6 months: Going Strong!

Warm greetings and blessed Christmas to one and all! 

Last Saturday, I popped by the clinic for my 6 months post-op review with the two funny surgeons. So far so good - swellings down, bones strong - and my jaw is as good as new! Thank God for seeing me through this entire ordeal - especially with the food. Since the surgery, I've shared with the people around me how much of a blessing it is to have good appetite, or even be able to swallow for that matter. They are smallest things we take for granted, but the most significant when you lose them, aren't they?

There's still quite a bit of asymmetry left in my jaws, but if you compared how I was then and now, that asymmetry is really almost nothing. During the last visit at 3 months post-op, one of the surgeons briefly proposed a second surgery to correct the asymmetry. I wasn't too keen on it then. When it was brought up formally during this review, I think I was even more disinterested in this follow up surgery. 

Honestly speaking, I can only say that I'm about 90 percent satisfied with how everything turned out (on a general basis); the last 10 percent due to the asymmetry. Being an artist myself, I feel rather peeved when I see imperfections. That being said, I'm not seeking the symmetrical perfections generated by machine, but symmetrical perfections generated by visual compositions - you know what I mean? It's definitely weird to have your face perfectly symmetrical (alien to say the least!). Seeing and knowing that it would be entirely for aesthetic's sake, coupled with the surgery cost and recovery period (your gums are going to get sliced again after all), I was reaaaaaaaallly not keen at all. (although, I MAY CONSIDER if only the cost is not from our pockets haha, but fat hope, girl). Whatever it is, after giving it serious thought, I'm not going to do the second surgery. 

On a side note, has anyone been amazed at how their post-op bite is? It's so amazing it's almost magical! I can't help wonder in shock when I nibble on a biscuit or bite through bread, and the line is clean and cut off in one bite! Even now!  *O*  So proud of my decision to do the surgery *pat pat* :DD

Day 31: Remembering me

It's one month! Yeeessssssss.

I sometimes forget how my face used to look like. I know, sounds a bit exaggerated but it's true! Recalling where my chin used to be or which direction my crossbite was, is not instantaneous. Hur.

It's funny how we get epiphanies or realisations in the unlikeliest of places. Usually in the bathroom, for me. LOL. But I really treasure those moments because time just seem to slow down a bit for you to take a step back and reflect on life.

I was showering last night when I thought of the things that I used to worry about with regards to my less-than-normal appearance. I couldn't help but chuckle at my own thoughts.

S.O.P. for Public Behaviour:

1. Avoid photographs. Unless bo bian.
2. Never walk or take photographs with your natural head posture. Try to look down slightly so your chin wouldn't look like it's protruding out, and your face less flat looking. 
3. Let the camera focus on your eyes instead. Or hair. Anything besides the asymmetry.
4. Forget about turning your head slightly to hide the facial asymmetry. You never practiced enough to get it right anyway...
5. Hope that the photographer stands on your right side whenever he/she takes a random photo showing your profile. I think it looks slightly better.. better than nothing riiiight.
6. Win people over with your character. May they always see your character first, that it outshines your odd facial features. 
7. Can you please think of how to manage that awkward moment when they comment that your face looks asymmetrical? (Well, I hope that I don't have to prepare this from now on)
8. Smile more! Don't be so conscious about your jaw misalignment; what they recognise as you, is you!
9. Be natural. Nicely.
10. Love yourself more :))

Some of the thoughts sound contradictory, I realised. Heeh. And that most of these thoughts circled around the asymmetry. I can't deny that it did affect me, but neither did it really bother me that much (except in that moment, but I would forget after). Sometimes when I slouch on a chair in public, I suddenly think: Oi, don't chin up so high, not nice la and then realise that I don't have that protruding chin so it doesn't matter anymore haha. It's such a nice feeling! :D

Occasionally, I do miss my au naturel old face, but I'm looking forward to the new! :)) And, thank God for the invention of photography! ....although that's kind of ironic, looking back.

Day 30: Depression part II

It's almost a month, my (uneven) swelling has come down a lot. My perception tells me that my right side still has about 15% left, and my left side 30%. Okay, it's enough that people don't stare.

