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Mandible liberation

29 Apr

I don’t think I’ve ever been as excited to go to a dentist as I was today. As I walked there, I started to feel nervous, though.  What if I were to open my mouth for the first time in three weeks and hear my jaw break again? I tried my best to forget about this thought.

When I got to the oral surgeon’s office, the receptionist recognized me and was ready with a waiver for me to sign for the procedure. I signed the waiver, which warned me about a number of things, many of which should have been irrelevant to this procedure (i.e. dry socket). A woman whom I hadn’t seen in the office before took me back to a room with a dentist’s chair and asked if I had any questions. I asked what my diet should be like with the wire off, and she said I should stick to soft foods, which didn’t surprise me. She had me sit down in the chair and asked if I wanted nitrous oxide. I asked if I needed it, and she said the surgeon would need to numb me for the procedure.

Just then, the surgeon walked in through the door, and said, “No, I don’t. She’s lying.” He explained to her that he was only taking off the wires fastening my jaw shut, and not the “arch bars”, which I gathered were the braces on my upper and lower jaws. He assured me that the procedure would be painless, and he wouldn’t even have to touch my gums. He went on to add, “You know what is going to hurt? When you try to open your mouth.” He explained that this was because I hadn’t used the muscles in my jaws for three weeks, and he compared it to the pain of getting up off the couch after sitting there without moving for three weeks. I didn’t tell him this, but I felt that the analogy was a failure because I had never sat on the couch for that long. He did, at least, tell me that it would get better relatively quickly, and I wouldn’t need to do any jaw exercises.

In any case, he looked into my mouth, and told me he was impressed  by how clean it was. “Hygiene is important,” he said, “It plays a big role in how you feel about yourself.” My self esteem has never been tied to my oral hygiene, but perhaps that’s because I don’t have a degree in dentistry. He then cut off the wires, and told me, “You’re a free man.” I started to get up out of the chair, but then he said, “You can open your mouth,” and I realized what he had meant. So I opened my mouth nice and wide, and somehow it didn’t hurt. Then I opened it a little bit wider and it hurt quite a bit, so I closed it again. I opened my mouth again, this time stopping before I felt any pain, and then slowly closed my mouth again. On the left side, my teeth felt soft against each other, but I hoped that this was just because I was unaccustomed to my top and bottom teeth moving relative to each other.

The oral surgeon explained that my bones will be considered to have healed in three weeks, and for the intervening time, I’ll have rubber bands in my mouth. As for eating, I’m not allowed to chew; the rule is that if I can slurp it, I can eat it. He warned me against Wonderbread (in which I have no interest, even not knowing whether it’s vegan) with peanut butter and jelly because that requires chewing. He listed a number of foods I can eat, including refried beans and rice, pasta, and mashed potatoes. I’m skeptical of his claim that pasta and rice can be eaten without chewing (unless blended), but I should be able to find enough to eat without his suggestions. After three weeks, I’ll be able eat some foods that require chewing, but apples will still be too hard. I’m also free to have my dentist repair my chipped teeth now.

The oral surgeon had his assistant give me toothpaste and a children’s toothbrush and instructed me to brush my teeth and my tongue while he went and did something else. The toothpaste, of course, was the non-vegan Crest, but I used it because I didn’t have my own toothpaste with me. I brushed the outsides of my teeth as I have been doing for the last few weeks, but when it came time to brush my tongue and the insides and tops of my teeth, I realized that I wasn’t able to open my mouth enough for the toothbrush (even being a children’s size) to fit through. I ended up having to settle for cleaning those parts of my mouth by rinsing. I might be a free man, but only in the sense that somebody who gets out of prison and put on house arrest is free. I’m more free than in the immediate past, but I’ve had better.

After I had cleaned my mouth, the surgeon showed me how to hook rubber bands onto the braces, which he explained were to make sure my teeth are “in the right ZIP code.” I can take the rubber bands out, but only when eating or brushing my teeth.

