SARME surgery and post-op day one

The big day has come and gone so I thought I would give you an update on the surgery and my recovery since then.

I had to report at the hospital at 1.30pm on Monday 11th March, which meant that I couldn't eat after 7am that morning.  I couldn't sleep well anyway as I was nervous so I was awake and having breakfast at 6am.  I pottered around as much as I could Monday morning (including making the last video) and then set off to the day surgery in Randwick.

I still felt nervous on arrival but the team of nurses and my anaesthetist came to chat to me at different times to go through various questionnaires and I felt confident in their hands.  They advised me that I wouldn't be having the four teeth removed at the same time as my surgeon and orthodontist had decided they would come out later.  

The day unit was a little different than a hospital ward, and I had to wait in reception until they were ready for me.  As soon as they called me through it was time to gown up and go straight through to theatre - no sitting around in a hospital bed for me.

Giving away my age again

In theatre I saw my surgeon Dr Tsakiris who came to assure me that I would be ok everything would run smoothly.  I feel so confident with him that any nerves or worry I had started to disappear instantly.  I also saw Andrew again (the anaesthetist who came to originally talk to me) and while all the team were busy with their jobs their focus was on me - asking if I was ok, keeping me chatting about what I did for work etc.  The drip went into my hand and before I knew it I was breathing oxygen through a mask.  I remember the coldness of the anaesthetic going into my hand and remember saying 'that feels good' before drifting off to sleep.

This was only my second experience of general anaesthesia and it felt like I woke up as soon as I had fallen asleep.  The surgery actually took around 1 hour and 40 minutes.  I was a little groggy when I came around and kept drifting in and out losing track of time, although I did feel quite relaxed.  I remember the nurses calling my escort to come and pick me up, and it felt like only seconds later until he arrived, even though it was 30 minutes.  My surgeon came and spoke to me and said that everything had gone well.  After a short while longer in recovery I was on my way home and soon enough was resting up in bed.

On my way home from the hospital

Resting up in bed

And so here I am one day after my SARME surgery.  I have been quite surprised with the pain levels in the fact that they have been low to non-existent!  I guess I must be very lucky as I have read from other blogs that people have been in tremendous amounts of pain after this procedure.  I am religiously taking the antibiotics and the panadeine forte (very strong painkillers) they prescribed me so the pain does not creep up on me.

While there has been no pain there is a lot of pressure and numbness on my upper jaw and the swelling is very, no extremely noticeable - think Joan Rivers meets Alvin and the Chipmunks.  

I am not allowed to spit or blow my nose for two weeks and this is because the sinus walls are damaged during this kind of surgery and need to repair.  I'm not even allowed to sniff which is frustrating as my nose is clogged, but I have been prescribed some nose drops for this.  Sometimes I have sniffed without realising which has caused some blood to come through to my mouth, but not tremendous amounts.

So what else can I say?  Well apparently a lot because I have not lost my ability to talk!  I thought it would be too painful but if you watch the video below you'll realise I'm the same old me!

The day of my SARME surgery

It's the day of my jaw widening surgery (SARME) so I thought I'd let you hear it from the horses mouth!

Maxillary expander update and three days until surgery!

My expander has been in for three days and I must say I'm getting used to it quicker than expected.  My speech is not half as bad as it was on Tuesday (I no longer sound like Joseph Merrick) and it's now only certain words and sounds that I have difficulty with.  Eating is still a challenge as food constantly gets stuck between the device and the roof of my mouth, but nothing that gargling water after every meal doesn't cure.

The strange thing is that since having my expander in my sense of smell seems to have heightened.  I did not expect this to happen and haven't read it in other peoples experiences so it came as a surprise, but I must say it's a rather pleasant surprise.  I seem to be picking up smells that transport me back in time to a place with fond memories - spices in an Indian market, the smell of damp English soil when camping as a child, the smell of the sea breeze on San Francisco Bay.  Call me crazy, but they do say that if certain senses are limited, the others compensate for them.

Aside from this it is only three days until my surgery and I am starting to get a little nervous.  However, I am in the care of an absolutely fantastic team who make me feel comfortable and I have every confidence in them.  Dr. Peter Tsakiris is my Oral and Maxillofacial Surgeon and will be performing the SARME surgery on Monday, Dr. Steve Stromotas is my Orthodontist (who also has an amazing, friendly and professional team of staff) and will be assisting me with the expansion device and later my braces, and my dentist Dr Kenneth Wong is keeping my dental health at top notch condition.  That's enough love for one thread!

So what am I doing this weekend?  Well apart from stocking up on mashed potato, soup, protein drinks and other soft meals I am going to make the most of my oral freedom <insert naughty pun here>.  I have some friends coming for dinner on Saturday evening (I love to entertain) and will be chilling out on Sunday and catching up with as many people as I can on the phone while I can still talk.

