Day 4: Rainbow Bright

Day 4:

• Inconvenience level 6-8/10
• Pain level: 5-6/10

To those of you who asked me early this morning how I was doing, I probably replied something like "Great! So much better than yesterday. I got a full 5 hours of sleep, I'm not as swollen, and you can almost see one of my teeth again!" This morning, at 6:00, I woke up feeling well rested (something that hasn't happened until last night post-surgery). My pain was down to a 5 and the inconvenience level was down to a 6. I even had two protein shakes for breakfast today! I haven't eaten that well in nearly a week! I even felt well enough that, by 10:00, I had built up enough energy to go for a walk down the road and back with my dad.

Here I am feeling all bright and bushy tailed. It's hard to see, but yes, I could actually open my mouth enough that I was able to verify I still have teeth in there... Things were looking bright.

Apparently, after averaging 2-3 hours of sleep here and there for a total of maybe 6 hours a day for 4 days while your body tries to heal will eventually catch up to you. That's the story of the rest of my day. Basically, today turned into a snooze fest where I was awake for 2-3 hours, fell back asleep, and woke again for 2-3 hours. Then, repeat. The good thing about that is, I was not awake for the transformation from "Bionic Man" to being punched by "Rainbow Bright" to happen.

Well, just when you've thought you reached superhero status and are on a good track, you turn around in the mirror to realize that Rainbow Bright has punched your face with her outfit choices... In case you didn't have a sister who was into Rainbow Bright, here's a picture of her.

Now, imagine my face punched by Rainbow's outfit... Yep, that's what you'll see in today's version of The Bionic Man meets Rainbow  Bright. She just looks so innocent, doesn't she?

Fast forward to 6:00pm. Finally, after several on and off naps all day, it hit... By the last time I woke up, my face felt like it was on fire, itches like crazy, and there's no doubt that I'm bright eyed... In fact, there are many bright colors to my eyes and face. I'm told itchiness is a sign of healing. If that's the case, you may want to come over and touch my face now, because I'm pretty sure the healing itch must be radiating from my face at this point. I've never had anything itch to the core before. Imagine getting bitten by 50 mosquitoes all on your face, dousing that with itching powder bought from Spencer's gifts, and now imagine that has all been poured inside of your jaws and sealed shut. Yes, my friends, the healing itch is flowing down...

So, back to Rainbow Bright. Aside from the itching, another wonderful side effect to this has been the discovery of shades, hues, and colors I've never thought possible before. My face is now as if my sister's Rainbow Bright met a thunderstorm, they punched each other in the face, and then had a baby. Here's my face as of 6:00. I must say, the colors are much more striking in person. If only computers and cameras did justice, you could see that I've created a whole new color scheme. Jealous, much? I know. You should be.

Ironically, it actually looks like I got a really crazy tan line. (Yes, if you can see the white showing through at the bottom, starting in a V-shape from my neck down is all normally colored like I got stuck on some strange other worldly beach for a short tan).

Signed,

The Bionic Man Gets Struck by Rainbow Bright

Days 2-3: Raging Roids

Yes, I am including day 2 into this post. Apparently, while I thought day two of recovery was over when I posted last time, day two played right into day 3. I can honestly say that this has been the scariest 24 hours of my life so far. There's no sugar coating this one. If my little brother hadn't been home today, I don't know what would have happened.

Day 2 (Part 2): 

• Inconvenience level 10/10
• Pain level: 8/10

As I signed off for the day yesterday, my face continued to swell. All of the oral surgeons and residents on my team warned me that swelling would continue and likely peak at 72 hours post-surgery. I suppose I thought by signing off early yesterday (closer to the 48 hour mark), I was being a bit optimistic. Here's what actually happened as the night wore on:

Day 3: 

• Inconvenience level 11/10
• Pain level: 9/10

There's no sugar coating day 3. I woke up at 6:00AM (which, apparently is now my new wake up time) and my face continued to swell throughout the day. By 10:00, the swelling had gotten so extreme that it was pressing against my temples and, before I knew it, was putting my airways at risk. And, the day just kept getting more difficult from there. In the next few pictures, pay attention as you can literally see the huge bumps on my temples where the swelling reached up past my eyes, into my forehead, and began to diminish my ability to hear.

