5 week (almost) update
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5 week (almost) update

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Posted by bruinmd on March 29, 2009 at 10:17:20:

Surgery date: February 24, 2009:
MMA: 10cm lower jaw advancement with counter clock wise rotation and about 4mm upper jaw advancement, septoplasty, inferior turbinate reduction

1)Day-time functioning:
-My day-time sleepiness really began to improve consistently after just over 3 weeks. I had experienced significant fatigue intermittently up until that point. I can say subjectively at least that I am feeling dramatically better during the day than prior to surgery. I am feeling more focused and the grogginess has improved dramatically. I need to take Klonipin at night to reduce grinding of my teeth (to limit the movement of my jaw at night) and this may contribute to some sleepiness during the morning upon wakening. But I am good to go within an hour or two after waking up. I strongly suspect this is drug-related. To say that I am happy with how I feel subjectively is a strong understatement. I recently got suckered into paying a $400 dinner tab for friends. But I was so happy to be out at night and night exhausted that I did it. So be careful out there about doing expensive acts of kindness!!!!!

2)Side effects:
Not much to complain about in this regard
a) Pain- has been almost non-existent since day #4. I took oral narcotics for the first week only at night to improve my sleep (with the mild pain that came from moving around during sleep). I did use Ultram as a narcotic substitute. People should be careful of using anti-inflammatory agents such as advil or aspirin soon after surgery as this can lead to increased risk of bleeding.

b) Numbness- i experienced significant numbness of my lower jaw- lower lip down to lower chin. The right side has begun to improve substantially. It is only about 4 weeks and I am beginning to notice some improvement already so I don't expect many problems with this.

c) Bite: seems to be perfect alignment. I had braces placed several months before but I am not sure what they have done. I did not need much pre-surgical orthodonthia and hopefully they will be off soon.

d) Swelling- mostly resolved. Still have some mild swelling of chin area.

e) Post-nasal drainage. This has been the only really annoying part of the recovery (but still not a big deal). It appears that the maxillary sinuses fill up with blood following surgery and it takes many weeks for this to slowly drain out. So often, i will wake up after expectorating some dried mucousy blood at night (sorry if too graphic). The nasal congestion has slowly improved. I have used afrin on many occasions at night.

f)Light-headed-ness. I found that I am prone to dehydration. This can contribute to feelings of light-headed-ness and lethargy. In medical terminology- this is referred to as being "orthostatic." One can measure this by taking your pulse laying down for 15 seconds and multiply times 4 (this gives you your heart rate per minute). You can then stand for several minutes and repeat the same heart rate measurement. If your pulse increases by more than 15 or per minute from laying to standing, you are likely dehydrated. This may explain some of the tiredness or lethargy. So ask your doctor if this seems to be a problem. And drink more fluid that you think you could possibly need (assuming you do not have any kidney or heart problems). This is just general advice and all issues should be discussed with your doctor.

3)Looks
-I had a mildly recessed lower jaw prior to surgery. It was not something most people (including myself) would have noticed. I was plenty happy with my looks prior to surgery. I would say about 50% of people don't notice a change and the other half think I look better. I like my new look and my new lower jaw. I did not have much room to bring my upper jaw forward without unwanted cosmetic results. So that I was able to have significant improvement in the apnea (only based on my subjective feeling) with minimal advancement of the upper jaw (only 4 mm) was a great thing. I believe only 4mm advancement was needed because of the "counter-clock wise rotation of the mandibular/maxillary complex).

4)Diet
-I have been eating blended soup, eggs, and anything I can mash without swallowing. I will be on a soft diet for a total of 4 months. The reason for this is because of the egg-shell thin areas of the maxilla (upper jaw) and fragile nature of the plates keeping it together. This sounds longer than many people but given how I feel, it is a small price to pay. I have a tremendous ability to swallow food without chewing.

Overall- my recovery has been a piece of cake. In hindsight (which is certainly not to be confused with foresight), I would not have worried about the surgery as much as I did or have waited as long. Other than fatigue for the first 3 weeks- there is almost nothing for me to complain about. My feeling is I would have skipped the many previous surgeries I had if I could do it over again. But this is easy to say in hindsight. I certainly would have saved a lot of time and money.

One important point- do not skimp on the surgeon. Research your surgeon well and go with who you feel the best is. As a patient- we all need to live and die with the decisions we make. Going to someone that is considered the best can make it easier to handle post-op complications. For me- there would be no worse feeling thinking things could have been different had I gone to another surgeon. And for this procedure- I would not spare any expenses. If you can't get your insurance to pay for it- try to find another way to get the money needed. Or wait to save up. With this procedure- the complication rate can vary dramatically between surgeons.

So good luck to everyone considering the surgery. This is just my personal experience- everyones' will obviously vary. I would do it again in a heartbeat.

Brian

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