I'll be updating this blog pre and post surgery so watch this space!

The expander is in!

I finally got my expansion device in today in preparation for my SARME next week on Monday and for the first time I have started feeling nervous!  The expander only took 15-20 minutes to be installed and glued into place, and after a quick check by the orthodontist I'm ready to go.

Learning to speak with the expander in is a lot of fun as I suddenly have a very prominent lisp.  Add to that the constant swallowing from the excess saliva and it all adds up to a rather attractive package!  I haven't tried to eat anything yet but have been warned to stay away from any sticky foods - so goodbye chewing gum, sweets and caramel :(

While I'm feeling nervous I am also excited as it means things are now moving along.  I can't wait for my SARME surgery next Monday and will keep this blog updated of my progress.

For now here are some photos showing the expander in my mouth as well as some side pictures which show the metal rings of the expander attached to my teeth.  Not very attractive camera angles but what can you do?

When my palette is split in half this device will widen my jaw

The metal rings surround two teeth on each side of the upper jaw and are glued into place

Another attractive shot

With this ring, I thee bled!

Ok, so grammatically the title of this post is pretty rubbish, but hey - I'm trying to be funny!

I went back to the orthodontist on Tuesday - just 24 hours after having my spacers put in.  The spacers were removed and the rings (which will eventually be connected to the SARME / expander device) were sized for my upper molars and front upper teeth.  I think I had become complacent about pain as the spacers did not hurt or cause any discomfort - but I can tell you, having the rings fitted soon kicked me back to reality!

The process of sizing the rings involves sliding various different metal rings up over the teeth in question (quite roughly I might add) in order to find ones which are the perfect fit around the tooth - not too tight and not too loose.  The rings hit my gums a number of times and I could feel the edges of them against the inside of my cheeks as well as against my tongue.  This caused some discomfort but luckily the whole process only took 20 minutes or so.

Once the metal rings were fitted I had some impressions made and the rings were removed - phew!  The impressions will be sent to the lab to have the device built and this will be 'installed' on 4th March. Oh happy day!

How much will it all cost?

When I started enquiring about 'fixing' my jaw I first did a lot of research on pricing.  While the costs have worked out to a little more than I originally expected (well OK around 40% more), I still had a fair idea of what I was letting myself in for.

So for those of you out there who are looking into SARME/SARPE, orthodontics and bi-max surgery - here is the cost for each stage along with a breakdown of what fees make up the total.  All prices are in Australian dollars before any rebates from my private health fund or Medicare.

Stage 1 SARME = $6,250

Surgical fee = $3,000

Teeth removed x 5 = $550 (total)

Day surgery fees = $1,800

Anaesthetist fees = $900

Stage 2 Orthodontics = $10,800

Braces, adjustments and all appointment fees = $10,800 ($3750 initial deposit then $470 per month for 15 months).

While the orthodontics sound expensive this also includes consultations for two years after orthodontic work is completed.

Stage 3 Bi-maxillary (double jaw) surgery = $23,000 (approx.)

Pre-op surgical appointment = $1,500 (approx)
Surgical fees = $17,000

Hospital and anaesthetist fees including 1 night high dependency unit and five night stay total = $4,000 (approx.)

Other fees for x-rays, consults, veneers, cleaning and general dental = $3,000 (approx.)

Grand total for entire treatment = $40,000 (before any rebates)

Expensive?  Well yes it is - but remember these fees are before any health fund or Medicare rebates.  I can expect to receive about $8,000 in total from these rebates.  Then there are the tax refunds on top of that - the Australian government will give 20% back on all medical expenses over $2,200 in any tax year (after rebates from health funds and Medicare).  The cost of these procedures will be spread over two years, but I can still expect to receive another $5,000 or so back, which brings the grand total out of pocket to around $27,000 which is much more manageable.

If you are still reading but unsure of the prices I think its a matter of putting things into perspective.  Some people would not think twice about spending this much money on a brand new car.  Some people will easily spend $10K on an overseas holiday.  This is something that will last me for the rest of my life, so I definitely think it is a wise investment.

Well that's all for now - it's late here in Sydney and time for bed.  If you have any questions feel free to drop me a line or leave a comment.

The spacers are in!

It's all finally happening!  I had an orthodontist appointment today and got the spacers put in ready for the expansion device which should go in about a week from now.  The spacers are simply little plastic discs that are placed in between teeth to create a larger space in between them.

I had four spacers placed in total (two on each side of my upper jaw) and I have to say they are not as uncomfortable as I was led to believe.  My orthodontist had warned me to take some painkillers as he said there would be soreness and I did take a couple of painkillers over twelve hours ago, but I have felt no pain whatsoever.

While its not the most attractive pose, here you can see one of the blue spacers in my upper jaw - they're kinda cute :)

I'll be back in to see the orthodontist tomorrow to have the final impressions made for the expansion device. Three weeks and counting!