By mid-day, my face had become more swollen than I had even thought possible. Then, the real issues started. Around 2:30, I started struggling to swallow. At first, I thought it was just that my body was having a hard time recovering. Then, things took a turn. My little brother was in his room when, all of the sudden, I realized I could hardly breathe. I got his attention. I was beginning to experience what felt like suffocation and, within a few short minutes, he had called my dad who got my grandpa to come bring me to the hospital. I nearly passed out on the front steps of the house. By the time I got to the hospital, my airways had become much more constricted and I passed out as I was put into the wheelchair. Somehow, the team got me into my bed, got an IV in, drew some blood, and started me on drip steroids again. As the Emergency Department doctor spoke to the oral surgeons' office, they came to the conclusion that two things were happening at the same time: my airways were being constricted by the worsened swelling and my muscles in my face were spasming and attempting to go back to their original places. Both of which were constricting my airways. 

After a couple of hours on drip steroids, a muscle relaxer to get my jaw to go back to its new position, and some anti-nausea meds, I got to head home again. The good news is, my body, being superheroic, has already begun repairing and all of my blood tests came back normal--my hemoglobin was even normal even after losing about 16 ounces of blood a short few days before. 

Now, I'm sure I could keep spinning this story with the Bionic Man/Superman theme since I was pumped up with a lot more steroids. While I know they're not the same kind that lead to bulging muscles, they were steroids, after all. But, today, I know and am grateful that these steroids were even more powerful than building muscles. These steroids and the people who used them are the real superheroes. 

Today, a team of providers across two hospital systems worked together to get me breathing again. While some steroids may build superheroic muscle, today, they helped me breathe again. Now, that's superheroic... And, this guy is taking the evening to be thankful for the prayers, messages, and support from everyone who has seen me through this. The real superheroes in life are the ones who know they can't do everything themselves. The real superheroes in life are the ones who pitch in their own part to be a piece of something bigger. The real superheroes stop in the middle of the day to check in to see how you are. The real superheroes might be your brother, grandpa, or another family member. The real superhero might be the friend who told you he was overcome with a feeling that he needed to pray for you at exactly the same time I was struggling to breathe. So, thank you to everyone reading this, to the teams of medical providers, and to all my friends. You are the real superheroes. 

Signing off for the night

Signed,

The Grateful LIVE Bionic Man

Days 0-2: Blissfully Flat

WAR NING: Some of the pictures below can be pretty gross and bloody. Proceed at your own risk...

I've been blissfully flat for the past few days. For some strange reason, getting your bottom half of your face sawed apart and put back together has a tendency to make you have really flat expressions. Yet, I am so blissfully happy I did it. Even with all of the complications, still having some massive swelling in my airways, and losing nearly a pound in blood, I already notice I CAN BREATHE!!!

Day 0 (Surgery day, November 10):

• Inconvenience level: 8/10
• Pain level: 6/10

The day finally came. I got up at 3:00 in the morning, showered, dressed, and was out the door with my parents and on my way to University of Michigan by 4:00. We arrived to check-in at 6:00, I was taken back at 6:30 for preparations and pre-op, and, as I rolled away, I remember nothing else until 2:30. My day had come and, although I had some nerves, I was not looking back. Apparently, after pre-op, surgery itself started around 8:30, I was in the operating room with surgery and post-surgery until about 11:30, and I woke up in recovery at 2:30. I was told coming out of such a massive surgery so quickly was a great sign. By 8:30, I had my own room. That night was pretty rough. During surgery, I lost about 10-12 ounces of blood, they had to put in more brackets and screws than they originally thought, and that night, they struggled to get the bleeding to stop and to keep my airways from swelling shut. Needless to say, I didn't sleep well that night.

One of the few things I remember from that day:

1. When the Anesthesiologist asks you in pre-op what you'd like to be called when you wake up, the reply "Bionic Man" will get you a smile, but then she'll quickly ask if "Clark Kent" is okay instead.
2. Oddly enough, most people completely lose feeling from the eyes down from this surgery which helps with pain control. Well, although I knew I was unique and I'm not most people, this is the one experience where you wish you were like most everyone else and lost feeling. But, while the left side of my face is totally numb, I can still feel about 50% of my right bottom jaw and 25% of my right upper jaw.

Day 1 post-op (November 11):

• Inconvenience level: 7/10
• Pain level: 7/10

Although I had a long night and only slept about 30 minutes total, thankfully, by about 11:00 the next morning, the bleeding had slowed to a minor trickle, I was on a drip steroid to keep my airways from closing, and I peed for the first time. Well, I'm not so thankful about the first day of peeing... I know, maybe that's a little TMI, but coming to this with a weird sense of humor and having a Master of Public Health, I discovered a new way to keep teens from having unprotected sex--put a catheter in the guys and, that first time they pee afterwards, tell them that's how bad an STI could burn. I've never before felt like the flames of hell were trickling out of my body until that. Lesson learned: get a research board to approve my project, insert catheters into the males, make teens go through that and see what it does to rates of unprotected sex. I have never had an STI and if it's anything like that, pissing flames of hell-fire is not the way to go, people.

