Archive | July, 2009

Old news

19 Jul

On the right sidebar, you’ll now see links to my Broken jaw recovery guide and Recovery timeline. These are intended to condense information from the blog in a way that might make the information easier to absorb. They actually went up last weekend, but I figured they’re worth a mention here.

As always, suggestions or questions are welcome in the comments (or by email).

What’s the first thing you should do after you break your jaw?

18 Jul

Start a blog, obviously. If you must insist, you can go ahead and seek medical attention first, but I do hope that you’ll consider publicly documenting your recovery.

When I first learned that my jaw would be wired shut for three weeks, I had a lot of questions about the road ahead. I wondered about things like how I would eat, how I could keep my teeth clean, and whether I’d be able to teach my classes. My oral surgeon and dentist gave me some answers, but I wanted to hear from people who had been in my position. I didn’t know anybody who had broken his or her jaw before, so I turned to the internet. Google turned up a few accounts, but these were generally either forum posts focusing on a single aspect of the recovery or summaries with only the most general information.

I started this blog because I wanted to document my recovery in a way that might be useful to others with similar injuries. I aimed to share everything that I learned and experienced through my recovery, just on the chance that it might help somebody else at a later time. Looking back, though, I didn’t do a particularly good job of it. Somehow, I neglected to take any pictures of my mouth while it was wired shut, and I wrote relatively little about food. This doesn’t necessarily mean that I’m a bad blogger and that this is a bad blog, but it’s a reflection of the fact that having a broken jaw can be overwhelming, and it’s not really possible for one person to write about everything that’s relevant to the topic.

It is also the case that people’s experiences with broken jaws will differ. Different people break their jaws in different places, recover differently, and have different daily routines that are affected in different ways. This level of diversity ensures that anyone with a broken jaw is uniquely qualified to add something to the understanding of broken jaws.

As for the practicality of starting your own blog, their are a number of sites that will run a blog for free. This blog is currently on WordPress.com. Another popular service is Google’s Blogger. These days, I’m also seeing an increasing number of blogs on tumblr, but my knowledge of that service is minimal. I honestly don’t really know how these three services stack up against each other, and I don’t think it matters much. All of them are more than sufficient for communicating information.

Finally, if you do decide to start your own blog, please send me the URL, either by leaving a comment or by email, so that I can add it to my blogroll.

Facial asymmetry

17 Jul

As I mentioned last weekend, my jaw has healed in such a way as to compromise my facial symmetry. As promised, here are some more details. Note that all of the photos here, like most photographs, are mirror images.

The asymmetry is least obvious when my mouth and lips are closed. My chin looks a little bit slanted, but my lips look fairly normal.

Closed mouth

When I open my lips but leave my teeth together, the asymmetry becomes a little bit more visible. My lips open a little bit further on the right side than the left side.

Teeth

It becomes more obvious as soon as I open my teeth. My lips open significantly further on the right side than on the left side, and my repaired teeth are  smaller than my natural teeth.

Mouth narrowly open

One of the more striking asymmetries is seen when I move my lower jaw as far as I can to the left…
Lower jaw to left
…and then to the right.
Lower jaw to right
No, I didn’t upload the wrong photo for that last one, I just can’t move my mandible visibly to the right.

Finally, here’s my wide open mouth. The picture’s a little bit deceiving because my head isn’t quite straight, but there is some serious asymmetry. My mouth opens considerably wider on the right side, and this is visible not only in my slanted chin, but the different amounts of tooth visible on the left and right side.

Wide open mouth

Unlike some of the other little remaining signs of the accident, this isn’t something I expect to go away. I’ve read much of a study (subscription required) by Edward Ellis and Gaylord Throckmorton in the Journal of Oral and Maxillofacial Surgery found that patients who had condylar mandibular fractures treated by closed methods developed shortening of the face (measured from x-rays of the facial bones). Ellis and Throckmorton found that asymmetry in patients with closed treatment tended to increase somewhat over time rather than decrease. One caveat is that their study didn’t include any patients treated by maxillomandibular fixation (MMF) as I was, but they speculate that patients whose jaws were wired might develop even more asymmetry than the ones in their study. Thus, I don’t think this asymmetry will be going away unless I should fracture the right condyle.

