I have bone!

On Friday I saw Dr. D, she did X-Rays and I have bone in both the area where they did on distraction and where the bone graft was.  YEA!!!!  She already has me thinking about next steps.  She doesn't think implants are a good option, so I will need a good prostodontist to work with.

I saw Dr. F yesterday and he's not ready to start moving teeth yet, he wants to see my teeth more solidly set in the bone.  I go back in 6 weeks, which is around the 4 month mark that Dr. D had said was how long bone takes to set.

Surgery #5 Complete

Last week I went in for surgery #5, another bone graft.  Dr. D did this surgery and took bone from my right tibia.

From all accounts the surgery went well.  Dr. D told my father (not a man to be trusted with details) that the work that Dr. S had previously done had made her job easier and that the surgery had gone well. I am hopeful.  I haven't been in too much pain with this surgery, which is nice.

Here are my post-op war stories -
I wake up in recovery and I have a nurse who is an idiot and doesn't even know it.  She goes to take my warmer away, except I'm still cold.  When I warmed up she took away the warmer but left me under a stifling number of blankets, including the plastic one that connects with the warmer.  Then I get a neighbor who "can't breathe" apparently he had a chest tube and it hurt to breathe, but he was actually breathing.  For anyone who has come out of surgery - you don't really care, you just want them to shut up.  Of course there was some mix up with the PSA so it took a little longer then necessary to get working and shut him up.  Finally the nurse comes to check on me and I asked what I had to do to get away from the guy, she laughed.  I wasn't actually trying to make a joke...

3 hours goes by and I'm still in recovery.  The nurse assures me she's working on my release to post-op ambulatory, but times goes by slowly (I was in front of a clock, it goes very slowly) and now I'm starting to develop pain.  I tell the nurse this.  I know that if I get medication that I have to stay here for a while, my thinking was that if I'm going to be stuck here another hour, give me drugs, if I'm ready to go then send me on my way.  She says that as long as my pain is below a 2 I should just wait.  Who the heck said anything about the pain scale?  I decided I should take my chances and get away from her before she killed me.

In post-op ambulatory the nurses were much better, I even had a student nurse who was a complete sweetheart.  They even gave me drugs!  Then I finally got to leave and go to my parents house.

Recovery has been ok, my leg is not as sore as I expected, but I do find it's often hard to get comfortable, particularly at night when I'm trying to sleep (emphasis on the trying).  But otherwise I'm progressing ok.

Good News

Last week I saw Dr. D, she said my tissue looks great and I am set for surgery on March 8.

I also met with one of the other surgeons in the office who agreed my tissue looked great.  I think he's the one who take the bone for the bone grafts.  We discussed where he would be taking my bone from - likely the tibia of my right leg, not my hip as Dr. D had initially said.

A clipping

Appologies for my lack of posts.  I've been to see Dr. F and Dr. D, but it was right before and after taking a vacation and then with the chaos.  But here I am.

When I saw Dr. F I complained that my teeth were moving (and they hurt a lot) - he told me that was good.  It seems my teeth were moving into place, imagine that.  The pain has subsided and I'm able to eat again!

Dr. D was a more interesting visit.  On January 20th she is going to clip out the distraction device.  Small in the office procedure.  She is going to leave the part of the device that is under the gums, under the gums. 

Then in late February, early March she is going to do another bone graft in the area that was not covered by the distraction.  At that time she will remove the part of the device that is under the gums.  She said she would probably take bone from him hip - I can't wait. 

When she had initially mentioned doing the bone graft I had thought it would be a smaller procedure, but when you start talking about taking from my hip I know it's not a small procedure. 

I turned in my screw driver

Today I turned in my screwdriver, meaning I'm done moving my distractor!  It's always nice to hit a milestone.  They didn't end up moving the distractor as much as I thought they would, but it's pretty darn close and now I have so much more bone.

