The one with the needles.

 I had my first medical appointment of the year on the 15th. I visited the Surgical Hospital for continued treatment for the correction of my occlusion. Yesterday was the postoperative appointment for my most recent outpatient surgery. There's not a lot to report, but I want to try to be more thorough. I also left this appointment with a new referral.

I am currently seeing a prosthodontist. Her name is Jenni. She's previously been in charge of my night guard, and now she has been working on my implants and raising my bite. As I've mentioned before my bite has remained open since my original jaw surgery. This isn't exactly an ideal position, so they're working to get the best occlusion possible for me.

During yesterday's appointment, Jenni noticed that I had a random gum flap growing above my implant screw.  I noticed this about a week after my surgery. We called the surgeon who performed the last procedure, and she said it was perfectly normal. I guess this particular gum flap was kind of odd because Jenni said she had never seen anything like it. With that being said, she had to anesthetize me and cut it away with a laser. I'll be honest, dental procedures still freak me out. Yes, even after all of this. However, I wasn't too worried about this tiny procedure. I've had so many needles. I've had my entire maxilla removed, repositioned, and screwed back to my skeleton.  Anything else is pretty much a piece of a cake in comparison. So here's where things get interesting.

She begins the procedure by gently inserting the anesthetic into my gum. About 2 minutes later I begin shaking all over. This shaking is all too familiar. It's like I'm suddenly freezing, but I'm not. My hand's jerk around and my legs noticeably tremble. I was wearing my Apple watch, so I quickly checked the heart monitor. My pulse quickly jumped up about 30-40 beats per minute. Jenni got pretty alarmed, and the dental nurse just watched in surprise. They suggested to call a nurse into the room, but honestly, this happened before and I just attributed it nerves. I wasn't nervous or upset, but the likely answer to this issue has been in plain sight this entire time.

Jenni suggested that I may have had a bad reaction to the anesthetic. I don't remember the brand that was used, but it contains adrenalin (like most). Adrenalin is used for a variety of reasons in medicine. I believe it is generally for serious allergic reactions, cardiac issues, and low blood pressure.  It's also a naturally occurring substance in the body ( hormone and neurotransmitter). It's used often in dentistry because it's a vasoconstrictor to local anesthetic solutions. This slows down the systemic absorption, which in turn prolongs the anesthetic effect. This also translates to cheaper and more effective.

I began to think back about how often these tremor-like episodes have occurred. She also began to ask me about the last procedure. I guess she was also trying to connect the dots.  Especially since I had severe tremors for about 3 days after my Maxilla advancement ( first jaw surgery).  She also explained they used a significant amount of local anesthetic along with general. That explains a lot. This conversation was taking place while I was having impressions taken so I couldn't speak very much. Afterwards, I explained to her that before the last procedure (outpatient surgery), I took diazepam to help relax my jaw. Therefore, I didn't have the shaking episode, but I did profusely sweat. The time before that I was under twilight sedation, so I don't believe anything significant happened. Although, I did wake up once abruptly with severe pain in my arm. Each time that I have had any significant dental work, I have been sedated, so it's difficult to really understand the if this is the cause. It seems likely.  I haven't received an appointment date yet for the Allergist, but I will update my blog once I know when I'll be going. I think this is an interesting theory. It would also be really good to know if there is some type of allergy or reaction to anesthetic because I'm quite sure I'll have more surgeries this year. Not dental, but if I'm really not interested in any other complications. This was a great catch, so kudos to her.

On another note, I'm still waiting for my appointment at the Physiatric Polyclinic at Peijas Hospital. I've been thinking about it a lot. Stressing about it mostly. I've almost been making a presentation in my head. How do I present my symptoms in a way that this doctor will not immediately dismiss me? Also here we are again, me telling this long-winded backstory. This thought alone is extremely stressful.

Will she take Dr. Kokkonen's referral at face value or will she attribute everything to Ehlers-Danlos Syndrome and send me away? The referral asks for an MRI with contrast. I hope she will at least honor this. As we know I haven't had the best track record with the public system, so fingers crossed. I'm seriously hoping that this will go well. These past few weeks have been a bit rough ( as usual). I have shoulder pain every single day. It's usually paired with facial pain, neck, headaches, sinus pain, tooth/jaw pain, hip pain, fatigue, upper GI pain, and sometimes peppered with depression. I haven't done very much in 2018. Mostly just physical therapy, a few friends have visited, and I've been trying to stay positive.