But you know, whenever I look in the mirror, I can't help but feel a little down cast  and depressed when I know and see that my face is still rather asymmetrical. I'm not talking about the asymmetries that is known only to the ruler, but those that can be seen by the naked eye. It frustrates me having to know that I did something about it, only to see that it's still not perfect. It's like a thorn in the eye to the perfectionist within me. I hope I'm not deluding myself by saying that it's just the uneven swelling. :|

Up till now, I don't think any doctor or nurse has commented that things are going really well (I mean, aside from the would healing and swell reduction) or that I look good (not that I'm fishing for compliments, don't be mistaken). Why do I keep getting the feeling that things are not going as ideally as it should be?. Maybe I'm just being over sensitive; maybe I'm over thinking. I hope I'm just having another one of those bad days.

Well, on a chirpier note, I can open 1.5 fingers wide now! And I ate kuay chap yesterday! Accompanied by the lou neng and tau kwa. Yum :))

Day 26: Recovery status

Hello again!

Reading through my older posts last night made me really glad of my decision to blog about this whole jaw surgery saga. Memories, in time to come, will all be but distant. And as long as technology doesn't fail, I will always be able to recall these events in my life through this blog down the road.

I also realised that most of what I've been writing about are on food, and not so much on how my recovery is progressing. Heeeee :)) I guess it's because things are getting along fine, and the improvements each day are all rather far and few. But in light of not wanting to forget the minute details of my recovery, and for fellow recovery mates who might need some assurance, I shall sum up on how recovery has been the past month (as much as I can remember).

Pain & Discomfort
Week 1 - Some pain is expected the immediate few days following the surgery. However, since you'll be put under morphine, it shouldn't be so much as that it becomes too hard to handle. In fact, I actually felt more uncomfortable than pain. My discomfort level was about 8-9/10, while the pain level was about 3-4/10.

There were two things which so caused my discomfort - tightness in my jaw and pain while swallowing. Firstly, this tightness in the jaw feels as if as someone put a rigid mold of your jaw (and made it like, 2mm smaller in size) over your face. And that feeling neverrrr goes away. It was especially tight in the mornings, but I would sometimes wake up in the middle of the night because it was just so tight. In all desperation, I'd lift my chin up slightly and look up to relief it. I'm not exactly sure if it's alright to do this, hence I did it really gently. But it did provide some temporary relief.

Secondly, the pain while swallowing feels like your worst sore throat, 5 times over. From what I understand, it is caused by the tube which they inserted down your throat during the surgery, which causes some abrasion I think. Whatever it is, it brought great difficulty in swallowing anything at all during the first 3 days, to the extent where I was afraid to swallow my liquid medications, water, Ensure and soup. Every swallow was a deliberate action, and required much thought and mental preparation. I know, it totally sounds silly to a normal person, but at that time, I really thought: Thank God for the ability to swallow and eat food.

Week 2 - Pain/tightness in the jaw gradually reduced day by day and was almost all gone by the end of the week. The sore throat also began to subside and was totally gone by this week.

Week 3 to 4 - Besides the pain from being unable to eat the foods that you want, you also might experience some from sore teeth due to the rubberbands for traction purposes. Both was equally painful to me.

Nausea
I felt nausea only once on the 2nd night (I think?) in the hospital. Not sure what caused it, but I think the most probably explanation would be side effects from the morphine (though I was off it for quite some time already). Either that, or the meds.

Swelling
Week 1 - The swelling for me was over a rather unusually large area. While most patient's would only be around the lower parts of the face, mine was all the way up to the temples and eyes. Just swell. My eyelids felt like I cried a river the night before, and I literally didn't have a nose bridge.. not that it was high to start with, as with typical asian noses. The surgeon said though unusual, he wasn't worried because the swelling was soft and not hard, which meant that it was just water retention and not blood-filled. The lips were also terribly swollen and there's no way you could close your lips up. I had so much trouble spitting out the mouth gargle because of that, and I had to resort to pushing the liquid to the front of my mouth, and then blowing it out. The end result: bubbles and more bubbles out from my mouth. Way to go.

Week 2 - Swelling subsides the most noticeably during the first three weeks (I feel). At this point, my face was still mighty swollen, enough to earn stares as I walk around in public. I had those cute little chipmunk cheeks. Hurhur.

