Burrito vs. MMA Patient-Round 2

MMA Patient WON!!!

Eating the low carb way without the tortilla helped.

______________

Not Even Tempted

My son has become quite a good chef - he's 15. When he expresses interest in cooking and baking, we always encourage him. Last night, he decided to make cinnamon rolls for breakfast.

The rolls just came out of the oven, and the smell is overpowering. Remember the last time you walked past the Cinnabon store and just had to have one? Our kitchen smells GREAT!

Oddly enough, those yummy sweet rolls don't appeal to me. One of the strange things is that I have not had an appetite or interest in most foods. While I'm eating quite a bit, my weight continues to drop. I'm down to 158 pounds (total lost: 14).

Here's a typical day in my food intake:

• Breakfast: 1 or 2 Carnation instant breakfasts with whole milk or glass of soy milk with protein powder


• Morning Snack: 8 Oz yogurt mixed with berries and fruit juice (sometimes with protein powder added)


• Lunch: Meat based soup, thinned with broth (about 20 Ounces)


• Afternoon Snack: Yogurt Smoothie, same as morning


• Dinner: Vegetable soup AND meat based soup (24-30 ounces total)


• Plenty of water and other fluids during the day

The pain in my chin has improved only slightly. I'm continuing with the pain meds, but I can't say that I'm thrilled about staying on them. The challenge is that I'm more motivated without the pain meds, but more comfortable with them.

Walk, Hike or Both

In order to increase my energy level, I've felt like I've needed to increase my activity level. For the past couple of days, I've taken a walk that's about 1.2 miles around the neighborhood. Yesterday was no exception. I woke up and went for a walk.

A few hours later, my friend called and asked if I was up for a walk. We took a 90 minute hike on the trails near my home. It was GREAT to be outdoors. After the walk, I felt fine, and was not too exhausted. It' still a real challenge in that I would like to be engaged in conversation, but since speaking causes more pain, I've been in listening mode.

Like many others at this point in the recovery, I'm still very uncomfortable, but feel like I need to be doing something. Something needs to be a mindless activity since concentrating for long periods of time is still a challenge (movies still require too long a period of concentration). Today's mindless activity was a trip Costco. We had to have a tire fixed and my son joined me for the adventure. Since I drove, I did not take the pain killers before leaving. Fortunately, the gods of the tire center were able to complete their work quicker than planned, and we returned home safely after three hours. Immediately on our return, I took the pain meds.

More on Pain Meds

I'm told, by reliable sources, that Percocet has nasty behavior altering characteristics. While it does help the pain, it doesn't necessarily make me a nice person to be around.

During dinner last night, my kids were told "See what drugs do to your father? You don't want to be like that do you?"

What more is there to say...back to Vicoden during the day and the Perc at night.

Why No Smiles?

With all the hardware in my mouth, it's just not possible to smile. On June 4th, that should all change when the arch bars come off. Just 11 more days!!!

Most of the external swelling seems less, with just a little left around my lips and chin. In addition, all the external bruising is pretty much gone. As the bruising went away, it was like watching the fall colors change from black & blue to yellow to ugly yellow, to gone.

Internally, my lips and gums feel swollen. My chin, roof of my mouth, lower lip and gums are still numb and have little feeling. Over the next few weeks the numbness should go away.

Pictures Taken May 23, 2009, 17 Days Post Op

Drugs...

Since the pain in my chin has not improved in the past 5 days, I've switched my primary pain medicine to Percocet.

I really hate the idea of taking stronger, more addictive drugs. However, being in pain makes it harder to get rest, and if I'm not getting rest, I'm not healing.

The Silent Treatment

Since my chin is still hurts quite a bit, I've been told not to speak at all. In all honesty, I had thought that I was doing a pretty good job of keeping quiet. Apparently not. We're now back to the white board and pads of paper. Skype chatting has also been a great tool. I've had a number of phone and video calls. The person on the other end has spoken, and I've been able to respond using the text field. Prettty neat technology...

Since it's a long weekend and the kids will be home, our house will be anything but quiet.

Shades of Gray

I've been told that I don't answer questions. Making my living as a sales person, I tend to answer most questions with another question or a statement that refers to the question asked. However, I rarely provide a direct answer. When I could speak, my communication approach seemed to work out (probably for everyone but my wife). For the past several weeks, however, I've had to change the way I respond.

Here are some examples of how I might respond both before and after:

Q1: How do you feel?

Pre MMA Answer: We had a great ride this morning! Any day in the saddle is a good day. Let's do that again tomorrow.

Post MMA Answer: Fine.


Q2: Are you in any pain?

Pre MMA Answer: When you say pain, how do you mean?

Post MMA Answer: Yes


Q3: What would you like for dinner?

Pre MMA Answer: The salmon you made last night was fantastic! You really out did yourself.

Post MMA Answer: Beef stew.


You get the idea.


On Naps

Today was an improvement over yesterday. My chin is still numb and hurts, so I'm back on Vicoden full time. I also took a 90 minute nap. I woke from my 90 minute nap really tired, but feeling like I had slept. I had that groggy good feeling. Prior to the surgery, I don't remember the last time I took a nap that lasted more than 20 minutes.

