What is bugging me today...

It is Wednesday night at 7pm and I have been up for 60 straight hours now, except for a 3 hour nap from 3am Tuesday morning till 7am tuesday morning. AND... I started back to work this morning I had a two hour job and it took me three hours to do it.... I am not sure what exactly my problem is... I think some of it is the fact that I hav been weaning off using the pain killers at the same time I have restarted my ADHD med (Adderal) after a 5 day vacation off of it.
I was suppose to work tonite from 3pm till 8pm but decided that was not such a good idea. After watching my cousins twins for a couple hours this afternoon I layed down at 3:30pm and was going to take a nap to make me feel better and get me thru till bedtime. I layed there from 3:30 till 5:30pm yet not one second of sleep. Last night I had gone to bed at 10pm.. I layed there untill my alarm got me up for work at 5am. What the Hell is wrong with me?????
I need to sleep. And it is not just sleep. I was doing great with eating from Sat thru Monday I ate (or drank) often got rest and took care of my self. Tuesday started off okay, not enough sleep but okay and it all went to hell from there. I am barely eating, can't sleep. and I can't say I am in constant "pain", but the freakin pressure on my face and teeth is unreal.
I am asking those of you who have been through this SARPE surgery and expansion process to let me know that the presure I am feeling is normal. During surgery my OS cranked it a few times and got a little gap started and that has been it. It has been a week and it has not been turned since and will not be turned untill Sunday, BUT, the pressure on my teeth and face is freakin unreal and does not let up for even a second. It feels like my teeth are literally gonna pop right out of my head, and all the front top teeth are loose and wiggle. AND what is even weirder is that without cranking the expander even once since my OS did it in surgery I am almost completly positive that my gap has gotten bigger and feels like it is still growing? Is this posssible?
I know I am flipping out here, part of it is lack of sleep and nutrition and part of it is that I have an intense fear that my teeth are going to fall out during my expansion and my OS and my ortho will not say that it is not a possibility, that it is something that CAN actually happen.
PLEASE, sarpe surviviors I need reassuance or a reality check or warning to go bang on my OS's front door and beg him to save my teeth before they fall out. Someone HELP me!

Sunday will began expansion!

Had my post op appt this morning with the oral surgoeon. He said everything looks good and to see my ortho for the key to the expander and have her show me how to turn it. I will start turning sunday(12/21) two full turns a day till Friday (12/26) when I will go back to the ortho and see if I am done turning.
I asked my OS about food and he said I am on soup and smoothies for most of six weeks for stability, for some reason I thought I may be allowed soft foods this week or next at the latest. I had even tries some sprial mac and cheese last night. (oops), well it was tiring and sore after just a tiny bowl so I guess there is a reason for the soup and smoothies. Christmas diner is gonna suck tho....LOL.
I am back to work tommarow so we shall see how that goes, except for the mass tension in my face I am feeling alright so I think It will be ok, we shall see how it feels when I start cranking the expander.
I am so afraid that I am gonna start turning it and my teeth are goiong to fall out. It is bad enough that since my surgery my top fron teeth are all loose, I can only imagine that when you start pulling on them they are gonna want to fall out. I have always been a tooth grinder at night so dreams or should I say nightmares of all my teeth falling out have been commmon, now it feels like I am tempting fate, and my ortho does little to relay my fears only saying that it can happen...NICE! thank you!
I was also suprised at how many freaking stitches I have. I am stitched from back right molar to back left molar under my gums, sompletly across. then a few stitches along the center of the palate, some on my left cheeck, then bruised along the right side of the back of my throat, and I can tell he did something thru my nose also. A lot more cutting then I thought they were gonna do.
Well that is all I have for now!

Surgery

Well Wedneday morning at 8:45am I checked into Ingham regional for my SARPE surgery and removal of bottom Right wisdom tooth. I get changed and my IV put in and the nurse brings mu consents to sign for surgery. Specifically Leforte 1, Sagital split, and Geino. Ummm? NO! First off I am not getting geino done at all not now not 2 years from now, secondly I have not even had braces yet. That surgery is for the most part coming up in a year or two. needless to say I am 2nd guessing my surgery. Eventually Dr. Mauro comes into see me and says I am just having the expasnsion (LeForte 1). Ok you know what you are doing then lets do this.
So I wake up from surgery around 2pm and notice a short time later that he never removed my wisdom tooth, Nice!