He told me I should come back to check in with him in two weeks. He isn’t planning on doing anything except taking a look at my mouth then, but he said that he’d have to wire it shut again if my teeth were in the wrong place. I was relieved to hear that he’s only had to do that once, but it didn’t occur to me at the time to ask how many patients he’s treated with this kind of injury.

After a quick stop at the front desk to schedule my appointment, I was on my way back to my office.

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A challenge

17 Apr

I’ve found my oral surgeon’s assurance, “You’re going to lose some weight” replaying over and over in my head over the last couple of days. I’m not exactly sure why. I wasn’t particularly disturbed by the idea of losing a few pounds. It may well have just been his level of confidence in his prediction that made it stuck with me like this. It also reminds of the nurse last week saying that I’m “already such a little guy” (which did bother me). By now I’ve come to see these remarks as the basis for a challenge to avoid losing weight while I’m wired. I haven’t weighed myself since two weeks before the accident, but I’ll aim for the most recent measurement I have: 155 pounds. As a rule, I’ll try to refrain from doing anything particularly stupid, like consuming to the point of feeling sick or drinking vegetable oil from a cup.

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One week check-in

15 Apr

Today marks one week since my mouth has been wired shut, and I commemorated the occasion by returning to the oral surgeon’s office for a check-in appointment. The oral surgeon looked in my mouth briefly and was impressed by how clean it was. He then started talking about eating. He told me that it was only two weeks before I could eat again, but added, “You are going to lose some weight.” He asked if I had been using anything like Ensure or Carnation Instant Breakfast. I told him that I hadn’t, although I didn’t tell him that I was vegan. I wasn’t particularly worried, because thanks to UPS online tracking, I knew that my supply of Vega had been delivered to my door while I was in the office.

I’ll be returning to the oral surgeon in two weeks to get the wires removed.

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A drug-free me

11 Apr

Yesterday, I struggled mightily to stay awake in my classes. At first I thought this was just because I stayed up late Thursday night, but then I began to wonder if Vicodin, which I had been taking twice daily, might have been playing some role. When I was in the office, I thought that the only side effect on the label was dizziness, but it occurred to me that it might actually have been drowsiness, and I had misremembered or misread.

When I got home, I checked the label of my container of Vicodin, and sure enough, it warned that the drug may cause drowsiness. I wasn’t experiencing much pain, so I decided I’d try to stop taking it.

I haven’t taken Vicodin since yesterday morning, and so far everything is going well. I don’t feel tired, but that may well be because I slept better last night. The most noticeable difference when I woke up this morning, though, was that I was able to talk reasonably well. My speech is still far from normal, I think that most people would find me comprehensible. I do struggle with certain sounds. For example, I can’t pronounce the “th” sound, so I have to use the “d” sound as young children sometimes do.

For the first time, I feel genuinely hopeful that I’ll be able to teach my classes next week.

In all fairness, I don’t know if my ability to talk has anything to do with my newly drug-free status. It may well be that it’s just a consequence of my mouth being a little bit less swollen. However, I do think it’s very much plausible that a narcotic like Vicodin would make it harder to exercise the relatively precise control required to speak clearly.

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Stitch removal

10 Apr

After my morning classes, I went to University Health Services to get the stitches removed from my lip and my chin. After waiting in the lobby for a short while, I was seen by the triage nurse, who I’ve learned is responsible for prioritizing patients based on the severity of their conditions. The triage nurse today was actually the same nurse who had bandaged my wounds on Monday, so she was somewhat familiar with my story. On Monday, though, I had been able to talk reasonably well, but today it’s very hard for me to convey information to other people, so I was relieved at not having to repeat my whole story.