Week 3 to 4 - Swelling was quite minimal and the differences each day decreases. Towards the end of week 4, I look almost normal, save some residual swelling on my left cheek (it was an uneven swelling for me since the first day). Someone commented that it was really not obvious at all, and couldn't really tell that I went for surgery haha.

Appetite
Week 1 to 2 - Appetite was really poor these two weeks, probably due to the sore throat. In addition, I think my stomach really shrank because I didn't eat much, and even if I tried, my stomach would have (what feels like) gastric pains, whether I ate or not. Thank God that they didn't last longer than a few hours each time though. But I'd say just continue to consume your liquids slowly and work the stomach up. This didn't last beyond the first week for me. I can't stress enough to eat drink up, because if you don't, your body won't have enough fuel to fight bacteria and prevent nasty infections. It's really bad timing to get sick now.

Week 3 to 4 - Appetite starts to increase considerably and the clear soup diet just will not be satisfying enough! Though I was like, filled with liquid, but I was still craving for more food. I think it would be a good time to start introducing blends and ice cream and all that sweet stuff. There's no other time when you eat without thinking twice (and thrice!) about the calories!

Sleep
Week 1 - Sleep is very, very interrupted. Two hours straight of sleep is a gem. Partly due to the nurse constantly waking you for your medications and checking your BP, and partly because of the discomforts that makes you a really light sleeper. I sometime gave up on sleeping and just stare into space.

Week 2 - Sleeping is more continuous, though I still wake up at least once or twice in the night.

Week 3 to 4 - Sleep became my greatest enemy once again, because I couldn't wake up in the mornings. Which is good... means that I'm sleeping well.

Energy Level
Week 1 to 2 - Due to the poor appetite, you won't feel like getting out of bed much. At least I didn't. But I think it's important to try walking around to work your muscles and stamina. The more you move, the more normal you'd feel.

Week 3 to 4 - By the end of the third week, I felt almost normal. Not that I can run a marathon (no high impact activities till 6 weeks post-op ya), but I could most definitely walk around without panting like mad, like I did in week 2. I had a lot of energy to think about food, that's for sure hahaha.

Oral Hygiene
Week 1 to 3 - Don't bother with the toothbrush. Keep it sealed in the packaging and just gargle your way. Make sure you gargle diligently and meticulously with the syringe though. Don't want any infection to set in.

Week 4 - Toothbrush upgrade! But be gentle with the pressure because your gums are utterly useless in detecting any sensations. Brushing is only limited to the outer and some parts of the inner (as much as your mouth is able to open to manoeuvre the brush).

Jaw's Range of Motion
Week 1 to 2 - Can generally say that you can't open at all, because you'll be banded shut and even with just the rubberbands for traction, the muscles are still not strong enough to work against the force of the bands.

Week 3 to 4 - By the end of week 4, I could open wide enough to easily fit one finger, up till the middle joint. It takes a lot of effort and jaw exercises (which I haven't been too diligent with. heh :\ ).

Bite Deviation
From the first week when I had a peek at my teeth alignment, I already noticed that it was not center to center. Not sure if the surgeons could not fit it accurately enough during the surgery, or that my bite shifted a few days after the surgery. For my case, because there was a lot of twisting and moving of my jaws in three planes involved, I can't say much as it's really not an easy work to do, to begin with. But the following weeks after the first, I had rubberbands to pull my bite nearer to the center. I began with about 3mm off center, now it's about 1.5mm off alignment. I don't really expect it to improve much anymore actually, because I think I'm already out of the malleable window period.

I hope the summary has been of help to at least one person out there. I think your outlook on life during the recovery period plays a really big part. I mean, if surgery has already been decided, Recovery is a road inevitable. And since you're already on it, why not make it a memorable experience? For myself, I get by each day looking forward to every meal (maybe not so much at the beginning though haha) and getting all the food I always wanted to eat, but didn't (mostly because of calories LOL). Maybe you should find something to look forward to too and chirp about it!

I will probably compile a series of day-by-day photos tracking the swelling from the beginning sometime later , when I see that my swelling is almost all gone. (sorry I'm kind of sluggish about having to sieve through all the photos at every post, that's why).