I don't have to see Dr. D for another 3 weeks and Dr. F for 6 weeks.  I nice break since I've been seeing them once or twice a week since the surgery.  Dr. D said she'll do another x-ray in 8 weeks to check my progress.  Until then, I feel like Madam Pomfrey in Harry Potter and trying to grow some bone - it's tough work!

I don't like this Dr.'s Appt!

Monday I went to see Dr. D and it didn't go that great.  My gum separated from one of my back molars, leaving a gap and allowing fluid to come out.

Now I'm on an antibiotic, which my body doesn't like.

Dr. D also decided to stop moving the bone for 2 days and then on Thursday she wants me to start turning the screw again, but only twice a day instead of 3 times a day.  I'll see her again on Friday.

Ugh, this is very annoying and frustrating!  But on the up side my mouth seems to be doing much better now.

Here is a photo of my mouth.  In the front you can see a large bar, that is the screw.  When my mouth is closed other then looking a bit swollen in that area you can't see the screw.  When I open my mouth obviously it's a different story.  On the left you can see my two fake teeth and then a gap.  On the right of the first gap are the 2 teeth that are being moved.  To the right of those teeth you can (hopefully) see another gap, that is how much my teeth moved in 4 days.  Above that gap you can also see some metal, that is part of the device that was put in my mouth during the surgery.  There are actually two of those ladder like pieces.  One is on the right side of where the gap is the other is on the piece of bone that is moving.

A new surgeon and a new procedure

On Monday I did meet with Dr. F.  We did discuss the option of a bone graft and distraction.  While he didn't say it in so many words, he did seem to think another bone graft would not work.

Today I met with a new surgeon from Dr. S's office, Dr. D.  She is wonderful!  My sister would even let her do surgery on her.  I walked out feeling even more convinced that distraction was the right way to go.  She would also like to have Dr. F move my middle tooth a bit before it has to come out, allowing it to pull some bone with it.

Then I can go on a cruise and enjoy myself before they put the distraction device in.

From there it will take a few weeks to move my teeth and the device will stay in my mouth for a few months while the bone behind it grows.  After that they'll see how things develop in regards to what exactly they will do.  But the bottom line is that a few months later I should be able to get implants put in.

A bunch of crappy choices

I saw Dr. S yesterday to discuss my next steps.  I was given 3 choices.
1.  Not really do anything, but have a prosthetic put in place for the missing teeth.  I didn't have 3 surgeries so I could get a prosthetic to put in my mouth.  That plan is out.

2. Have another bone graft, they'll take out my middle tooth during this surgery.  Then hope to have enough bone to do 2 implants and bridge the 3rd tooth in.

3.  Have Dental Distraction.  What the heck is that?  Well they put in an appliance and move 2 of my teeth, which will bring the bone and tissue with it.  You can read a bit more about this type of procedure here: http://www.bilodeauorthodontics.com/case6.pdf Pictures are included of the device.  I need to go meet with another surgeon in the office who specializes in this area.

When I spoke to Dr. F last time I got the impression he wasn't too kean on the Distraction.  But looking at my other options, it seems like it has the most hope.  I already had 2 bone grafts that didn't get the job done.  I should say the last bone graft did work, it just didn't fill in the complete area that needed bone.  But if I had all these issues with the first 2 grafts, I question if a 3rd graft will be the answer.

Moving my newly cleaned teeth

I saw my surgeon last week and went for a cleaning this week, just to round out the excitement, I have the orthodontist next week.

Dr. S's next plan is to move one of my teeth.  It is the tooth next to the gap in my mouth, he wants to move it forward to help close up the gums.  By moving it (using the braces), the gums  (which haven't closed up right with my last 2 surgeries) should close up better.  I can't wait, I love moving teeth!

The other thing he said is that it looks like I will lose my front tooth, he said the bone just isn't there and he thinks it's part of the reason that the gums aren't closing up right.  It doesn't sound like something they're doing for a little while.  My dentist, LF, also agreed that the tooth didn't have good bone structure and it's not in good shape internally anyway.  But LF is as always, excited about my progress.  She however was not too excited that I have been using perodex since my surgery, it's been staining my teeth and I will agree they were looking pretty gross.