Well They tell me that since they could not find a bed for my in the hospital that Dr. Mauro said I could go home. Umm no I think I will stay. I felt like hell and knew that I could not take care of myself. I basically slept from the time they put me out before surgery untill they released me at noon the next day with brief intermintent periods of wakefulness to ask for drugs, suction out the blood from my mouth and go to the bathroom.
I have actually been suprised how much pain I have been in I am on day 4 and I am still drained and my teeth feel like they are in a vice and going to pop out of my head, and I haven't even started expanding yet. (except what the dr did in surgery). Somebody please tell me that my teeth will not pop out of my head and that this is normal.
I tried to post on Archwired with some of my questions but it will not let me register so that is a no go, and I have tried to ask questions a couple times on the orthgnathic yahoo groups but never get answers to SARPE questions on there so I am not sure what is normal pain wise after SARPE, and when I should expect to feel a little better.
So to sum it up, I feel like crap, not sure how long i should expect to feel like crap, oh and my ortho for got to give me the key so I can turn the expander when the time comes, and of coourse they arenot open till tuesday.
Someone remind me why I did this to myself!

4 Days till my SARPE

Thursday night I got my RPE put in and it sucks just as badley as I imagined it would. I am a little over 48 hours with it in and it has only got slightly better. I have gotten a little bit better at swallowing, but other than that not much improvement. I detest speaking because I hate how I sound. Eating is not even worth the effort. I had to reheat a bowl of soup five times before I was finished with it last night. And the lovely sounds I make, the slurping and clicking ( I really hope that goes away). I guess I am done venting now...
I do have to admit that I am looking foreward to surgery on Wednesday for two reasons.
1. The sooner I start, the sooner I finish
2. I really need a break, an excuse to lay down and just relax, if only for a week.
These last few weeks have been the hardest of my life, and except for still grieving the loss of a family member and friend, everything else goes on hold for a week after my surgery. No school, finals will be over, no work, no dr appt, or ortho appts,time with my daughter, an excuse not to be doing 1001 things and not feel guilty about it.
So wednesday morning I check into the hospital at 8:45 and my surgery is at 10:45. I have no idea if I will be out of the hospital the same day or the next. Hopefully the surgery will go smoothly and my time with the expander will be short, altho I doubt it. My OS says he plans on me expanding about a 1/2 inch (12 to 13 mm) That is a freaking huge gap! It would be really nice if I could lock myself in my house till spring when I have passed the expansion part of this orthognathic journey I am on. I just try to keep reminding my self that this will all be worth it in the end!

Almost got my RPE in....

I went in on the 14th to get my RPE installed, I had one tooth that had been really sensitive the last two days and when the assstant tried to fit the rpe bands around my teeth I thought I would hit the ceiling. I was sure the tooth was being ripped out it hurt so bad. The assistant gave it a couple tries but decided to wait for Dr. Novak to give it a try.
Dr. Novak came in and gave it a go but could not get it on either. She decided to put spacers back on my teeth and wait a week or so to see if the tooth that was bothering me would stop hurting, she also added to more bands for good measure for extra space. Not sure how that will help with getting my tooth to stop hurting. I tried to get her to let me take the RPE home and put it in myself. It is easier to deal with pain when you are inflicting it upon yourself, but she said no she has a feeling that the RPE does not fit quite right, but she can not tell for sure untill my tooth stops bothering me so much. So I have a week and a half to call them back and tell them that my teeth do not hurt and we can try agian.
Well on the bright side that is at least a week or so that I do not have to wear the RPE before surgery.

It has begun.. The spacers are in...

The periodontist appointment went well on Oct. 14th, so my spacers went in on the 15th. OUCH! thought I was all fine till I went to bite into a sandwich, wow! was not expecting that. Good thing is I had 3 days to try out my liquid diet for surgery in December. I am now a pro at smoothies. have come to the conclusion that my nutrition supplement of choice will be carnation instant breakfast and I have a lot of soup to make and freeze.

I had my fitting for my RPE last friday and it will go in on November 14th a full month before my surgery. That should be fun, a whole month to have a huge piece of metal in my mouth doing absolutly nothing but getting in my way. But on the brighter side.. I am at least getting somewhere now. and every step I take is one step closer to finishing this process!

I had no idea..

So I got my surgery packet yesterday in the mail from my OS. In it it talks about how I will be on a no chew diet for 6 weeks and banded shut for that time also. This surgery is the SARPE and I had been under the impression that this surgery had an easier recovery then my second surgery (upper,Lower).
So I called my OS's office to ask them about this.. figuring that the surgery packet was geared more for upper, lower, ect.. surgery.... Seems I was wrong. I was informed that I would be on a no chew diet for the entire 6 weeks and banded shut for much of that time. FUN!

So I am suppse to be trying out liquid meal supplements to find some that I like now... Any suggestions on what ones taste best? Which ones to avoid, and what if any are more affordable?
TIA!

December 10th!