Also, why they never called me "Clark Kent" or "Bionic Man" escapes me. Most communication that day happened by writing on a whiteboard. Sadly, a sense of humor doesn't always get communicated that well on a whiteboard. But, when I got my X-rays to make sure things went well, I finally got a smile out of the nurse when she said "Wow, that went fast" and my reply was "Well, what can I say, I don't know if you knew this, but Clark Kent is secretly Superman, I'm faster than a speeding bullet". Apparently, when you're on massive doses of Oxy and Toradol, you forget that Superman and Bionic Man are two different people. But, hey, at least I got a smile out of her.

Around 2:45 that afternoon, I drank my first meal in 2 days and they asked if I felt I could go home or wanted to stay another day. Knowing what I do about the risks of catching an infection in the hospital the longer you stay, I felt it was time to go. The oral surgery residents came in, banded my teeth together, we got my prescriptions, and at 4:30 I was released. Of course, that's not the best time to leave Ann Arbor on a Friday, but we finally made it home around 7:30.

Day 2 post-op (November 12):

• Inconvenience level: 10/10
• Pain level: 5/10

It's 2:00 in the afternoon as I write this. So, there's plenty of time for more to develop. But, the good news is, so far today, my pain level is down, I've had an ensure, protein shake, and tomato soup. The even better news is, I almost fit the pictures of how I imagined I would look after surgery. Apparently today or tomorrow will be the worst for swelling and things will then go more smoothly after that. Also, I can pee again without feeling I'm peeing lava. Today is a much gentler version, now it feels like I'm only peeing out scalding hot water. A few notes from today:

1. It's much harder than you think to drink 80 ounces of water a day when it all has to go into your mouth using a syringe that has a maximum capacity of 2 ounces
2. Apparently, sawing your face apart and putting it back together means you can still breathe better than before surgery--even with the swelling--but, it also means your face will continue to swell for 72 hours or so and then stay at that point for up to one week. Let's hope this is the peak of swelling.
3. I've already lost about 5% of my body weight from the volume of blood loss and difficulty getting calories in 2 ounces of liquid at a time.
4. On the bright side, I was finally able to see into my mouth and got an infant's sized toothbrush into my mouth far enough to clean out some of the blood that was stuck to one of my front teeth. I still can't see my smile, my mouth is banded shut, and I can't really make expressions with my face, but if I can breathe already at this point, I cannot wait to see what happens throughout recovery!
5. I am blessed to have a little brother who is more than happy to help me, my parents and he take shifts checking in on me, and my head is finally clear enough that I'm able to write a (hopefully logical) blog post.
6. I've also realized that I have amazing friends!!! Thanks to everyone who has offered to stop by, offered encouraging words, for all the prayers, and especially the friend who offered to bring me baked goods... Um, exactly how am I supposed to eat that? Hey, it's the thought that counts and, I'm almost there, right?
7. I'm starting to notice small bruises popping up randomly from my neck all the way up to my eyes.

Finally, here are a few pictures of me from today ( Sorry about the dried blood, but it's surprisingly difficult to remove...):

Compared to what I thought I might look like at this point, I'm doing remarkably well. Even the surgeon was surprised by how well they got the swelling under control. I imagine being hooked to a steroid drip for several hours when my airways almost closed is still having some benefits at keeping my swelling down.

Thank you all for the prayers, positive thoughts, and dropping me texts, encouragements on Facebook, and so much more! You all rock!


Signed,

The Bionic Man/Clark Kent/Superman/The Blissfully Flat Expression

The Final Countdown

T-Minus one day! I cannot believe the day is almost here. I have surgery TOMORROW! I arrive at University of Michigan at 6:30AM and surgery begins at 8:30AM. Who knew back when I got my braces on June 25, 2015 that Thursday, November 10th, 2016 (one year and 5 months later) would come so soon? Back then, when they said "you have to wear your braces for a year and a half before having surgery", it seemed ages away and like I had tons of time. Now, time has flown by in the blink of an eye. Let's hope the same happens for recovery. For those of you wanting to know the details of why I'm having this surgery, you're about to get a very detailed explanation of my mouth and surgery details. The good news is, there are pictures... and, really? Who doesn't like pictures and a story? (just pictures of my teeth, so don't worry about whether you'll see anything "gory")

Okay, for the color coding and explanations. It's pretty easy to see that when a horizontal line is drawn, my upper jaw is rotated. Clearly, those of you who thought I was a little twisted now have some physical evidence.