Being severely sleep deprived for so long, my body would crave sleep during the day, but would only allow itself short naps when given the opportunity. So if I needed a nap, I could take a five minute nap, and then make it through the rest of the day. Even under the best of conditions, I just wouldn't nap more than a few minutes. Due to the demands of life, work and reality, I rarely took a naps.

Mug Shots...

I had hoped to start this blog with a baby picture. But, being the youngest of four, there just aren't any. Maybe some day I'll get over it...


The first two pictures were taken about a year before the MMA as part of getting fitted for a MAD (mandibular advancement device). I'm 5'9" and weigh 165. For the week prior to the surgery, I ate and ate and ate, bringing my weight up to 172. After a week, my weight dropped to 160, where it has stabilized.

ICU, just a few hours post-op (May 6, 2009)

Day 1 - I figured out how to apply ice and listen to music.

Day 2 - At Home

Day 3

Day 7 - May 13, 2009

The infamous "arch bars" and rubber bands.

And today, May 20, 2009 - Two Weeks Post Op

Due to the arch bars and wax (to protect my gums from the arch bars), my lips are still a bit "pushed" out. This seems more apparent on the "front" mug shots. It will be interesting to see how everything changes in two weeks when the bars get removed.

Managing Expectations

Taking the pain meds helped tremendously. I feel better this morning than I've felt since the surgery exactly two weeks ago today. That's not to say that I'm going to be getting on my bike and riding a century with 10,000 feet of climbing today, but at least I can now see that century in my future.

The emotional recovery is as significant as the physical recovery. There have been a number of different things that I have done to recover emotionally. The most significant was to set expectations.

Prior to the surgery, I wrote down my expectations for recovery:

1. Expect pain and embrace it as part of the recovery
2. Don't judge progress on a daily basis
3. Be thankful and appreciative to everyone, but focus all my energy on the recovery
4. Stay hydrated and nourished
5. Shower and get dressed first thing each day
6. Find a simple way to update family and friends (that's what this blog is about)

There have been a number of times where I have gone back and reviewed my list. It's helped me stay focused and look beyond the challenges of each particular day.

Medication - Or Lack There Of

I'm not a big fan of pain medication. I've always stopped taking pain medication as soon as possible. It inhibits thinking and alters moods. I've felt that the pain medication has slowed recovery from injury since I can't always differentiate the effects of the pain medication from the injury itself. The sooner I stopped taking the pain medicine, the faster I would recover - WRONG!!!

This recovery was no different. A week after surgery, I stopped taking Vicodin and thought that the Tylenol would be sufficient. I was wrong. When updating THE surgeon during the visit today, I described my pain as very significant. He asked what I was taking, and I said just Tylenol. He very kindly pointed out that perhaps I should reconsider my pain killer of choice to something a bit more powerful. He also pointed out that the greater the pain, the harder it would be for me to rest and recover. (As my kids would say - DUH!!!)

I'm now taking Tylenol with codeine and it seems to provide more relief than straight Tylenol. My plan at night is to take the Vicodin in hopes it will contribute to restful sleep. We'll see.

The decision to continue the stronger pain medication should have been obvious, and looking back, I made the wrong decision to stop. But, we are who we are. I expected the recovery to be difficult. On a scale of 1 to 10, I expected a 9. 9 turned out to be about right. I've had other rough recoveries in the past - operations, broken bones, bike crashes, etc. Perhaps those recoveries would have progressed faster by taking advantage of modern medicine.

Note and acknowledgement to female readers: I've never given birth - so any pain I've experienced is relatively minor to compared to "real" pain resulting from having enjoyed that first apple.

Music

Today's Whining

What's got to be one of my biggest challenges is the ability to focus. Most activities take more energy than I can muster - reading, TV, movies, conversation, etc. I haven't figured out if it's the discomfort or the energy level that make concentration difficult.

I've never been able to just "hang-out" and listen to music. Now, that's all changed. I've come to enjoy spending hours just lying around listening to music. With the ability to "stream" familiar music from the web, there is almost an infinite content.

To feel more energetic, I've tried to expend more energy as well. I took three 15 minute walks yesterday, and did my best to clean the kitchen after dinner. Today, I'll increase my physical activity just a bit more.

Burrito vs. MMA Patient

The Burrito Won

The burrito is the ultimate meal: lean chicken, black beans, avocado, tomatoes, wrapped in a whole wheat tortilla. What could be healthier? When the family had burritos last night, I had one too. It looked delicious with all the yummy fixings. Knowing that I would need to make mine extra "smudgy", I added sour cream and cheese (I figured the calories would be a bonus too). By adding enough chicken broth and salsa, I was in for a wonderful treat. And I was.

With the help of the magic bullet, and 14 ounces of chicken broth, I pulverized about a quarter of the burrito. It was a bit too thick. Fortunately, I have leftovers and will try again today, but without the tortilla.