So it seems we have a tentitive Surgery date for December 10th.. providing everything goes well at the periodontist. Please pray that everything goes well at the periodontist I cannot afford any treatment and would hate if thing got put on hold for lack of money now. SO if everything goes smoothly I will be having my RPE installed on november 14th and surgery on December 10th with the possibility of the braces being put on right before surgery but the ortho wasn't sure if she was going to do the braces before or after surgery.
So my question is... why do I need to have the RPE installed one month before surgery? It is just going to be sitting there doing nothing but getting in my way and making me talk funny?

We have a plan.. I think?

So I saw my ortho today.. FINALLY! it seems she is going to wait to put on the braces till after my expansion surgery. The last hurdle I have to jump before the expansion is they now want me to see a periodontist to make sure I have adequate bone around my teeth. Due to the bad bite I have clentched and ground me teeth till most of the molars were broken so they want to make sure there was no further damage before they install the RPE for the expansion.
The only problem with seeing a periodontist is figuring out how I am going to pay for him. The costs just keep adding up and I am not seeing how I can cover this. I figured out how to pay for the braces... cool! Got a line of credit to pay for the dental work.. paying that off monthly, now they want mne to see a periodontist.. I am out of ideas on that one and the appt is for Oct. 14th. With any luck it with just be an evaluation and no work will be needed.
Soooo.. providing everything goes well at the periodontist on the 14th I will get my spacers placed on the 15th and fitted for the RPE on the 24th. November 14th the RPE will be installed and I should get clarification on tuesday from Dr. Mauros office but my Surgery sholuld be on December 10th, one day before my micro and algebra finals. Hoping I can take both of my finals on December 9th..LOL
So that is where i stand right now...... now back to waiting and praying....

Hurry up and wait...

I am getting so freakin frusterated. SO today is suppose to be my rescheduled consult with my ortho, my last consult was rescheduled because my ortho had to reschedule her meeting with my OS to discuss my case, so today my orthos office called and said that my consult had to be rescheduled agian because this time my OS did not show up to their meeting.

The problem is I go to school full time and have to plan my SARPE surgery between semesters. My ortho wants me in braces 4 months before having my first surgery, this was perfect as my semester break is from Dec 14th - Jan 6th. My OS only does surgery on wednesday. Dec 17th is the only wednesday that is not a holiday. I need my braces on NOW to have my surgery between semesters.
I am working at getting into the nursing program and I am down to my hardest science classes, I cannot take a week + off mid semester, my grades will suffer and I can not afford that.

I also worry that everytime my ortho and OS need to get together to discuss my case durring the course of my treatment that It will be a huge ordeal that throws my treatment schedule off by months, because they cannot find time to speak to each other.

AAAAAAAAAAAAAAHHHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!! ok I think I feel a little better.... no not really

If I don't get this going I am going to be in a wedding in June with braces, an expander and a huge gap between my front teeth. If I can get my surgery done in Dec I have 6 months to close the gap and hopefully get the expander out.

I am a control freak and HATE not having control over my treatment.

porcelain or metal..that is the question? Anyone have the answer?

I brought up getting porcelain braces on my top front teeth with my Ortho.. and she said it was only like $250 more or something like that BUT... that my treatment would be longer, they are bulkier, and harder and tend to tear up your mouth more.
The bulkier part is what got my attention. as you can see in my pics below my overjet is huge and I can help but wonder if the porcelain brackets would push my lip out further then the metal? This I can imagine would make my face look even more deformed maybe to the point that i cannot close my lips around my teeth.
Does anyone know if the brackets are that much more bulky that they would make a difference? I keep going back and forth on what I want to do.
I would love to hear what everyone else thinks. Personal expirences, opinions, facts, ect... What would you do or what did you do and why? Especially from anyone with a severe overjet.
Thanks Guys!!!

I hate delays

Seems things came up in my orthos schedule and she was not able to meet with my oral surgeon since my xrays and molds were taken so as I was on my way to my consult to find out when the braces go on and when my SARPE was planned for I got a call from the receptionist saying they need to reschedule because the Ortho can not meet with my OS till 8/11. So now my consult is scheduled for 8/14 at 7pm. Two more weeks of waiting. I hate that I am such an impaitent person, but I just figure the sooner I get this started the sooner it will be all over.
It is probably for the better tho. I won't have the money to pay my initial payment on the braces till after 8/'21, and with the timeline i was on my braces would have probably been planned to go on before that date. So now I have a couple extra weeks to wait for the money to come in. That and I have my friends wedding on 8/23 and my 15 year reunion on 8/16, and it would better to attend these events without the full mouth of metal.

Definition of the surgeries I will be undergoing:

Le Fort I Osteotomy
Sensory nerves to the upper lip and cheeks are coloured blue

The Le Fort I osteotomy involves separating the maxilla and the palate from the skull above the roots of the upper teeth through an incision inside the upper lip. The maxilla is fixed in its new position with titanium screws and plates. Surgery time is around three hours. The operation is frequently carried out with the mandibular Sagittal split osteotomy when it is termed a Bimaxillary Osteotomy.