LET'S TALK ABOUT WHAT IS HAPPENING HERE:

To get more technical, let's break this down by color. But, first, below, the picture nobody ever sees--my bite. Much of the reason nobody ever sees this is it's physically impossible to see my full bite with teeth without holding my mouth open with my fingers. So, I both snapped a selfie and held my mouth open at the same time so you could see both my bottom and top teeth (you're welcome):

To those of you wondering "Um, is he even biting together?" Yes. Yes, I am. This is what it looks like when my mouth is completely shut. And, no, you're not hallucinating, my teeth do not touch. That gives you a little idea of what I mean by having a severe jaw deformation. Now, imagine biting into a juicy, crisp apple with that bite. Yeah, not going to happen. Sadly, there have never been any "Snow White" moments for me. No biting the apple, falling asleep, and then waking to the perfect person kissing me. **Sigh** I guess now I have more evidence that fairy tales aren't true. Well, that and I don't really recommend people going around kissing someone who just had an apple for a snack and is having a nice nap.

Now, to color code it and explain some of the things going on (I'll explain by color below):

What's happening overall?

First, you can see the horizontal white lines. As I explained above, it doesn't take an expert to see my jaws are slanted. So, for the procedure, they're completely removing my upper jaw, rotating it, moving it forward 4mm (1/6 of an inch), then reattaching it with plates and screws. Next, they're cutting my lower jaw at the back, rotating it, matching it with the upper jaw, and moving it forward 13mm (a little over 1/2 an inch). Then, it's on to cutting and chiseling my chin so it still looks normal and natural. Hey, I guess that gives a whole new meaning to having a "chiseled chin". Maybe that will go on my dating profile--handsome and debonair with a chiseled chin. Too much??

Let's talk about that top jaw:

First, the green line that goes up and down. That line goes from the tip of my nose, down to the point of my lip, and down to my chin. As you can see, both jaws are positioned to the left. Now you can start with all of the jokes of how I'm off center.

For that yellow circle. Even the untrained eye can see that there's a clear slant here compared to those horizontal lines...

And, what about those blue circles? As you can see, the left side, the blue circle surrounding the back 3 molars fits almost perfectly between the white lines. On the right, not so much. A huge part of that is the fact that both jaws are rotated and misplaced.

Now for the bottom jaw:

In the red circle on the right, compared to the left side of the picture where the teeth align with the white line, you can clearly see the back teeth sticking above the white line on the right.

LONG STORY SHORT, both my upper and lower jaws slant upward on the right of the picture (my left), are misaligned (do not align to the center), rotated and are too small. Basically, they both have a deformation from birth that is not fixable with braces. Both jaws are incredibly slanted and stunted. (This is the part where you all get to make jokes about me being slanted and stunted)



FOR THOSE OF YOU WHO LIKE TECHNICAL DETAILS:

Right now, my airway is only about 1 cm (less than half an inch) around. It should be closer to 2 cm (almost an inch). Moving both jaws forward (the top 4 mm (1/6 of an inch) and the bottom 13mm (a little over half an inch) and rotating them makes my airway approximately twice the size it is now. And, with that, you can see why that might be a problem for me breathing, speaking, chewing, talking, and why I have sleep apnea at my age.

By fixing the deformations of my jaws, here is the full list of the conditions from my medical chart that the surgeon said this procedure will treat (I'll translate from medical terminology to English below). To skip the medical jargon and get to the end of this, find the ** below. (I feel a little bit like I'm tricking you into a fun "Where's Waldo" experiment by making you look for the **. But, hey, give me my fun moments for now)

OSA on CPAP (Obstructive Sleep Apnea with a CPAP machine): Basically, this means my airways are too small and they close while I sleep causing me to not suffocate in short spurts... Okay, not quite that bad, but basically, my body can't breathe and wakes me up to make me breathe again. So, a machine pumps air into my lungs all night to help. It's pretty weird when you actually think about it, right?

Snoring: Anyone who has spent time around me without my machine does not need me to define this. They already know the definition of this word VERY WELL.

Daytime somnolence: I feel tired during the day. Well, no duh. If you suffocated off and on all night, you'd be tired too.