I was kind of annoyed when the triage nurse asked how I was going to get enough food with my mouth wired shut and then added “You’re already such a little guy.”  I’m about 6′ 1″ tall, and I weighed 155 pounds when I stepped on a scale during spring break. I certainly don’t consider myself to be big, but this was the first time in a long time that anybody described me to my face as “little.” I could afford to lose ten pounds before I’d be classified as underweight. The remark seemed particularly inappropriate coming from somebody who was supposed to be giving me a medical evaluation. I mean, if I had stepped on a scale, then it might be appropriate to bring up my weight, but I think it’s reasonable for me to expect the nurse not to make uninformed comments on health-related issues. I know she meant well, but it still seems inappropriate to me.

After the triage nurse, I was seen by a doctor and a nurse. I was amused that the doctor who looked at me asked if my bicycle was damaged. I did my best to tell him that it wasn’t even scratched, although I haven’t cared enough to look at it. The nurse took out the stitches. She had a fair amount of trouble with this because the thread on my chin was the same color as my facial hair, which I’ve been unable to shave since the accident.

I went into UHS hoping to ask somebody whether I should be concerned about the pain I’ve been experiencing in my left ear. I think it’s probably just swelling around the site of the fracture, but I wanted to check. Unfortunately, I wasn’t able to communicate this question to anybody. Looking back on the visit, it seems like somebody should have recognized the obvious difficulty I was having in communicating and offered me a pen and paper to write down my answers. On the other hand, perhaps I should have brought my own pen and paper.

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The newly wired life

8 Apr

My mouth has started to feel sore, but I’m not too worried because my mouth used to feel this way all the time when I had orthodontic braces and went in to have them adjusted. My tongue is adjusting to having wires on the bottom of my mouth. I don’t really understand how this is possible, but I haven’t been able to find any wires on the top of my mouth.

The oral surgeon called this evening to check in with me, which was nice. He was able to understand me, which I found impressive (he said he had plenty of practice). He repeated some things which he had apparently told me earlier when I wasn’t alert enough to remember them. He told me that the procedure went well and that he was able to get the bone exactly where he wanted it. He also talked to me about the Zip-N-Squeeze bags he gave me for taking in purees and liquids. I actually haven’t tried to use them yet; I’ve just been drinking through a straw.

One consequence of having my jaw wired is that I now have to crush my Vicodin tablets before I take them. This certainly isn’t a difficult task, but I’ve found that whatever I take it with tastes very bad.

There is some good news, which is that I can now tilt my head back without any pain.

Surgery

8 Apr

I actually managed to sleep pretty well last night, which these days means five hours without interruption. It may be because I was exhausted from not sleeping well since the accident, or it may be that I started taking Vicodin to ease the pain.

When I awoke, the swelling in my face seemed to have subsided a little bit, but I was skeptical that the improvement was enough so that the surgeon would be able to work on me. Shortly after I had finished changing the dressings on my wounds (a rather laborious process due to the large number of abrasions), my ride arrived, and it was time for me to leave for the surgeon’s office.

When I got into the surgeon’s office, a man whose position I don’t know (but he certainly wasn’t the surgeon) had me confirm that I was on an empty stomach. He then seated me in a chair, put a mask over my face, and put me on laughing gas. I had never been on laughing gas before, and I didn’t find this pleasant in the slightest. This was partly because it gave me a sharp pain in the top of the head. Furthermore, the man tried to make small talk with me while I was on laughing gas, and I found it more painful to talk while on laughing gas than usual. I suspected that this was because I had adapted my jaw motions to minimize pain since the accident, but that the laughing gas didn’t allow me this level of control. I’m not much of a small talker to begin with, so I was thoroughly annoyed with this man, and I considered responding to him with a string of expletives. I thought that I could get away with it because I was under the influence of the laughing gas, but my better judgment prevailed. The man eventually realized that I had stopped answering his questions and saw the pained look on my face, and he shut off the laughing gas. As he did so, the surgeon walked in, and told him to put an IV in my arm.

The next thing I remember, I had woken up with my mouth wired shut and the surgeon was telling me that he hadn’t quite been able to get my bone to stay in place without wiring my jaw. He told me he wanted me to come back so he could look at my mouth in a week, and one of the receptionists asked me if 1:15 next Wednesday would work. I knew that I had class at that time, but I didn’t think I’d be able to communicate this fact, so I just agreed to come back then.