Fourteen week billing update

13 Jul

I haven’t received any billing-related mail in the last week, so this is something of a non-update. I don’t mind not receiving bills, of course, but this is not quite as good as learning that my insurance has paid the outstanding balances.

Recovery update

12 Jul

It’s now been fourteen weeks since my accident and a month since I had the arch bars removed. For the most part, I’ve considered my recovery a success ever since I got the arch bars out and ceased to be under the care of the oral surgeon, but that wasn’t really the end of this adventure. Some things have continued to get better, but other things aren’t completely normal. Here’s my list of things that have improved and things that haven’t.

  • My mouth is opening a little bit wider than it was four weeks ago.
    Open wide
    By my measurement that’s about five centimeters between my upper and lower front teeth. That’s a full centimeter better than my last estimate. I also do better on the three finger test.
    Three fingers in mouth
    That’s a lousy picture because it’s actually pretty hard to take good pictures of one’s own mouth with a camera in one hand while sticking one’s other hand in one’s mouth. In spite of the bad picture, it’s significantly improved from last time, and in fact, I’m able to pass the test without my top teeth even making contact with my fingers.
  • Four weeks ago, I wrote about as “tingly numbness” on the left side of my face. This has perhaps improved somewhat, but it’s definitely still there. I’m hopeful that it will eventually go away altogether because it’s similar to the sensation I had on the left side of my face after having my wisdom teeth removed. That lasted a few months but did eventually go away.
  • Four weeks ago, I also mentioned a creaking sound from my jaw. That has gone away.
  • I continue to get occasional feelings of soreness on the right side of my jaw, but I think that these feelings have become less frequent.
  • I haven’t mentioned this before, but for several weeks, I’ve been getting occasional sharp pains on my left cheek.
  • There’s a region in my left jaw which is somewhat tender. I’m guessing this is the area around the fracture.
  • As you might notice in the first photo above, my face isn’t very symmetrical. I’ll write about this more extensively in the near future, but this isn’t something I expect to improve.

Accident reconstruction

8 Jul

Since my return to the site of the accident the other day, I’ve spent a good deal of time thinking about how the locations of my various injuries might reveal some information about how I hit the ground. Unfortunately, the only conclusion I’ve come to (so far) is that something very complicated must have happened because there was evidence of contact with the ground in so many places.

Here is what I think is the complete list of body parts which showed evidence of hitting the ground:

  • Right cheek (abrasions to the right of eye and mouth, black eye)
  • Right earlobe (minor abrasion)
  • Right side of upper lip (two chipped teeth and a cut which was sutured)
  • Right side of chin (laceration was sutured)
  • Neck (very minor scratches)
  • Top of right shoulder (abrasion)
  • Left elbow (small abrasion)
  • Right elbow (large abrasion, some soreness for a few weeks after accident)
  • Back of left hand (minor abrasions just below bottom knuckles)
  • Palm of left hand (skin stripped from an area near the wrist)
  • Back of right hand (small abrasions on lowest knuckle of index finger)
  • Legs (various scratches and scrapes, none bad enough to bandage)

There were probably a number of minor scratches on my torso, but none seemed particularly significant at the time. Note that there’s no reason to believe that the left side of my face (where the mandibular fracture was) made contact with the ground. The fracture was most likely caused by the force to the right side of my face.

The one thing that seems pretty clear from the injuries is that I fell on the right side of my body. This is something I had assumed since the day of the accident, and something that seems consistent with the accident having happened while turning right. Beyond that, it’s hard to say much. It hardly seems  geometrically possible that I could have fallen in such a way that all of these body parts could have come in contact with the ground. Here are a few of the more puzzling questions:

  • How did I manage to scrape both the front and back of my left hand? I’m just baffled. I really don’t have a clue.
  • How could I have scraped the top of my shoulder against the ground? Uneven pavement might have helped. Other than that, I don’t know.
  • How did I scrape both of my elbows when falling on the right side?
  • How did I scrape my elbows and my hands, but nothing on the arms in between?

