A long overdue followup

June 4th, 2012 § Comments Off § permalink

I was recently contacted by someone who found this blog and thought that I may not have made it past last March. It turns out that I did make it, and I’ve had an interesting year.

Since the last update, I have kicked the drugs prescribed by my doctor with positive effects. I found that the retainer I was using after the surgery was causing my joints to flare up causing me frequent discomfort and inflammation. Several nights without the retainer were enough to clear up ongoing discomfort. After a few weeks, most of the inflammation had subsided. Occasionally I managed to upset my jaw by eating something too hard or drinking caffeine (mainly coffee) too often. The solution was always simply taking it easy for a few days.

About 3 months ago I had a new set of retainers made by Dr. Alan Marcus in Milbrae, CA. The goal was just to maintain the alignment I had on the upper teeth and correct the lower incisors which had drifted in the several months since I used my pervious retainer. After an adjustment or two, the new retainers fit great and now I barely notice them. These are a different style of retainer with a wrap-around wire on the top that never goes over the teeth (this is important!), but goes all the way around and applies pressure front and back. The lower retainer is a short 4-tooth piece that clips on easily and is easy to talk with.

In the two and a half years post surgery, my joints deteriorated slightly, enough to through off the alignment of my bite. Its not significant and impossible to notice by anyone except a dentist or orthodontist (or myself).

My orthodontist(s) and my surgeon have starkly different opinions about how to properly handle a surgery like this from start to finish. My experience will probably be different than anyone else’s, but there’s a chance it will be similar. Here’s a few tips I would offer to anyone considering the surgery:

  • Its worth it, but like any investment it takes time to pay off.
  • It requires more patience than you currently have, but you will learn.
  • You will eat a lot of blended foods — buy a great blender, a juicer is optional.
  • You will get tired of blended foods.
  • Likewise, you will get tired of soft foods.
  • The truth probably lies somewhere between what your surgeon and your orthodontist says.
  • You will lose weight. I lost about 10lbs in the first few weeks.
  • If you notice clicking, sticking, friction, or any feelings that you didn’t have before the surgery, take note and tell the surgeon if they persist more than a day or two.
  • You won’t have the same symptom or feelings twice as you recover so its impossible to learn from the past. Be sure to bring up anything that feels unusual with the surgeon.
  • Experiment to avoid frustration. If one thing isn’t working, try something else to see if thats better.

Best of luck and remember that while it may be hard for a short while, you have years of enjoyment ahead that will make the current day or week of pain seem irrelevant.


Amitryptaline is The Devil

May 9th, 2011 § Comments Off § permalink

I got a prescription for peroxicam again. That helps keep the inflammation down, but still doesn’t prevent me from clenching. Upside: I can eat harder foods without throwing my joints into a tizzy. Downside: the fine line between destroying my joints and living life inched slightly to the right.

I also had an equilibration (grinding specific teeth to improve bite) done in Santa Barbara. That helped my teeth fit together much better and now they mesh somewhat reliably. It was kind of painful morning between that and a visit to the surgeon. That was about 6 weeks ago. It was a noticeable improvement and now my teeth hit evenly and at the same time on both sides.

Now I have noticed something that I can finally put my finger on: the amitryptaline is making me dumb. Seriously. I can go from a high-functioning individual and accomplish a lot on one day to a bumbling idiot that can’t make heads or tails of the work he did the day before. Sure, I may be exaggerating a little, but its incredibly frustrating. I’m taking half the prescribed dose which barely stops me from clenching and it has a terrible effect on my mood and capacity to get things done for the next 24 hours or so.

Here’s my decision: quitting the damn amitryptaline cold turkey. I am so incredibly frustrated by it that I am forced to find alternatives.

Alternatives I’ve tried – perceived success
alcohol – moderate, not repeatable
cranial-sacral massage – 3 to 4 days of relief
exhaustion – somewhat
no retainer – mixed

Will check back when I’ve found something interesting.

