better. It's not like the MMA can be undone...

Me - as I am now four and a half weeks post MMA. Still have swelling on left side.

Before - After

Before - After

The chin pain is about the same as yesterday, and I'm optimistic it will continue to improve.

Perhaps not medically proven, I'm convinced that my metabolism has dropped from being so idle for the past month. To pick up my metabolism, I'm trying to eat more and exercise.

I went for my second bike ride today and it felt good. My aerobic fitness has dropped significantly (my heart rate hit 178 on the hardest part of the ride) and my power seems reduced. The best way to increase metabolism, recover aerobic condition and increase power is to spend more time on the bike. I used to ride at 5:15 a.m. because I was awake. I plan to hold off on the morning rides until my sleeping patterns get established.

Back In The Saddle

...with my trusty steed.

Went for my first bike ride today. We rode 14.5 miles at a very comfortable pace. It was GREAT to get back on the bike.

The chin pain is a bit better today. In the morning it was quite mild, as the afternoon goes on, it's increasing a bit, but still better than yesterday.

Beaver Cleaver

Many years ago, we named our best chopper Beaver Cleaver. A funny story about the Beaver - the Beaver used to live in the bottom drawer of the kitchen cabinets. Shortly after our son was born, we had a party. One our our friends suggested we consider baby proofing our kitchen when his two year old pulled the knife out of the bottom drawer.

A good knife makes the post arch bar diet possible. I'm cleared to eat only soft foods. With a good knife, you can make mush out of just about anything.

Today I ate in a restaurant for the first time. There were ten of us celebrating my niece's high school graduation. I ordered salmon, potatoes (self mashed), and mushroom risotto. When the meal was served, I mashed, chopped, and mushed the food all together to make it nice and soft. It took tremendous concentration. When I finally looked up, I realized that everyone else had finished their meal, and while I had thought that I did a pretty good job finishing my portion, my son pointed out that at most, I consumed just a little bit of the meal and seemed to spend most of the time "playing and mashing" my food together. Based on the amount of food I brought home in the doggie bag, the boy was right.

As far as the recovery goes, the chin pain continues, and has improved slightly . The surgeon called me to check on the chin and said any improvement, even if only slightly is a positive step. I return to see the surgeon on Monday.

Without The Hardware

Liquid diets are easy eating - effortless. You just drink up. Now that the arch bars have been removed, eating is really quite a challenge. I've had two meals since the arch bars came off: lentil soup (not pureed) and slow cooked tri-tip with sweet potatoes and carrots mashed together. There are two major challenges with eating: the jaw muscles haven't been exercised and my mouth opens only 17 millimeters. Put those two together and eating seems like a major workout.

Here's what its' like being arch bar free for 10 hours:

1. Green light to get back on the bike. OLH Sunday morning (who's in?)
2. Lips rest comfortably against my gums
3. Lips don't feel like they are sticking out
4. Teeth more comfortable without wire anchors holding the arch bars
5. Teeth still have no sensation (like wooden teeth)
6. Gums still numb
7. Lower lip and chin still numb
8. Hard to speak due to jaw's limited range of motion
9. Upper teeth and gums feel like they are in a different spot - which they are
10. Still have chin pain in same isolated spot. We're hoping it goes away without the arch bars

The big question is has my sleep improved. It's returned to where it was pre-MMA. I'm no more tired or rested than before. I'm being cautious not to make any judgements based on a single day, but rather wait several months and see how I feel. Without the arch bars and their definite discomfort only good things will continue.

Need I Say More?

Actually, I can't say much at all since my lips and cheeks are numb from the Novocaine used to remove the arch bars. It was a 5 minute office procedure. No big deal. The surgeon cut the wire around the tooth and then removed the wire. I'm told that other surgeons perform the procedure under general anesthesia - seems a bit excessive, in my humble opinion.

And dinner from the slow cooker is looking good!!! It's got just 8 hours left to slow cook.

Yummy

My boy was at it again - this time he made chocolate chip cookies.

For some of us - me included, chocolate chip cookies taste better raw. There was absolutely no way I would even attempt to eat chocolate chip cookie dough. But, the nice thing about baking is that it's a step by step process, and the chocolate chips are the last ingredient to add. Let's just say that I found a new way to meet my daily calorie intake that's more tasty than just about anything I've had in the past 28 days. And, I didn't need to put it in the Magic Bullet with chicken broth.

Tomorrow is a big day - the arch bars come off. I expect only good things to continue from now on.

Nasty Box

Spontaneously, at 6:40 this morning, music just started coming from this strange box next to my bed. What is that box and who put it there? The worst part is the nasty box woke me up!!! What's up with that?

This is the first time in longer than I can remember where the alarm clock has actually woken me up. My previous pattern was I would set the alarm clock, and wake-up 1-2 minutes before it actually turned itself on. My internal body clock had always known what time it was, regardless of time zone and the alarm was just a back-up.

I managed about 9 hours of sleep last night (5 straight, then woke up a few more random times, taking Ibuprofen and Tylenol at 4:00 a.m.) and (complaint warning:) woke exhausted with a headache . Only sleeping 4 hours the previous night as well as the chin pain may have contributed to not feeling rested today. However, the chin pain seems continues to improve, even if just a little.

First Day Back

As I've blogged earlier, I absolutely love my job. In fact, I was so excited about my first day back at work, I woke up at 2:30 a.m. By 5:00 a.m., more sleep wasn't in the cards, so it was back to the grind. My plan is to work about half-time this week. For those of you that haven't experienced a Silicon Valley start up, half-time is about 8 hours a day...

I also had a scheduled visit to the surgeon today. Here's the medical update:

1. Arch bars come out Thursday (66 hours to go) - need I say more
2. The Neurontin seems to reduce the sharpness of the chin pain
3. All the stitches in my mouth are GONE. Since I never saw them, you have to wonder where they all went

Success - No Nap

Made it through the concert without a nap.