A Christmas Miracle

I might be being overly dramatic, but I did have a good visit to Dr. S this week.

He said he likes the development of the bone, YEA! 

He doesn't want to touch anything in my mouth for a while, but he wants to see me in early February and then he'll take a better look at the work he needs to do on the soft tissue, basically not all of the closure closed up right, it's better then after the last surgery, but needs more work.

Also, he's still not sure about my middle tooth next to the bone graft.  I may still lose that since he's thinking it might be part of the reason for the problems in the area. 

Did I mention the bone was developing?

The Orthodontist

I hope you haven't waited too long for this...

So on Monday Dr. F put my teeth back in.  They had a tough time getting the wire back in.  My teeth narrowed in a bit since I didn't have a wire in for a month.  Dr. F put in a new wire that would help pull my teeth back out again.  I hope it works or I'm going to end up with 2 really skinny implants when this is all over.

But he told me to be careful eating since I'm not totally healed up.  I did enquire about my overdue dental cleaning, that will have to wait at least 2 months.  He did laugh at my question, which I did preface with, "I know I can't do it for a while," which was a little annoying.

I think we have some bone!

I saw Dr. S today and the bone graft is looking good.  YEA!

I do need a little work on the soft tissue, which I had figured out already.  But that will just involve some Novocain in the office.   That will be some time after Christmas.

He took out some of the loose stitches, which was nice since they area annoying, but it hurt A LOT.  I felt like he was just poking me with sharp objects.  But now I can feel the roof of my mouth much better.

Also, I can eat regular food again.  I had pot roast for dinner!

I also saw Dr. F,  but you'll have to read about that later in the week.

The good, bad and the slow to post

I saw Dr. S last week, sorry it's taken so long to post.  I keep forgetting when I'm actually at the computer to post about it.  But I'm here now!

So the good news is that I have not lost any bone.  Yea!

The bad news is that he didn't seem to like how part of my gums closed up.  And I still have a small hole into my sinuses.

We're now at the "wait and see" stage.  Oh, I thought I was already at that stage.

I am still on a "very soft" diet, which isn't so great.

I also still have a little bit of pain at times, either that or I'm addicted to tylenol and advil.

1st Doctors Visit

I had my first Doctor's visit today.  I saw an associate of Dr. S.  He didn't do too much, did make me properly brush my teeth though.  Said that things were healing appropriately.  Moved me up to mushy foods - pasta, mashed potatoes, eggs...  Originally I thought I would be much more up on my feet at this point, but I'm not.  It didn't sound like they wanted me to return to work next week like I had originally planned, so I wont be.

I see Dr. S next Monday, I suspect I will learn a lot more then.

I also saw Dr. F, who basically did nothing.  The surgeon doesn't want to have my teeth put in for another 2 weeks until the swelling goes down more.  Dr. F decided not to bother putting the wire back in until then as it's not needed.

It seems like they're taking things very conservatively at this point, which is ok.  I'm not sure if after the bone loss last time they're feeling more conservative or if there were any issues with the surgery where they are feeling a need to be more conservative.  

I will say that today I have had a bit more pain then I have had in the past few days and I'm taking the same amount and types of pain killers.

Oh, and laughing hurts, no more funny sitcoms for a few more days.

Coming along

So I'm coming along, the swelling is down to a point where I don't look grotesque (or did my sister say I looked grotesque?  Ahhh, sisters!)  Well, I don't look that bad, but am still pretty swollen.  I also have some bruising on my neck and throat, but it's light and hard to see.  My mouth still hurts too, but I'm taking mostly just Advil and the Percocet at night to help me sleep.

This morning I woke up with a gross taste in my mouth and it seemed very mucusie mixed in with a bit of dried blood.  There also seemed to be bits of something in there.  I'm hoping it's just some particles from my smoothie last night, but I'll find out more today when I see the surgeon.  But after losing the bone last time I'm a bit nervous about anything that doesn't seem 100% right.

