Day 3: There's no place like home

Sunday - three days after surgery and I was ready to go home.  In fact not only was I ready to go home, but I just had to get out of that hospital.  The food was bland, the bed was uncomfortable and I was completely bored!  I must have seen the same daytime TV shows over and over again and while I had brought my laptop, I had left my hard drive at home with all of my movies.  On a positive note though, I can now tell you everything about personal blenders, carpet cleaners and frying pans made from stone.

Luckily for me, the checkout process is just as fast as the check-in.  The nurse came and removed the valve from my hand and I removed (rather painfully) all of the sticky pads from my chest.  I packed (how did I end up with so much stuff) and waited for some friends to come by and pick me up.  I had time for a couple of selfies before I was collecting my drugs and on my way home.

As you can see my face is still very swollen but I am starting to talk clearer as each day passes.  I still have a lot of numbness all over the lower part of my face and this is to be expected for a number of weeks.

Finally I was back in my own apartment and it felt good!  I made a smoothie before sleeping on and off for the remainder of the day.

Day 2: Oh what a (terrible) night

So I wish I could say that my first night in the ward was uneventful but it was actually quite scary.

Throughout the first day after surgery I had been experiencing reflux - this had made my already swollen and sore throat worse and in turn limited how much I could comfortably breathe.  The weird thing was that I kept feeling as if there was a lump at the back of my mouth that I couldn't swallow.  As my nose and sinuses were also completely blocked, it didn't make a great combination.

Late at night as I was trying to drop off to sleep, I suddenly felt as if the swelling in my throat was too much and I couldn't breathe properly.  I started to work myself into a panic where my heart was racing and I was sweating profusely.  I pressed the call button for the nurse who took all of my stats, but by that point I think I had worked myself up too much.  A doctor also visited and listened to my breathing and assured me there were no obstructions, but again this did not help.  It didn't fill me with a huge amount of confidence that neither the doctor or nurse seemed to know the actual surgical procedures I had been through - they knew I had jaw surgery but did not know that included a septoplasty, which when you are complaining about breathing problems would be very important to know.  And while I don't want to speak badly of the hospital staff - I was in a panic and yet the while all this was going on I felt as if the nurse would disappear for 10-20 minutes at a time while I was feeling as if I would pass out.

Finally at 1am, I asked if they could call my surgeon as I felt I needed his advice.  Around ten minutes later the nurse returned after having spoken to my surgeon who said that this was a normal reaction and that I could use a nose spray to try and relieve the pressure in my sinuses.  After hearing the advice that came from my surgeon I relaxed as I feel very confident in his care.  I finally calmed down and dropped off to sleep a couple of hours later.

In the morning my surgeon came to visit and I of course apologised for having him be woken up - he didnt seem phased at all.  I told him about the lump I could feel at the back of my mouth and he said this was soft tissue that is left hanging because my upper jaw was moved back.  Apparently it will tighten over time.  Knowing what it was instantly made me feel better.  He said that I could leave the hospital that day if I wanted to as they generally want you to leave as soon as you can (less chance of infection at home), but if I felt like I needed to I could also stay another night.  I decided to stay another night as I didn't quite feel ready to go home.

After he left I had the compression bandages taken off my face which relieved a lot of the pressure.  It did give my face a lot more space to swell though and swell it did!

I am not an animal, I am a human being, I am a man!

My drips and lines were also disconnected just leaving a valve in my hand - this added a great level of freedom as it meant I no longer needed to wheel around a whole bunch of equipment.   During the day I had some more visitors and my friends Luke and Sheryn dropped off some lovely flowers and books.  My other friends also returned with balloons.  I'm lucky to have such great people around me.

More updates to come....

Day 1: Let me sleep!

I had slept on and off throughout the night in intensive care and by very early the next morning the place certainly was a hive of activity.  I always seemed to have someone poking or prodding me - either taking my blood pressure and other stats, putting antibiotics or fluids into one of the three lines in my arm or moving me around.  Of course they were only doing their job and making sure that I was well, but it was still really tiring!  To help ease the discomfort though I had my handy self-administered morphine, which I could press every 5 minutes giving me 1ml morphine each time.  Good times!

At some point early in the morning I was moved from my bed to a reclining chair before I was finally able to sleep for a while.

My surgeon came to see me mid-morning and told me that the operation was a great success and that they achieved all they wanted to.  If I remember correctly he said my upper jaw was moved both upwards and backwards 5mm in each direction, my lower jaw was extended forwards 11mm and my chin was repositioned outwards and downwards.  He also said that I had some bone loss in one area of my jaw and he used bovine bone which my body would accept and fuse with my own bone.  His parting words to the team were that they could remove both the gastric tube and the catheter.  While it was not a very pleasant experience having either of them removed, I'll spare you those gory details and just say that I was happy once it was over!