In fact, after the concert, Deb even pointed out that this is the first concert I've attended without a nap. In fact, I've been known to be snoozing before the first measure of the first piece.

Let's hope work goes well tomorrow... I'm going to put in half days for the coming week.

What's Left?

My son's orchestra performs this afternoon. The concert will be an unofficial test to evaluate the surgical success. I have yet to attend one of his afternoon concerts - 3 a year for the past 4 years - without falling asleep. In all fairness, I still take afternoon naps, and the concert takes place shortly after nap time. Yesterday's nap - only 20 minutes - spontaneously occurred watching the movie Doubt. Deb says that the part I missed was a bit slow.

As the recovery progresses, there are a few remaining effects of the surgery that need to resolve:

1. Chin pain - 6 on a scale of 10. Definitely improving.
2. Tight feeling on teeth at the gum line - feels like childhood braces were tightened. Likely due to arch bars
3. Grumpy, cranky, short tempered, impatient - personality flaws that existed prior to surgery - the surgeon would not agree to address these items
4. Numb lower lip and chin - common effect of surgery as are the remaining items on this list
5. Numb roof of mouth
6. No sensation in teeth - others have described this a wooden tooth feeling

If all goes well, the arch bars come off this week. My hope is that the arch bars are the root cause of the chin pain and the tight feeling at the gum line. Once these two sensations go away, I expect to be completely pain free and life will be good. Maybe #3 will change too. Soon I'll be saying "GREAT and I feel rested!"

If there would be an item 7 on the list above, it's shaving. Using a razor blade to scrape a chin with no sensation really scares me. So far, I've been lucky and it's worked out OK. So why not use an electric razor? Good question. I've actually tried one, and the added pressure from using the electric razor was uncomfortable on both my chin and near the mandible sites that were extended.

How Did You Sleep?

That seems to be the most common question I'm asked. In fact, the surgeon asks the question regularly as well.

One of these days, the answer is going to be "GREAT and I feel rested." We're not quite to that point yet. The biggest change is I'm now sleeping about 8.5 hours a night which is a HUGE increase from the 4-6 hours pre-surgery. Last night I had an uninterrupted 6.5 hour sleep run but woke up with the chin as active as ever. I took Tylenol and ibuprofen and slept on and off for another 2 hours. (3.5 hours of clock time elapsed - it took me about an hour and a half to fall back to sleep.)

I have a couple of ideas on what's preventing my getting restful sleep:

1. The strong and sharp chin pain disturbs my sleep
2. My sleep debt is so significant, it will take longer to payoff than my mortgage

Given that I have a lower AHI number than many patients who typically have this surgery, the best indicator of success will be my sleep quality and how I feel the next day. For people with severe sleep apnea and a high AHI number, success is typically measured by reducing the AHI number 50%. For someone with an AHI of 80 to go to 40, would be considered a success. From what I have read, many of the people with the 80 AHI actually end up w/AHIs of 10 or less, so they notice significant changes.

I've always been a very light sleeper. One theory, not proven medically, is that my central nervous system is very sensitive to external stimulus when sleeping, whether that stimulus is chin pain, appnea, hypopnea, or as seen in my many sleep studies, an "unexplained arrousal (sleep studies have measured 15-30 per hour in addition to appnea or hypopnea events). I believe that these unexplained arrousals are really appneas or hypopneas that aren't long enough to "officially" count as a respiratory sleep event.

So now that we've likely eliminated all the apneas, hypopneas, and unexplained arrousals, the only thing left of the list is the chin pain. Hopefully that will be gone in a few days, and I'll wake up like everyone else - well rested.

Questions Tell All

Earlier today, Deb asked if my weight had stabilized. Since I regularly update this blog with comments on my weight, it's quite apparent who reads the blog regularly. Not being able to answer her question with a simple answer as I had been doing immediately post-MMA, I reverted back to my old ways and I responded to her question with a question of my own. Perhaps the surgery has altered my appearance, but it still has not removed the character flaws from before.

Note to Deb (when/if you eventually read this): You are the most wonderful and amazing spouse. I am very luck to have married such and wonderful wife.

Nice People

I returned to the surgeon's office this morning for my scheduled visit. He readjusted some of the rubber bands and checked on the progress with the chin pain. While it's too soon for the Neurontin to kick-in, he's wants to ensure that the pain does not increase - which it hasn't. As the chin pain goes away, I will transition from the opiates -Percocet, Vicodin, and Tylenol w/codeine - to Neurontin over the next few days.

While waiting for my appointment, I met some very nice people. First, there was an infamous MMA blogger (recognizable from his pictures), just sitting in his chair waiting for his appointment as if he were a mere mortal. We had the opportunity to chat and share stories about our experiences. In many ways, we followed the same path - consultations with the amazing Stanford sleep doc, xPAP, tonsillectomy, oral appliance (same orthodontist), xPAP & oral appliance, then MMA. He mentioned that he will be looking into relaxation techniques and meditation. It might be worth a shot to check into that as well, as I've been known to be quite a "high strung" person. (In another Blog, I'll comment on my Transcendental Meditation exploration from about ten years ago),

Also waiting was a family with a teenage son who were considering jaw surgery. Hopefully they found resources like sleepnet.com and other blogs to provide them with more information from both the medical and patient point of view.

Finally, there was a patient who came in on her way home from the hospital. We did not strike up a conversation as she only stayed in the waiting room for a few minutes, and as I vividly remember, from my visit on the way home 20 days ago, all I wanted was to get home. Meeting other nice people in waiting rooms was not a priority 2 days post op. I wish her a speedy recovery.