My friend drove me home, and I was actually alert and comprehensible enough to direct him to my house by a different route than the one that we had come by. He saw me into my apartment and left me with a container of oatmeal that he didn’t want and that I hoped to be able to drink through a straw if I prepared it right. My friend left, and I went to bed.

Just short of two hours later, I was awoken by my cell phone. It was somebody calling from the oral surgeon’s office, needing to know my father’s date of birth for insurance purposes. I did my best to answer the question, but she became frustrated when she couldn’t understand me at first. I did eventually get the answer across, but it strikes me as terrible judgment to have called in the first place given the circumstances. She should have known that I was recovering from anesthesia, that there was a good chance that I’d be resting, and that my jaw was wired shut. If she really wanted to know the answer, she could have contacted my parents (whose information I had provided for insurance reasons) instead; they would have been happy to answer and easier to understand.

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An insurance form

6 Apr

This afternoon, I completed an insurance form for the cycling club. I don’t really understand what it’s for. I don’t see why there would be an insurance policy that would pay anybody other than me (the club didn’t incur any costs from the accident), but I’ve already signed a waiver freeing the club from any liability.

The form wasn’t particularly remarkable except for two things. First, it had checkboxes for 21 body parts, and I was to indicate which had been injured. I ended up checking just under half of them (10). However, most of the injuries were very minor, such as light scratches on the front of my neck and my right ear. The second thing was that I was asked to indicate whether my injuries were minor or serious, and I wasn’t sure what the answer was. While a broken jaw certainly isn’t fun, plenty of people recover from it, and relatively quickly. I assumed that there was some serious legal definition of “serious injury,” and I looked around and found that I was right, at least in the State of New York.  A Google search turned up a page on the New York serious injury threshold:

“Serious injury” means a personal injury which results in death; dismemberment; significant disfigurement; a fracture; loss of a fetus; permanent loss of use of a body organ, member, function or system; permanent consequential limitation of use of a body organ or member; significant limitation of use of a body function or system, or a medically determined injury or impairment of a non permanent nature which prevents the injured person from performing substantially all of the material acts which constitute such person’s usual and customary daily activities for not less that ninety days during the one hundred eighty days immediately following the occurrence of the injury or impairment.

I’m nowhere near New York, and neither is the insurer, but this was good enough for me. While most of that wouldn’t describe any of my injuries, I definitely have a fracture.

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Monday doctor visits

6 Apr

I called the oral surgeon’s office as soon as they opened at 8AM. They were able to make an 11AM appointment for me, but they told me that  I should get a referral from University Health Services (UHS) so that my student health insurance plan would cover treatment. I called UHS, and they told me that I should come to urgent care to get my authorization.

I very much resented being required to get this authorization. It seemed ridiculous that they couldn’t just trust the emergency room doctor’s word that I needed to see an oral surgeon. I spent the better part of an hour waiting at UHS before seeing a nurse and then a doctor. The nurse took my temperature and my blood pressure (both were normal) and asked me a few questions about my accident and the injuries. She showed me a piece of paper with faces showing various levels of discomfort and had me rate my pain according to the numbers labeling the faces. However, there were two sets of labels, one from 1-10, and one from 0-5. I didn’t ask which one she wanted me to use, but I said my pain was about a 2. For the most part, my injuries have been a bit uncomfortable, but not particularly painful.  The doctor looked at my various injuries and had another nurse bandage my scrapes. This actually made me rather glad to have come in because I had so many scrapes and not enough energy to bandage all of them. The nurse also gave me material for dressing my wounds for the next five days before I go back to get my stitches removed. I left with a bill of $15.60 not covered by insurance. Most of that was for the bandages the nurse had given me, which were $55 before insurance  (and $11 after).