Hope all is well with you all, and I'll be posting again soon! Take care!

Form Follows Function: the reason for orthognathic (jaw) surgery

In architecture, there is a common saying which goes: form follows function. And I'd say that concisely sums up my reasons for jaw surgery.

When I was younger, I didn't have this crossbite and facial asymmetry which I saw in my teens. I guess it was a deformity which developed with time. 

Hmm, deformity... That's a nasty word.

Sure. It is as nasty as it is true. Deformity is an abnormally formed part of the body (quoted from Dictionary), or jaw, in this case. And for me, it caused some functional problems, such as being unable to chew my food properly as I'm supposed to, pain in the jaw joint when I'm chewing on some tough meat or vegetable, and also having chunks of meat and vege (yes, chunks) stuck at this particular spot in between my molars because of the way the molars have grown to be and are only half or less in contact with each other.

Psychologically, the asymmetrical external also affected me to a certain extent. Don't get me wrong, I am not dissatisfied in the way God had made me, but to say that I loved the way I looked, that's not true either. I merely accepted myself the way I was, and the way I am now. I was and I am happy! I'm not one who is so super conscious about looking pretty (I believe in beauty from the heart), but you know, I'd just like to look 'normal'.

So in view of the functional problems I was having, I decided to just do it, once and for all.

Of course, that came with a lot of worries, most of them about how others' opinions. And even up till now, I'm still trying to figure how I should approach the topic. How will I explain to others on the reason for surgery? Will they accept the reason of 'for function'? What if their impression of me changes to think of me as someone who is vain, and think that this is plastic surgery?

If any of you, dear readers, are in or have been in my shoes, I know you get what I mean. And for the majority of people with normal, well-functioning jaws, I also know that it's going to be difficult for you to grasp the reason that it's for function. But really, just listen with an open mind. And be thankful for your well developed jaws!

Jaw surgery is not a small surgery. And it doesn't come cheap too (thank God for insurance). The road to recovery is an arduous journey (and that now, nearing three weeks, just seems endless!). As with every kind of surgery, despite the medical advancements, there are still risks; and one can always expect the unexpected in life. Why would I want to go through so much pain and trouble and time, with money, for beauty sake?

Being brought up in a home with every decision based on christian principles and values, you can be sure that my parents would be the first to object to this surgery if it were just for aesthetics. It took my parents time to be convinced that the physical pain I will go through (if I were to undergo the surgery) is worth a risk to take, after considering both the procedure and surgical cost. When the orthodontist first presented my parents my dental situation and to consider this invasive surgery, they immediately rejected the idea. That was when I was 17. Three years later, after many back and forths from the clinic (to the orthodontist's exasperation, oops), and much prayer, we finally went ahead with the surgery. It was a big decision, but a good one at that.

I can't deny that this surgery gives cosmetic improvements. But, this is only because form follows the function of your jaws. The initial, and final factor, for deciding on surgery is still to correct function of the bite.

For those of you who are contemplating this surgery, I urge you to truthfully and seriously ask yourself what your primary reason is. Functional or aesthetics? For me, it was functional, but it doesn't mean that this surgery can't be done solely for aesthetics. During one of the pre-op consultations, the surgeon asked me if I had any dissatisfaction with my face. I truthfully replied: "Not really. Just my bite.", to which he responded: "Wah, so simple ah?" It's true :)

If you are more focused on the aesthetic results than the functional, I think you shouldn't do it. Reason being, in surgery, it is very difficult to obtain accuracy in alignment during the moving of your jaws (the surgeons can only do their best, minor tweakings are left to the orthodontist). And in cases of moderate to severe asymmetry, post-op residual asymmetry is not ideal, but neither is it uncommon to have. Imagine if you were to enter into the surgery with aesthetics on the top of your list, only to realise that you still have some asymmetry left, you'd feel so unhappy, dissatisfied, and that for all that suffering you experienced post-op was for naught.

However, if you are considering the surgery for the right reasons, I'd say GO FOR IT! It's definitely worthwhile, and better do it when you're young because recovery will be much faster and with less chances of complications. The road to recovery is tough and you may have bouts of temporary depression, but cling on to hope and when it's all over, I think the sufferings will be all but a distant memory. I think I might forget about it actually (that's why I keep this blog!).