I think one of the most surprising things for me on this morning was that I could talk pretty well and had a good chat with surgeon, albeit with slurred speech and a lot of drooling.  Prior to my surgery I had read blogs where people couldn't speak for weeks, but here I am talking there very next day.  A big reason though will be that here in Australia, they generally do not wire your jaws shut and just use elastics to guide your bite.  While the elastics restrict movement to allow your jaw to heal, they do not completely stop movement.

After lunchtime I was transferred to a ward where I had a private room and I got to have my first liquid meal of fibre milk, clear consommé and water.  I also looked at myself properly in the mirror for the first time - it was not a pretty sight.  Everything was swollen and bruised - my face, cheeks, lips, neck and my arms where the lines were inserted.  On the inside everything was swollen too including my gums and throat - of course this is to be expected after major jaw surgery.

Sing to me, my angel of music!

I was feeling very weak so lots of rest and sleep were in order.  Having to wheel around a drip and grapple with five sets of lines each time I wanted to use the bathroom was tiring in itself.  Later on that afternoon Frankie came to see me in hospital followed by my friends Gerry, John, Jack and Daniel.  They brought me a lovely robe and lots of magazines to keep me occupied.  After another liquid meal I bedded down to try and sleep off the discomfort.

D-Day: Jaw surgery time

I'm writing this post six days after my surgery but backdating it to October 16th (the day of surgery) to preserve the record.

I woke at 4am on the morning of my surgery feeling fairly calm as I had been all week, but unable to sleep any more.  As I showered and got ready to leave to leave though, the nerves really started to take hold.  The gravity of what I was about to go through came crashing down around me and the end of two years of treatment and planning was finally here.  All I wanted to do was have a cup of coffee but as I had been fasting since midnight all liquids were a no-no.  I got my things together for the quick 20 minute drive to the Prince of Wales Private Hospital and headed out into whole new day.

The good thing about having a 6am check in time was that it was quiet.  There was no traffic on the roads and the hospital itself didn't have hordes of people so actually felt quite serene.

I made my way up to surgery check-in where I filled out some forms, paid my insurance excess (of course!) and signed various waivers about surgery.  I then met my anaesthesiologist who re-iterated the information he gave me over the phone the previous week and generally just wanted to ensure I was feeling okay and had all of my questions answered.

Finally I met with a nurse to talk about my health and and was given some rather attractive compression socks and a gown to get changed into before I was asked to wait in the patients lounge.

What an attractive gown!

Nervous grin

From here everything moved pretty quick.  I was asked to leave the patient lounge after only a couple of minutes and climb up onto a trolley.  At this time I said goodbye to Frankie and was wheeled through to the operating theatre holding area.  I got to speak with my surgeon Dr. Tsakiris and with the team that would be looking after me during surgery.  My anaesthesiologist then popped in to give me some pre-surgery sedation drugs (felt like I'd had a few glasses of red wine) and advised there was a slight delay on the surgery as they were waiting for someone else to recover first.  Twenty minutes later I got more of the sedative and that's the last thing I remember until I woke up after surgery.  Even though I had apparently been conversing with the team right up until having the general anaesthetic - I have no memory of those moments.

Waking up after the surgery was not great, but not as bad as I thought it was going to be.  I had no nausea and as the drugs were still in my system I had no pain - but I did of course feel very uncomfortable.  I remember trying to talk to one of the nurses and wondering why I could not get any sounds out.  In the end I reverted to a pen and notepad to communicate.  Things were a little bit of a blur from here.  I'm sure I spoke with my anaesthesiologist as I seem to remember him saying 'you'll have an attractive smile in no time', but that easily could have been a dream.

After recovering from anaesthetic I was taken to intensive care and this was when I first felt the gastric tube that was inserted during surgery (and still there).  This was really thick and went up my nose and down the back of my throat all the way to my stomach.  I remember trying to swallow and feeling it there and I can honestly say it was one of the weirdest and most concerning things I have ever experienced.  I suddenly noticed all the lines and cables around my body when Frankie arrived to see me and I suddenly felt very emotional.  I kept asking myself 'why did I do this?' but the realistic part of me knew this was a natural reaction and it would be worth it in the end.

From here I slept on and off for until morning and lost all concept of time.

Various pre-op appointments - only days to go!

Over the last month I've had a number of appointments in preparation for my surgery which is now just a couple of days away - so here's a quick update.

On September 17th (one month prior to surgery) I had a pre-op appointment with my maxillofacial surgeon.  It was quite a lengthy appointment which I was glad of as it gave me a chance to ask lots of questions and generally be put at ease.  We discussed the surgical plan and what he hopes to achieve before he took some moulds/impressions (to make the surgical models and splints), 360 degree x-rays and plenty of photographs.  He also took various measurements of my jaw and profile and explained what I should expect during my stay in hospital - which will involve waking up from surgery with a gastric tube and (I'm cringing while writing this) a catheter.  Eek!