About an hour after getting out of UHS, I had my appointment with the oral surgeon. He seemed nice and friendly without being intrusive (and, as a somewhat shy individual, I’ve found a lot of medical professionals to be intrusive). He showed me my x-rays, and explained my fracture, a condyle mandibular fracture. I was mildly disgusted when he told me that the model skull on which he was pointing out the condyle, a thin part of the mandible near the joint, was a real human skull, and I became altogether horrified when he removed the jaw from the skull and asked me to hold it.  He told me that the condyle fracture was a common type of fracture, which usually was treated without open surgery. The usual treatment was to anesthetize the patient, prod the bone back into place, and wire the jaw shut for a few weeks. In a small proportion of cases, however, this doesn’t work, so an open surgery is necessary. He added that there was a small number of cases in which it isn’t necessary to wire the jaw shut; sometimes the bone will stay in place well enough that  it is sufficient to keep the patient on a liquid diet. He didn’t specify any time frame for the liquid diet, so I asked if this liquid diet would be for the rest of the patient’s life. “No, just a few weeks.” he answered, laughing.

In my case, the surgeon said, it will be necessary to wait a few days until my face is less swollen to do anything. He wasn’t sure whether it will be necessary to wire my jaw, and he won’t know until he has me asleep in the office. He told me he would have his receptionist call me in the afternoon to set up an appointment.

The oral surgeon also expressed concern about my two chipped front teeth. I told him that I was planning on having them fixed, but I thought that the broken jaw was a more pressing concern. He agreed, but said that I should have a dentist put a temporary seal on it. He said that since I had only  lived in the area for seven months, he couldn’t imagine that I would have had any reason to find a dentist by now. I was more than a little bit amused by this, having long been told that I should have a dentist clean my teeth every six months. I said, that I had, in fact, found a dentist, and I told him who it was. The oral surgeon told me that my dentist was a great dentist, and then made an appointment with the dentist for me that afternoon.

I also asked the oral surgeon if he had any suggestions for keeping my mouth clean if my mouth were wired shut. He suggested getting a children’s toothbrush and Sensodyne toothpaste. I wasn’t crazy about the Sensodyne suggestion, but I decided to get a children’s toothbrush to use with my usual Tom’s of Maine toothpaste.

I had plenty of time to get to the dentist’s office, but somehow I still ended up running to catch the bus to get there. This certainly wasn’t a good thing for me to be doing with broken jaw, but I didn’t fall, and I did catch the bus. When I got to the dentist’s office, he put a seal on one of the teeth, which he said almost had a nerve exposed. He said that both of the teeth were only chipped in the outermost layers, and he expects that they will be fixable. However, we’ll have to watch them carefully, and they may end up needing root canal work.

I repeated the question about keeping my teeth clean to the dentist, and he suggested a Water Pik, so I added that to my shopping list, too.

About twenty minutes after I got out of the dentist’s office, I got a call from the receptionist at the oral surgeon’s office. She told me that the next two appointments available were Wednesday of this week and Tuesday of next week. She added that she’d have to check with the surgeon to see if Wednesday would be too soon and call me back later. She also told me I’d need a friend to drive me home from the procedure, so I headed into the office to find somebody who could do that for me.

I was relieved to learn when the receptionist called me back a couple of hours later that the surgeon will be able to do the procedure on Wednesday. Although I’m not in pain most of the time, there are enough positions that are quite painful, that I’d really like to get it done as soon as possible. After scheduling the appointment, the surgeon transferred me to another member of the office staff, who told me that their office didn’t contract with either of my health insurers, and she told me the cost of the service, which was just under $3700. I knew that my insurance would cover some of the costs, even if it was out of network, but I wondered why I was referred to an out-of-network doctor in the first place. I know I’ll be able to afford whatever it costs, but of course I’d rather pay for as little as possible.