As of now at three weeks post-op, if my face were still to have residual asymmetries but with my bite problem solved, I wouldn't really bother having another surgery to fine tune the external aesthetic imperfections. Reason being, it's just not worth all the trouble. Unless, the maxillofacial surgeon advises otherwise. (By the way, my surgeon did clarify that he was not a plastic surgeon, but an oral and maxillofacial surgeon.)

Hope that this has been helpful to at least someone who is considering the surgery and at crossroads. You need a lot of mental preparations and family support before and after surgery, and especially so during your recovery!

Feel free to leave any queries behind and I will be most glad to have them addressed!

Phew! That was a load off my mind. I've been wanting to post this for a long time but couldn't get a clear head to write, but now I have! Thank God.

See you next time!

Day 14: Can't feel coldness?

Hello friends!

I am crossing the two week mark as I type this. Hoorah!! The journey has been long indeed, but fret not fellow mates! Light is only at the end of the tunnel, and don't lose hope that it's going to be soon!

For those who have read my previous post, I was really depressed yesterday. And thinking about it, I think it was very much a combination of many, many things that were happening at home and mentally which culminated into (a temporary?) depression. But anyway, I always believe that, to some extent, you are what you think you are. Don't keep thinking that you may be having depression, or you might really fall into one. Neither, do you go around thinking that you're immune to depression and mental breakdowns. Rather, be always aware of your emotional and psychological well being, sorting them out, making sure that you don't find yourself in that pit of poor emotional state. Many are familiar with the term YOLO. But I will use it from a biblical perspective, to say that the life we have on this earth is so short. If we don't spend every moment of it with our spiritual and mortal bodies in good health, how will it be glorifying to God and a channel of blessing unto others? Put your focus on things happier, and your outlook on life will be much brighter too!

Now back to what you're here for: the progress report of my jaw. Last night, I was just being cheeky and took a small piece of ice to suck on in my mouth. And to my (slight) horror, only my tongue could feel the temperature of the ice! The roof of my mouth was just totally ignorant of its presence. I mentioned this to Dr Wee during my review today, and he went like: "Oh, it's normal one." Okay, if you say so :'(

I'm also off all latex in my mouth today! YEY! And while Dr Wee was trying to take out the rubberbands, he commented that my mouth was very small. I just couldn't help but exclaim: "I know!!" because that's what I've been called since I was young by my aunt. Of course the small mouth wasn't very apparent from upper primary onwards when my jaws started growing misaligned. But ever since the surgery, I've noticed that trademark look from toddler photos return. It's a good thing :)

I would also like to share a recipe which I found very exciting to try: the Avocado Banana Milkshake! Of course, in the first week following the surgery, you wouldn't have the energy to do anything else other than your full time job of feeding yourself (IKR can't believe it takes 2 hours to drink 200ml of liquid). But when your appetite is better and you start craving for more food, here's a recipe good and nutritious to try!

There are countless recipes on this and I'm by no means a food expert. But here's what I've decided on the best combination of ingredients. You'll need:

• ½ avocado
• 1 banana (medium sized, about 15cm long)
• 150ml fresh cow's milk
• 50ml orange juice
• 1 tablespoon honey
• 10 cubes of ice

(Note: this makes about 600ml of smoothie)

Just plonk all those into the jar and blend away! Any more banana would make the smoothie very medicinal tasting, for some reason. So unless you're a banana fanatic, don't try it. You may prefer to add more ice/water or milk to your liking, especially if you're drinking from a small straw. It makes sucking alot less laborious. Happy blending!

Day 13: Depression finally hits

Depression finally hits me. Everything was going so well, I thought what Dr Wee said about post-surgery depression was a joke.

I can't brush my teeth. I can't eat my favourite foods. Watching my family eat pork and chicken just crushes me. Looks like I'm looking alot at the 'can nots', isn't it? WHY AM I LIKE THIS. This is really not my normal self. I don't know if it's the monthly thing making things worse for me, but I'm definitely feeling downright depressed, irritable and frustrated, for lack of better words.

D-Day.