Physiotherapy on the Public Side & Kela 

My last post was so incredibly long, I'm not sure if I explained my physiotherapy situation accurately or clearly. I mentioned that I currently go to private OMT physio at Orton Hospital, and it's pretty expensive. The Neuro Polyclinic made a plan for me to continue at Orton, but in order to so, I had to apply to specialized physio through the public health scheme. I had to apply through Kela. This is Finland's Social Security system. I have had significant battles with these guys for the last few years. This situation is no different. Kela recently denied my rehabilitation plan suggesting that my symptoms and diagnosis do not match. This is infuriating. They also suggested that I go back to my local healthcare center and ask them to assist. The main issue here is that OMT or manual physiotherapy is not available in public healthcare scheme. Therefore, they cannot offer it. However, they are required by law to honor this rehabilitation plan. This means they have to assist in paying for my private physiotherapy or provide adequate physiotherapy for my condition.  In the past 7 months, I have paid around 3000 euros or more. This is truly unfair. Every Finnish citizen or permanent resident should have access to the care they need at a reasonable cost (At least by Finland's standards).  It's not like I am asking for anything that doesn't belong to me. It's more like demanding the care that I require and deserve.  My primary physician has sent my plan back tot he Neuro Polyclinic, so I am waiting to hear if they come up with some type of solution. All of this bureaucracy is insane. I can imagine many people give up. Not me. I have already gone forward with a legal complaint against Kela's decision, and I'm definitely not done. Let's see how long this takes to sort out? They have had the referral at least two weeks already.  The clock is ticking!


I'll update again very soon. Thanks so much for continuing to follow my journey!

Best wishes,

Amie

TMJD is literally a pain in the neck.

I have to say living with a skeletal/jaw defect isn't fun. Everyday is a winding road as Sheryl Crow would say. No really. Each morning I wake up with the fun surprise of sore teeth, neck soreness, headache,  eye pain, dizziness, or feeling as though I took Mayweather on in the boxing ring. I have to say I feel a lot less lucky than Pacquiao. In a way, i've looked forward to this surgery with fear and anticipation. I'm afraid of the actual (yucky) surgery part and i'm happy for the outcome. I read someone's surgery diary that explained the moment the braces came off (post surgery) they took a bite of a sandwich for the first time, and in this moment he knew this was all worth it. I can't imagine what that must feel like. Biting food with normal and symmetrical teeth. I also look forward to this one pivotal moment. I know I still have a long road to hoe. Especially since I have to continue orthodontic treatment for 3-6 months after my surgery.

Neck Pain

 In the past month I got to see a really cool picture of my neck via X-ray. The first thing I noticed was of course how weird it is to see my skull with braces. The next thing I noticed was how straight my neck was. Normally there is a small inward curvature in the neck. This is called lordosis. Since, i've started having neck problems I have lost that curve in my neck. This too can be common ( annoying but, common). I'll post a pic of how this might look compared to a normal cervical spine.

Image borrowed from: http://www.utahhealthquest.com/text-neck

I borrowed this image (first image above) from a website to show the difference between the current state of my c-spine and a normal cervical spine. I have thought about seeing a chiropractor in addition to my PT. If I do elect to visit a chiro i'll definitely share my experiences here. I also added a few pics of my Kinesiology tape form my PT. The physio really doesn't go light on the taping. Kinesiology is the scientific study of human movements. The tape is used to alleviate pain, balance muscle movements, and reduce inflammation (these are just a few of the benefits). The lower picture also helps to show my trapezius imbalance. It's still strange to think that all of these issues began with a skeletal imbalance.

Surgical Fears 

I'll just dive right in. I am quite afraid of how I will look post surgery. Although, the surgeon says the possible side effects are to become better looking (hehe), I know my face will change dramatically.  The surgeon said I will have a much fuller upper lip and basically my nose will be repositioned (rhinoplasty).  He also said to hide all of the mirrors for a few months. I have noticed subtle changes in my face since I began orthodontic treatment. I can see that my jaw has shifted. My face became extremely narrow at some point and now I noticed that my jaw is slowly widening. It's very subtle but, looking at my own face daily I can notice these changes. I suppose what I feel is normal and just like anything else they will be dispelled with education, patience, and time. In the next blog, I will cover some pre-surgical preparatory ideas!

Check out the images below of my orthodontic treatment updates!

As always- thank you for reading!