While I typed these questions, I actually thought of an explanation for how I might have gone down. Here’s my best guess. After losing control of the bike, I fell to the right, with my right shoulder and face hitting the ground but my hands remaining on the handlebars. As my body slowed down but the bike continued skidding, my hands let go of the handlebars, and with the left side of my body moving faster than the right, I sort of rolled over so that both my left and right arms hit the ground. This course of events would seem to explain the second and third of my questions, but not the first or fourth.

It’s really all quite a mystery, and I’ll probably never know what really happened.

Carrots

7 Jul

This evening (by which I mean Monday, July 6), I acquired three large carrots, weighing a full pound among them and ate them. My jaw handled them just fine, but I was concerned about my repaired front teeth, so tried to bite with my side teeth. This was somewhat challenging because it was hard to open my mouth wide enough to fit the thicker parts of the carrots into the side of my mouth. However, I did eventually succeed in eating all three carrots, allowing me to answer in the affirmative the question of whether it is possible for me to eat so many carrots as to make me feel sick. Fortunately, I’m feeling better already, though.

One of the three carrots I ate, in my hand (which I did not eat).

One of the three carrots I ate, in my hand (which I did not eat).

Thirteen week billing update

5 Jul

I’ve seen a little bit of action on the billing front this week.

  • When I posted my last update, I had just emailed my second insurance information to Berkeley Emergency Medical Group and Bay Imaging Consultants. The next morning, I received an email from Bay Imaging Consultants informing me that they had billed the second insurance. I have still heard nothing from Berkeley Emergency Medical Group.
  • I received a bill from Alta Bates Summit Medical Center for my treatment. The total amount was $1,944.10, but insurance adjustments decreased that by $505.45 and insurance payments knocked off an additional $1,413.65, leaving me to pay only $25. I plan on paying  this amount by credit card in a few weeks so that it will go on my August statement rather than July. I have the money in my account, but I might as well earn interest on it for another month.I also requested an itemized bill from Alta Bates by phone, and this arrived on Friday. I haven’t found it very helpful, though. It does have a charge of $16.72 for “ORAL/IBUPROFEN 600MG T”, which I’m not sure I received. It’s possible that it’s something they had me take some in the hospital (but sixteen dollars worth?), but I definitely didn’t take a bottle home with me. The doctor actually gave me a prescription for ibuprofen, but the pharmacist told me to just buy it over the counter. I don’t plan on looking into this because I don’t think it would affect the amount I pay after insurance.

    Incidentally, neither the original bill nor the itemized bill tells me which insurance paid, but I think it’s my father’s insurance because I did tell Alta Bates that his insurance was primary.

The accident revisited

4 Jul

I have to begin with a confession. When I wrote about my accident, I wasn’t entirely sure that everything I was saying was true. I didn’t say anything that I knew to be false, but I didn’t remember all of the details of how I had fallen. When I had no information about something, I didn’t say anything, but there were a couple of statements I made that were guesses based on what I did remember and what seemed to be the best information at the time.

For example, I wrote that I had been taking the downhill stretches faster than I was accustomed, and claimed that this was the cause of my accident. It’s true that I had taken some downhill stretches faster than I would have when riding alone, but I never had any specific recollection of going fast down the particular hill where the accident took place. When I stated that I had been going faster at the time of the accident, I was extrapolating based on what I did remember in a way that seemed to explain why I had fallen. Similarly, when I said that my bike crossed over the center line in the road, I didn’t have any specific recollection of that having happened at that particular turn. I had some recollection of it having happened somewhere, and it seemed reasonable to conclude that it was the place where I had crashed.

Anyway, I needed to make that confession because I revisited the scene of the accident this morning, and what I saw there led me to question both of the claims discussed in the preceding paragraph.

As I approached the turn where the accident took place, I could see that there were plenty of signs warning of a difficult turn. First was  something painted on the street by a well-meaning amateur.