I am feeling so excited and anxious at the same time! Can't believe that it's already tomorrow! What if I develop some complications during the surgery or the recovery period? No wait, stop it girl. Put your trust in the Lord and commit to Him everything.

Those were the thoughts that ran through my mind the night before the surgery, and even till I was in the OT. 

23 June 2014

6.30 AM - Alarm rings. I wash up like it's any other day; wake my parents up, and had a short prayer before we left the house.

7.30 AM - The car zooms out from the lot, we reach the hospital at 8.

8.30 AM - Our queue number gets called and my mom settles all the administrative matters with a trainee officer. Could see my mom getting increasingly dominant as the clock ticked.. but oh c'mon, everyone starts somewhere :) Still, I'm glad to have my mom settle all the paper work for me. I just need to plonk myself on the bed heehee!

9.15 AM - Time for the lab tests samples to be given: my pee and more blood drawn from me. Don't really know what they're testing for though hmm.

9.30 AM - The hospital porter (I didn't know they had that) brought mom and I up to the ward for more admin procedures to be done by the nurse. It was a really decent ward. No frills, plain but tastefully and warmly done. Totally my style. Mine was a 4-bedder and right next to a window. Soooo pretty :)

9.50 AM - Time to head to Dr Tan's clinic! Mom signed a indemnity form from the hospital holding herself responsible should anything happen to me outside. Our appointment was supposed to be at 10, and we really had to speedy gonzales there. 

10.05 AM - Waited for a tiny bit before being called by the clinic's nurse to go in. Saw Dr Wee and Dr Tan for the last time before the surgery. On a side note, their clinic is really nicely done. Each consultation room has a view outward towards a settlement of bungalow and terrace houses amidst rather lush foliage on a hill. A really calming view for the patient and it brings in natural light too.

10.45 AM - We leave the specialist centre and Dad, Mom and I sit at the void deck to eat breakfast. Well, excluding myself. I was just watching them eat.

12 PM - We return promptly to the hospital at 12 and I was so dying of thirst. I could feel body telling me that I was heaty and really needed water, but yet, I couldn't drink!

1.45 PM - The nurses bring my surgical gown to change into and a bed to wheel me to the OT. 

2 PM - Surgery is supposed to start, but the anesthetist is late. Dr Tan comes over to greet me with his 'hello deaaar' (rather odd, but sweet), and assure me that this was a big decision to make, but a good one at that. I had no idea why I kept tearing throughout waiting to enter into the OT. Perhaps it was the lack of familiarity in environment and I couldn't see well because I couldn't bring my glasses in. But most of all, I think I was deep down afraid of unprecedented things that could happen during the surgery. Can this be called pre-surgery depression?

2.45 PM - the anesthetist FINALLY arrives and looks at my file and asks for my weight. His speaking had this really annoying atas accent, an impression made worse by him making me wait so long >:/ I was tearing all that while :(

2.50 PM - Was wheeled into the OT and transferred myself unto the operating table. Totally went against my fantasies. I thought I was going to be lifted by brawny doctors and nurses haha! The anesthetist begins to sedate me although he was just supervising a junior staff. When she pressed the wrong spot he went: "No, not here! Hereeeee." He told me that the table had a bed warmer installed so I'd be toasty warm and i replied "Oh, cool." My head began to feel so heavy and I knew that the drug was taking effect. It was like the gravity pull on my head was 5 times heavier just on my head, and at the same time, I felt like blood was rushing away from my head. 

6.15 PM - Dr Tan called my mom to inform that the operation was successful. 

7.30 PM - Dad, mom and sis arrived at the ward to see my bloody state (as I look at the pictures my mom took). I remember continuously drifting in and out of sleep and the nurse asking how much pain I felt on a scale of 10. I signaled to her 5-6/10. That night, I woke up countless times because I couldn't breathe and kept wanting to suction all that bloody gunk out. My throat was so hoarse, partly from the tubing inserted during surgery and my continuously breathing from my mouth. I saw my mom sleep over and having to wake up each time I did, to observe the nurse help me and be on standby for any more help needed. I felt so bad that she didn't have a good posture for sleep - she was sleeping cramped up on two chairs.

Recount to be continued..