Bimaxillary osteotomies take around five hours to complete and may be carried out in conjunction with chin surgery and liposuction/liposculpture. Blood transfusion is required. On occasions bone grafting is required in the Le Fort I osteotomy to ensure bone healing and union across the bone cuts. The graft is frequently harvested from the hip. Bone graft material may be harvested from the chin or lower jaw in bimaxillary cases – leaving the hip intact.

Cosmetic improvement is startling for those individuals requiring these procedures, and with proper planning it is unusual for patients not to be delighted with outcome.

Mandibular Sagittal Split Osteotomy

The back of the lower jaw is split bilaterally under general anaesthetic in the region of the wisdom teeth, which are generally removed in a separate operation at least 6 months prior to corrective surgery.

The procedure is carried out in about 1.5 hours and permits the lower jaw to be advanced or pushed back with adequate bone contact for healing.

The bone is fixed in its new position by screws which are inserted through tiny external skin incisions which are located at the angle of the jaw. These heal with minimal external scarring.

Mandibular Sagittal Split Osteotomy
and Genioplasty (Chin Surgery)

The mandible has been pushed backwards and surgery has been carried out to the chin (Genioplasty)Sensory Nerves to the lower lip pass through the jaw and are coloured blue

Whilst day case treatment is practiced in the USA, it is common practice in the UK to spend one night as an in-patient.

Some adjustment to the position of the dental occlusion (bite) is not uncommon following surgery. This is achieved by joining the upper and lower jaws together with elastic band traction for a week or two.

Facial swelling is variable and is controlled with intravenous steroid injections over the first 24 hours. Patients require a liquidised diet if the jaws are held together with elastics - or soft diet for the first two weeks, after which time more solid food can be introduced.

Specific Complications:



The Mandibular Sagittal Split Osteotomy

The sensory nerves to the lower lip are coloured blue.

Screw fixation is demonstrated on one side. Screws are placed above and below the nerve

I thought I would add what my Dx from Dr. Mauro was:

The assesment on April 3, 2008 was (1) mandibular retrognathia, (2) maxillary posterior hyperplasia, (3) apertognathia, (4) cranial base to mandible dicrepancy, (5) lip incompetence, (6) dental deterioration due to aberrant maxillomandibular relationship. hmmm and my parents thought I just needed braces..LOL

The treatment plan at this time :

(1) Restoration of all carious teeth, (2) comprehensive orthodonic therapy to level and align the dentition relative to alveolar and basal bone compromises and compensations, (3) orthognathic surgery to stable condylar position criteria which would require Le Fort osteotomy, a maxillary postierior intrusion transpalatal expansion and mandibular sagitattal split osteotomy and mandibular advancement.

So I finished the dental work I needed to get done before I start braces or surgery. My back molars had all broke due to the extreme pressure and grinding because my bite is so far off.

So since my dental work is done I had a consult with my oral surgeon Dr. Mauro to see what is next and he said to make an appointment with my ortho Dr. Novak because he wanted the braces on before he did the expansion surgery (SARPE). So July 16th is my diagnostic appointment with the ortho. I hope to have the braces on by mid august. I also hope that I will have money to pay for the braces by then ..LOL
I will update after my ortho appointment since Dr. Novak is the one who will be determining the time-line for my procedures.

here are pics of me at the start of this whole process

This is embarrassing to post these pics for the world to see..lol. But I am doing this as much for me as for anyone who reads this blog. I want to be able to see exactly how far I have come as I go through the surgeries, braces, dental work, ect... I have lived my whole life with this smile and it has controlled every aspect of my life. I lack self confidence, I hate the way I look. It effects the way I make friends, interacts with friends, family, coworkers, ect.. I lack the self confidence to date, I even worry about what my 3 year old daughter feels about what I look like when I smile.

I NEED to get this fixed and am so excited to begin the process.

So on to the pics.......

front view

Front view close up

profile

ouch...how bad is that

This is my teeth touching...WOW!

So bad that I can actually stick my tounge out with my teeth touching at molars

Insurance actually approved my surgeries.

I got the call yesterday morning that my insurance is going to cover SARPE and ..well actually I am not yet sure what the 2nd surgery is gonna be yet, did not discuss that one much with my OS since he did not believe that my particular insurance would cover my surgeries... but Yea!!! they are going to. I have my first 2 appts. scheduled one is for more x rays and one is a consultation to get fitted for the expander for surgery. I also need to get some dental work done first.. some fillings and caps.
I had my consult with my ortho last friday and the total cost for braces will be $6,700.00 oop. No dental or ortho insurance :(... oh well I guess it is time to put those student loans to use. I will post agian after my first few appts. when I have a clue what the plan is and post my starting pics...It's not gonna be pretty..LOL