SLOW!

Then there were the road signs as I approached the turns.

Right Turn, 15MPH
I’ve always been a careful cyclist, so this signage came as a surprise to me. I just couldn’t believe that I’d ignored it. The fact that I didn’t remember it being there  might suggest that I wasn’t paying close enough attention, but I also could easily have forgotten in my post-accident shock. (It also occurred to me that when the EMT asked how fast I had been going and eventually got me to agree that I had been going 20 to 30 miles per hour, I had admitted to breaking the speed limit.)

When I got to the actual turn, there were even more warnings.

Yellow Light, Right Arrow

I stopped at the corner to reflect on things and examine the scene for a while. Obviously, with the accident having happened 90 days earlier, there were no visible traces of my accident. However, one patch of pavement did catch my attention.

Cracked pavement

With the shade and an unfavorable angle, the photo doesn’t adequately display the magnitude of the hazard that this presents to bicyclists. In particular, it’s hard to see in the picture how deep some of the ridges were. Here’s another shot, which still doesn’t really do it justice, but it provides a little bit more information.

Another view of the cracked pavement

Also, the hill that preceded this turn actually did seem pretty steep, contrary to what I had thought when I looked at it on Google Street View.

Somewhat steep hill

In the hours since my return to the site, I’ve become increasingly convinced that the condition of the pavement played some role in my accident. The evidence is far from conclusive, but my biggest objection to that theory was easily resolved. This objection was that the cracked pavement was only found on the side where I was supposed to be riding, and I remembered crossing over the center line. As I mentioned previously, though, that memory of crossing the line may not be from this particular spot. Moreover, even if it is from that spot, it’s possible that I lost control on the broken pavement and then crossed over the line and fell.

I’ve spent a good amount of time examining my injuries and the scratches that the bike acquired in the accident, trying to figure out exactly how I fell and whether that might convey any information about the quality of the pavement I was on. The main way that such information might arise is if the bike were scratched in places that wouldn’t touch smooth pavement when I fell on it, but might have been able to touch pavement that was sufficiently uneven. Indeed, there are some scratches in places that seem like they shouldn’t have made contact with the road, but it’s not clear to me that the scratches could have come from falling on the ridged pavement either. The only other possibility seems to be that these scratches predated the accident (but I didn’t notice them until afterwards) or that they were acquired while the bike was at the fire station.

Since the morning, I’ve also had flashbacks of falling from my bike towards badly cracked pavement. I suspect that this isn’t an actual memory but something that my mind has fabricated to support my new theory of the cause of the accident.

Of course, all of this speculation on what happened that day has only minimal practical value. Determining the cause of the accident isn’t going to change the fact that it happened. Nor would it change the fact that the worst effects of the accident have, by all indications, passed. The only possible benefit from knowing why I fell would seem to be liability purposes, and not only does it seem unlikely that I’d be able to build a strong enough case, but I have no interest in pursuing litigation against a city that is broke when my insurance companies seem to have picked up most of the tab for my bills. I’d much rather see money go to fixing road hazards, which is why I reported this spot on the East Bay Bicycle Coalition’s hazard reporting site. Much to their credit, Oakland’s Public Works Agency apparently does a good job of fixing hazards quickly after they are reported, according to an article in the East Bay Express.

Apples

4 Jul

When the oral surgeon took my arch bars out, he told me that I’d be able to resume eating the hardest foods “some time around the fourth of July.” Obviously that was an approximate date, but it seemed as good a day as any, so yesterday I acquired a bag of eight Royal Gala apples. Originally, I was planning on saving them for breakfast, but I got hungry around midnight, so I ate one at about 12:05AM and another a few minutes later. I had another one for breakfast, and just finished another one a few minutes ago. So far, I haven’t had serious problems with my jaw, although with the first couple there was some pain on the right side (opposite the fracture). My repaired teeth also seem to have handled it fine.

In other news, I took a ride back to the scene of my accident this morning. I’ll write about my visit as soon as I can, but there’s actually quite a bit to say about it, so the post might not make it up for a day or two.

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