Another Lazy Day

It's an absolutely amazing beautiful day. Anticipating the afternoon heat, the temperatures will be in the 90s, I spent the entire morning outdoors. I took a walk and spend the rest of the morning relaxing on a lounge chair in the backyard listening to music.

Nothing remarkable with the recovery. My chin has two sensations - complete numbness on the skin, and a pressure/tingling pain on the the bone. Combined the sensations are a bit bizarre. I'm still challenged in getting sleep and wake up with headaches. I expect the sleep will continue to improve as the pain diminishes.

To My Children - I'm sorry and...

... I would do it to you again the same way

That's right, I'm talking about the liquid medicines we force our children to take. I've been taking liquid Tylenol and Ibuprofen, and all I can say is that I should have tasted this dreadful stuff before having forced my children to swallow it when they were sick - YUCK!!!

On the positive food front, I've discovered how to pulverize food with the blender. I just had a savory chicken thigh. Deb decided to avoid cooking in the afternoon heat and cooked a chicken in the slow cooker all day. The house smelled delicious. So, throwing caution to the wind, I took out the Magic Bullet (a must for all MMA recoverers) tossed in a thigh (minus the skin and bone)and added some chicken broth. The first "solid" food in about 10 days. Hopefully this will create a turning point in energy as well. Getting concentrated calories will be a real plus.

More on the numbers

Yesterday I was able to achieve the eating goals that I set. I consumed 2200 calories and 3 liters of fluids. It was exhausting to keep up on the food all day long. Between 6 a.m. and 7:30 p.m., I consumed 13 beverages, including 6 ensures, apple juice, orange juice, fruit replacement supplement, and lemonade. Normally it wouldn't be a big deal to drink 3 liters of fluid - I regularly consume 4-5 liters a day. The challenge in drinking so much now is that I need to sip each drink with a straw. Since my lower lip is still completely numb and my teeth are still immobilized in the "closed" position so it's too hard to use a glass and drink quickly. I would not fare well in a beer chugging contest today. Perhaps with the larger airway, I may be able to pick up a new sport...

I'm hoping to vary my diet today and introduce some soup. Any good tasting soups that fit through a strainer will make a great meal.

Today - another 2000 calories and 3 liters.

5 + 3

8 hours of sleep last night. That's got to be more than the grand total of what I have slept in the prior six nights combined. Thank you Ambien and generic pharmaceutical manufacturers around the world. I did wake with a terrible headache, which I'm attributing to poor nutrition and liquid intake from yesterday. Perhaps the surgery procecure and the recovery contribute to the headache as well.

Nutrition has got to be a key part of the recovery. While I've been making efforts to drink enough, I could be doing much better. Today, my goal is to consume 2000 calories and 3 liters of fluid.

The Little Loop

I just returned from a walk around the little loop - just a short 15 minute stroll through the neighborhood. It was great to get out.

We visited the doctor this morning. He cleaned things up a bit and suggested that I try to ease back into a regular sleep pattern, avoiding sleeping all day long. In my case, I'm going to avoid being a zombie all day long and try to concentrate the sleep during the night, if at all possible.

In addition, I'm going to switch to over the counter Tylenol and Ibuprofen, away from vicodin. The vicodin makes me tired, groggy and slow, none of which can be good for the healing process.

With regard to food, I'm drawn to sweet drinks (with protein powder) and ensure. Soups do not yet appeal to me, but I'm hopeful that will change soon.

Just a quickie...

Sleep remains elusive (although I did have an exhausting dream during the afternoon nap) and the food hasn't really changed. I have tried to drink without the special implement and it works better sometimes than others. I had hoped to consume everything from a biking water bottle, compliments of Steve and Lance Armstrong, but it's just a bit too ambitious this early on in the recovery

Weight seems to have stabilized down at 10 pounds, and I can fit in the "skinny" pants. Fortunately, they don't make my butt look too big - a major concern for most of us males.

The Big Reveal

Before

After

So there you have it - the before and after pictures. (The "bars" on the after picture are "Arch Bars." They are stainless steel braces that immobilize the jaw. Patients typically wear the arch bars for about 4 weeks.)

Today was busy. Prior to leaving for the doctor's office, I ventured on my first walk. I had a plan, and over did it. The plan was to walk 5 houses down the hill. I went 7. Upon my return, I crashed for the post walk nap. - Let's just just say that I should have stuck with the original plan. Those 2 extra houses were a killer.

The doctor visit went well. He said all looks good, and come back in a few days. On the way back from the doctor, we stopped at the grocery store to expand my diet. We settled on liquid fruit (8 Oz = 1 complete fruit). The grocery store visit was far beyond what I should have done. We came home, and I only made it as far as the couch before passing out.

In an effort to keep my energy going, I ventured out on a second walk. I had a plan, but ignored it - again. The plan was to go 7 houses up the hill. I went 11.

The weather here in the San Francisco Peninsula has been spectacular. While we drove to the doctor's office, we passed more bicyclists than I've seen in a long while. It's great to see all those people hammering hard up the hills and putting in a few miles for me.