What day is it?

Since my surgery I have been a bit oblivious to my surroundings.  At times I'm awake and aware of things, and at other times my brain is mush.

My pain has been subsiding, but my swelling is up.  My head looks like a lopsided watermelon, my lower left side is swollen and my upper right is swollen.

On my lower right I noticed today that Dr. S removed the bracket on a tooth.  I don't mind seeing it go since it was the bracket that was leaving my gums irritated, though I'm sure Dr. F will be putting it back on.

I did have some nausea last night, which was cured when I threw up after taking the anti-nausea medicine. I'm not sure that's how that is supposed to work...

Surgery #4

Disclaimer - I'm writing this slightly delirious after surgery.

Last Friday I saw Dr. S and here is what he said he was doing during this surgery.  He was going to mix Bone Morphogenic proteins with a bit of bone from my jaw and something else.  He was going to open up the gums more to allow more blood flow and healing.  He showed me some pictures of another case with a similar problem and the mouth looked great at the end.  He did think he was going to have to take my one middle tooth out and asked permission.

Monday I saw Dr. F and he took out my wire and teeth, which felt really weird.

Tuesday:  Surgery was supposed to take 2 hours, it took over 3.  The anesthesiologist was able to get me intubated through the nose using the camera.  Though Dr. S had to move my tongue, which might explain why my tongue hurt after the surgery.  He did not take out my middle tooth, he said it had enough bone around it.  My throat hurts and it hurts to talk.  My jaw hurts from where he took the bone.  My parents are driving me nuts.  My face is very swollen.

I'm on clear liquids for 3 days, then liquids for another 3 days.

Not much going on...

I haven't written lately, because there just isn't much going on.  I'm just waiting for the next surgery in November.  I did go away to England and Scotland for 2 weeks, the food wasn't great, but I was able to eat it and that made me very happy!

This week I did go to see Dr. S, but there wasn't much to report from that.  He told me to keep doing what I'm doing.  That this sometimes happens with adults and he was confident the bone stimulating proteins would help.  I did keep some of the bone, so that's good.

One other good thing is that my primary care physician has opted not to have me come into the office for a pre-surgical clearance, he feels that I'm in good health and he can clear me without seeing me.  I think since he did one back in July too helped.  So I have one less thing to do before the surgery.

Another procedure...

I went to see Dr. S yesterday.  He cleaned out the wound more, which does not hurt but feels really weird.  He said he needs to open up the wound again and put in the BMP/Bone stimulating proteins.  But this will involve going under general anesthesia so I will have it in the hospital.  He said that the recovery wont be nearly as long, just a few days.  Sounds great!  But he did say I could eat pretty much anything I wanted, he didn't recommend candy apples and other really hard foods though.

I also saw Dr. F, he put in the last tooth I was missing, which is good.  I do not see him again until the day before the procedure/surgery.  He said that this delay will delay the braces a bit but otherwise things were going well with my teeth.

good news and more bad news

Yesterday I saw one of Dr. S's colleagues.  The good news is that he said I'm fine to take my trip in September.

The bad news is that it's because it will be a while before Dr. S will be able to put in the bone stimulating proteins.  Apparently, I need to heal up before he can put thim in and this doctor indicated it would be a few months.  But what was even more interesting was that he indicated that Dr. S might need to put more bone in.  I'm not sure if this doctor was seeing more bone loss then Dr. S had initially seen, or if Dr. S was giving me the better scenario hoping that he would be able to just use the bone stimulating proteins.  Either way, time will tell how much bone I lose and how to deal with it.

I had thought the bone stimulating proteins would go in sooner, but the more I think about it Dr. S didn't give much of an indication of when they would go in.  It was Dr. F who seemed to indicate that they would use them soon.

The most frustrating part is knowing that all this will delay the whole process.  I'm not sure if it will delay the braces much since the bone is more for the implants then for the the braces.  But this would certainly delay getting the implants.