A couple of days later I had a telephone call from my anaesthesiologist who introduced himself and had a chat with me about how they would be taking care of me.  He again re-iterated that I will have a gastric tube and a catheter when I wake up from surgery.  The thought of a gastric tube didn't actually bother me until just now as I have realised what it actually is.  I thought it was a tube which goes down the throat to the stomach to deliver food.  Nope.  It is a tube which is inserted through the abdomen and into the stomach.  For some reason that bothers me a lot more than a tube down the throat.  Of course all I need to do to forget the gastric tube is think of the catheter.  Double eek!

Then on October 10th I had a pre-admission appointment at the Prince of Wales Private Hospital where they took my blood pressure, did an ECG, took some blood (in case I need a transfusion) and gave me information about the big day.  On October 16th I will be checking into the hospital at 6am and can expect my surgery to start around 8am.  As it is a 5-6 hour surgery, it will be the only one my surgeon performs that day.  Then after a night in intensive care, I will be transferred to a ward where I will most likely stay for 2-3 days.

Finally today I had a pre-op check with my orthodontist who also placed several surgical hooks into my mouth.  These are small metal hooks which are crimped around the wire of my braces.  They are used during surgery to help my surgeon move my jaw around once the bone has been cut.  In the photo below you can see one of them between my front teeth.

So that's it!  No more appointments now, just a count-down to the main event.  I must admit that I am feeling very excited, scared, positive and apprehensive all at the same time.  While I'm not too concerned about the surgery or the pain, I am nervous about the end result and hope that after all of this time and effort I will finally be happy with what I see in the mirror.

And on that very deep note I shall finish this post and will write another update soon.

I feel very special - thank you Cindi

This is a short post but it still deserves a blog post all of its own.  My friend Cindi is flying out all the way from California to spend the first two weeks with me after my jaw surgery.  She is coming to help take care of me and I feel very lucky to have such a great friend.   Thank you Cindi, you truly are amazing and I cannot wait to see you.  xxx

I have a date for my double jaw surgery!

I'm very excited to report that I am now booked in for my orthognathic (double jaw) surgery on October 16th.  This surgery will be the most major and invasive part of my treatment plan and involves a number of medical procedures.  It also means that I am nearing the end of my journey, although I will still have to wear braces for up to six months after surgery.  I'm going to throw around some medical terms here, so I will do my best to explain what everything means.

Preparation for surgery
I have a pre-op appointment in mid-September.  At this time my maxillofacial surgeon will take x-rays, moulds and from there make my splints and build the final surgical plan.  It will also give me the chance to ask lots of questions and make sure we agree on the outcomes.

The surgery
Orthognathic surgery is a very general term, the definition of which is 'surgery to correct conditions or abnormalities of the jaw and face'.  More specifically, my orthognathic surgery will involve:

• LeFort I maxillary osteotomy (upper jaw) and Bilateral sagittal split osteotomy or BSSO (lower jaw) - That's literally quite a mouthful, but in layman's terms they will remove sections of bone from my upper jaw (maxillary) and lower jaw (mandibular).  This will take my upper jaw upwards (to remove my gummy smile) and backwards (to finish correcting my overbite) while at the same time correcting the skewed angle at which my upper jaw has grown.  My lower jaw will be split and extended forwards, creating a stronger, more balanced profile.
• Genioplasty - also known as chin augmentation.  A surgical implant will be used to alter the shape of my chin.  This in conjunction with the double jaw surgery assists in creating a balanced profile.
• Turbinectomy - a procedure in which some or all of the turbinate bones attached to mucous membranes in the nasal passage are removed.  This is used to relieve nasal obstruction.
• Septoplasty - a corrective procedure to straighten the nasal septum.

At the moment it is estimated that my surgery will take around six hours to perform and will involve a three day stay in hospital with the first night being in a high-dependancy unit.  Here is a YouTube video (don't worry just an animation) which gives you an idea of what the osteotomy part of the surgery will look like:

Recovery time

I will need to spend the first couple of weeks at home resting and will have several weeks of swelling and bruising.  I'll also be on a liquid and soft food diet for at least six weeks, so hopefully I will lose a bit of weight at the same time!

Results
So what will this mean for my face?  Well I'm not going to come out of the other end looking like Joan Rivers or a contestant from Extreme Makeover that's for sure.  And despite the suggestions of my friends, I've opted not to have a breast enlargement "because you may as well while you're there"!  What I should end up with is a squarer jaw line, no overbite, a stronger chin, a straighter septum, a balanced profile and of course teeth that all meet and a better functioning jaw.   Hopefully I will just look like a normal guy.

I must admit that while I make jokes and say that I'm fine with everything, I'm actually starting to get very nervous.  I'm not so worried about the pain or the healing as I know I can handle that, but I hope that the end results will make this whole journey worth it.  I hope that I will be able to look into the mirror and finally like what I see.

So that's my big news!  Keep posted for more updates in the lead up to my surgery.  I also plan to blog from my hospital bed so you'll be with me every step of the way!