Mandibular hypoplasia: My lower jaw is deformed (see above)

Maxillary hypoplasia: My upper jaw is deformed (see above)

Speech articulation disorder: Specific sound patterns are mispronounced because my teeth do not meet to form the correct sounds. For example, "th" has an extra "s" sound in it and my "s" sounds a little bit more like a cat's hiss instead of that clear "s" like a snake hiss (now, tell me you didn't think of how those two sound different when I put them in animal terms).

Problems with mastication: It's hard to chew (again, see above if you can't figure that one out).



HERE ARE THOSE TWO ASTERISKS:

**Wish me well, send positive thoughts, messages, and texts (I just can't talk for about 2 weeks. So, texts will be appreciated while phone calls will be unanswered--mostly because of my jaw being banded shut, but depending on who you are, maybe a little bit of ignoring you too. Just kidding...)

If you're the praying kind, please send up prayers! Also, prepare for images of a VERY swollen face to follow. In case you missed it before, this is my best guess of what I'll look like:

Signed,

The Slanted One... Errr... I mean "The Future Bionic Man"

The Journey to a Bionic Man

Some of you may know already, but many of you don't. I'm going to be taking a journey very soon. I want to document some of my progress. That journey is the first step toward becoming a bionic man... Well, not really, but I'm going to have a boatload of metal holding my face together by the end. That counts as bionic, right?

I've had a CPAP (machine that blows air constantly into my mouth and nose) for the past 3 years and it only helps bring that cycle from every 3 minutes to an average of every 5-6 minutes. So, two years into this is when I met Dr. Sean Edwards, an Oral and Maxilliofacial Surgeon at University of Michigan. This guy holds a DDS (degree to be a dentist) and an MD (a medical doctor). So, I half wonder if I should be calling him Doctor Doctor Edwards. Seems like it might be fun. But, he still insists I call him "Sean".

Here's a great picture of me training to be a fighter jet pilot... Well, actually, that's me with my CPAP mask on, but who is keeping track?

I have had sleep apnea diagnosed for the last 3 years (but I probably had it for years before that, possibly my entire life). I'm only 30, weigh about 165 pounds and stand almost 6' tall. I also have a slim neck. By all standards, I do not fit the mold for someone to have sleep apnea. But, I have had a pretty severe jaw deformation my whole life. Many people tell me it's fairly unnoticeable, but I'm finally on the journey to have it repaired.

If you're not familiar with sleep apnea, basically, when I sleep and my jaws relax, it closes the airways and I stop breathing. I have a jaw deformation that causes my airways to be smaller than they're supposed to be when I'm awake. Then, when I fall asleep, my jaws relax and close off my airway. My body then realizes it is essentially suffocating, wakes me up slightly, my jaws go back to their tense state, and I begin breathing again. This cycle repeats on average, every 3 minutes. As you can imagine, that's not a great cycle for your brain to process, for energy to return, or wake feeling rejuvenated. That's why, if you've ever seen me in the morning, I am essentially a cranky zombie until I've had coffee... Well, at least that's the story I'm sticking to for now. After surgery, I may have to change my excuse.

Back to the surgery... To simplify things, my airways look like the left-hand side of the picture below now (narrow). The surgery they'll do will cut off my top jaw, reposition it, cut the back of my bottom jaw so it is no longer connected and reposition it. Both jaws will then be held into their new positions with screws and plates. That will open the airway like the right-hand side of the picture (note how much wider the airway is).

If you're really curious, the top jaw movement is called a "Lefort 1 osteotomy", the bottom jaw a "bilateral sagittal split osteotomy" and they're also doing a "sliding genioplasty" to balance it all out. Basically, that's fancy "doctor speak" of, "we're going to break your entire face, from the nose down, into pieces and then put it all back together with metal." I still prefer to say I'm on my way to becoming a bionic man. Seems slightly more comforting and less emasculating than admitting I went to a doctor and asked him to break my face apart and then put it back together again...

Of course, while the outcome is going to be great, all of this also means I'm on an all liquid diet for 2 weeks, mashed and blended foods for 2 more weeks, and then slowly transitioning back to normal foods after that. I'm told there will be massive swelling. If you like pictures, this is for you. I imagine, when I hear the doctors describe massive swelling afterwards, that means I'll look something like this**:

Signed,
The Future Bionic Man
(but, you may still call me "Tim"-if you must)




**Disclaimer, it may appear so, but this is not an actual artist's rendition of me swollen... ;)