16 months and still in pain

March 3rd, 2011 § Comments Off § permalink

Its not constant pain. Its not every day. I’ve been making an effort to eat soft foods and keep from stressing my jaw. But life and work conspire to make this difficult. I had temporary relief over the last weekend by not wearing my retainer. Somehow that kept me from clenching much and things were actually starting to feel good. Of course, it seemed that things were going too well. I woke up this morning with my joints very tight and my right joint has been in pain all day. Eating soft food sucks and I constantly push that. Taking it easy sucks. Taking medication sucks. Destroying my jaw also sucks. So I’m stuck between a lot of things that suck.

I want to take the “magical joint medication”, piroxicam/feldene, again. That stuff was great. Or at least I thought that it was keeping me together. I’ve been not as good at taking my evening medications lately. I can usually get all my morning medications, but forget the evening ones. As such I’m missing about 33% of my fish oil and 50% of my supplemental calcium and vitamin D. I’m trying to get back on the wagon here.

I sound defeated. I’m not. I am simply exhausted. I will get through this. I have no choice.

Really the most interesting and frustrating part is this: every time my jaw flares up again, it is a different, unique symptom. I swear. Not once since the 6 month point have I said, “I know this symptom, I know what caused it, and I know how to avoid it.” Every single time the pain or discomfort or feeling is completely new. The location may be the same, but I swear I haven’t had the same symptom twice. That absolutely kills me because it is so unpredictable.

15 months and pain or how to melt a joint

February 14th, 2011 § Comments Off § permalink

January was stressful. The first part of February has been too. Coincidentally I’ve been having tightness and soreness in my right joint along with occasional “locking” when trying to close. I tried to relax, and ended up taking a pill once and a while but I have a somewhat high tolerance for pain and let it stick around too long. I visited the surgeon last week and they reviewed my 1 year followup X-rays.

I am slowly eating away at the bone on my right joint.

Fantastic news. How do I fix it? I was told to relax and keep taking my fish oil. That’s not helpful. The doc noticed that since I have lost a fraction of a millimeter on the right joint, I was contacting my right teeth before my left when I close. So the new plan of action is to send me to another doc who will grind down my teeth so they meet at the same time. I was obviously skeptical and continued to ask “is there _anything_ else I can do?” He didn’t say much.

I am a little pissed to say the least. All that I know I can do to prevent this besides getting back on the joint preservation and anti-inflammatory medications is to keep taking the amitriptyline in small doses and see some doc to grind down my teeth. I am Not Happy.

On the upside, I am taking the amitriptyline and it is helping somewhat. I will make an appointment with this guy and post some pics of my melting joint below. Yeah, and I’m not posting any more pics of my face because I’m lazy. I may dig up a photo taken around Christmas for a general idea of how I look now.

13 Months, or so

December 18th, 2010 § Comments Off § permalink

Its been just over thirteen months and I am overdue for an update. I had my 1 year followup with the surgeon recently and heard nothing but good news. Everything looked great, my bite was excellent, and they wanted me to start weaning myself off of the medications. I was taking an anti-inflamatory (doxycycline), a joint preserver (feldene/peroxicam), and an anti-clenching medication (amitryptaline). I was told to wait about a two weeks after my scheduled cleaning.

The cleaning went well after I told the hygienist to give me frequent breaks and not to put much pressure on my lower jaw.  The best part was when the dentist came in to check on me and commented how if it weren’t for the xrays, he would have no idea that I had surgery. There is no visible evidence. Period.

Two weeks passed and I stopped my medications. All was well for a few more weeks when I started noticing soreness and tension around my right jaw joint. I took a small dose of the anti-clenching medication for a few nights and found relief.  Recently I have noticed that I clench when I sleep fairly regularly. I have had limited success with just relaxation techniques but sometimes that’s not enough. I have also noticed that I don’t enunciate enough when I speak, usually moving my face just enough to speak. I have encountered this before and I just need to focus on pronouncing what I say. If you see me making weird expressions, I’m probably just stretching my face!

I promise to update this post with some photos in the next few days since I really need to document my progress. I will be back at the surgeon in February for another followup.