Fairly recent picture of my teeth. My midline is still off but, that will be treated after my surgery. 

Image of my bite a few months ago. 

Watching my teeth transform. These are pictures taken over the course of one year. My crossbite is very obvious in all of the pictures. 

Temporomandibular Joint Disorder (TMJ, TMD, TMJD)

I'm sure at some point in your life you have consciously or unconsciously began to grind your teeth. Some people do it for years and don't notice. Others aren't so lucky. In the past two years i've experienced a lot of negative side effects of bruxism. At some level, I think I have always been a night grinder. For years I woke up with headaches and jaw stiffness. I never really thought anything of it. After I got braces, I began to notice a huge change. My head hurt terribly every single morning, my teeth were sore and hurt, I began to have blurry vision, and random shooting pains in my scalp. I was so alarmed I had no idea what was happening. At first, I convinced myself that I was dying ( like any normal person with these experiences). Panic ensued. This in turn resulted in a lot of stress, which led to more teeth grinding. For months I didn't understand what was happening. The new braces I had put on were causing so much trouble and discomfort. Within one month I had lost 10 pounds (5 kilos) because I was unable to chew my food properly. I noticed that I got very dizzy suddenly, and my neck had started to hurt horribly. I brushed this off to issues from my lower back. Just a few months prior I had been diagnosed with a herniated lumbar disc. I began running a year prior and apparently this was the result. Today, my lower back is basically healed. As my cervical/thoracic spinal symptoms increase, I wonder more and more about how my uneven skull could have played a role in this situation.

Having random shooting pains in your head and eyes can be really scary. I found myself panicked and visiting the local Emergency room many times looking for answers.  I had all kinds of fun diagnoses. A neurologist said I had a migraine disorder (wrong). Another Dr. believed I had anxiety issues (wrong).  Then there was the herniated disc factor followed by the idea that I had rheumatoid arthritis (which was also incorrect). I got brushed off by my local health care center many times. The health care centers in Finland (where I currently reside) are organized very differently than in the United States. Which can be favorable but, if you have an odd, non-text book condition- can be very difficult.  All along the answers were laying in my malocclusion and bruxism. After talking about my symptoms with my orthodontist, doctor, and surgeon- they came to the conclusion that I had TMJD. I was told to eat only soft foods, avoid chewing hard or large meals (which is hard- hey I love cheeseburgers), and no gum. I was also advised not to talk a lot (which if you actually know me, is VERY HARD). My orthodontist sent me to a nutritionist. She was concerned about my sudden weight loss. I also began physical therapy for my jaw and neck. I'll talk about that in a different post. 

My journey with TMJD has been crazy. About 6 months ago I was having terrible ear pain. At first I thought it was just the changing and windy Finnish weather. One day I went to put in my headphones and I noticed that one side wouldn't fit and was super painful. Two days following this I began having the absolute worst pain in my jaw. It felt as though someone has sent a huge volt of lightning through my face. Half of my face was numb ( like a huge slab of meat just sitting there) and the rest of my face was constantly tingling. I went on with this for a few days. I also forgot to mention that a week before this happened I had the surgical molar bands installed onto three teeth. My jaw was quite angry about this new addition and I guess my bruxism got out of hand. 

The following week I elected to visit a private doctor (ENT specialist). He believed I had irritated one of my facial nerves and that the area was inflamed. I was put on medicine (NSAID) for two weeks and this cleared up the issues. This process has been long and arduous, and I still have one more molar band to go on June 1st. 

In the midst of this my orthodontist has tried to control my bruxism in a few ways. She hoped the PT would help. She initially got me a very large mouth guard that didn't work. It was so big and since my bite is not aligned ended up on my pillow at some point during the night. About two months ago, she ordered a new type of guard. Which I'm happy to report is working. The orthodontist ended up fitting it for my teeth ( which is still somewhat ill-fitted because of my every changing teeth and bite) but working. I would otherwise have a fitted guard ( and I will after my surgery). Unfortunately, since my teeth are still moving there is no way to fit a guard to my teeth. 

Two weeks ago I actually ended up breaking a molar tooth because of my bruxism. I took out my night guard for a few minutes and accidentally fell back asleep. This resulted in a fracture. It's crazy to think about how many things can go wrong just based on jaw alignment.

My first unsuccessful night guard 

My latest mouth guard ( you can find it here: http://www.aqualizer.com/html/faq.html) 

Once again, thanks for reading!