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The hospital

5 Apr

Upon arriving at the hospital, I found myself waiting in the hallway for an room. A man–whose position was not made known to me–asked me a number of questions about the accident. He also asked about my medical history. He asked if I’d ever had surgery, and I said I’d only had wisdom teeth removed, which he translated as a “no”. Somebody cut my shirt off of me, an act which rather annoyed me because I felt very much capable of removing my shirt myself, and I resented the loss of the shirt.

Eventually, they did find a room with space for me, and they proceeded to move me into the room and ignore me for a while. I found myself periodically whimpering, half because of the discomfort in my jaw and half because I thought it might make somebody pay attention to me. Lying on the bed, I had some time to examine my wounds–at least those which I could see. Both of my hands were bleeding: my right hand on the back side, and my left hand on both the front and back. I had scraped my right shoulder and both of my elbows, and it seemed like there was some blood on my face, but I couldn’t see my face. I also noticed that my top and bottom teeth weren’t lining up normally.

A doctor came in and introduced myself. He looked at my wounds briefly, and seemed particularly interested in my bleeding hands. He suggested, “Maybe you should wear gloves next time.” I half expected him to look at my bleeding right shoulder and suggest that I also wear a shirt next time, too.

The first person to see me for any significant amount of time was an x-ray technician (or whatever the person who takes the x-rays is called). He complained repeatedly that the doctor should have just requested a CT scan of my head because he wanted so many different angles. He did, at least, assure me that I was a good patient, although I don’t have any idea why he thought this to be the case. There was also apparently some problem with the equipment, and so some of the shots had to be retaken several times. I heard the technician talking to somebody else in the room where he controlled the x-ray machine, and it sounded like he was saying that something was far out of place. I didn’t know what he was talking about, but I suspected it had to do with my x-rays. The technician came back into the room and told me he just needed one more x-ray. He told me to lean my head back for the shot, but I found it too painful to my jaw to lean that far back, so he found an alternative position.

When I returned to the bed and waited to be seen by the doctor, it occurred to me that I had been carrying my iPod Touch on my bike at the time of the accident. This was only significant in that it could be confused for a phone. I found the bag of my possessions near the foot of my bed, and–sure enough–the iPod was in my shoe, and my phone was nowhere to be found. I knew that I’d get my phone back whenever I got my bike back, but I didn’t know when that would be. I figured I could probably take a bus down to the fire station to pick up the bike, but I didn’t know how long it would be before I’d feel up for the trip.

Eventually, the doctor came back and asked me how I was doing. It seemed like a strange question, given that the answer should have been apparent from my very presence in the emergency room (not to mention my appearance). I tried to be optimistic, answering, “Pretty well given the circumstances.” He answered, almost as if he was trying to undercut my optimism, “Well…you broke your jaw.” He told me that I’d have to see an oral surgeon as soon as possible during the week so that the surgeon could “fix [me] up.” He then explained to me how hitting the right side of my head had caused a fracture on the left side. He also started to tell me about “the other way to break your jaw”, which apparently involved hitting the front of one’s chin. When he finished explaining, I told him, “I guess I’ll have to try that another time,” attempting to sarcastically allude to my lack of interest in another way to break my jaw. He didn’t seem to appreciate my morbid sense of humor, answering, “No, I think once is enough.” He didn’t tell me how the oral surgeon would be fixing me up, but he said that I’d need to be on a liquid diet at least until I saw the oral surgeon. I couldn’t imagine chewing with my jaw feeling the way it was, so I wasn’t at all bothered by this restriction.

The doctor and a nurse then proceeded to clean off my various wounds. In addition to the ones I had seen, there was a cut on my upper lip, a cut on my chin, and a few abrasions on the right side of my face. The chin, I was told, needed to be stitched. As the nurse and doctor cleaned and stitched me, my thoughts turned to my teaching job.  After a subpar fall semester, I’ve put a lot of work into teaching this semester, and I was concerned that I might not be able to finish the job with the broken jaw.

After my chin was stitched, the doctor raised the question of whether my lip needed to be sutured. I felt my lip with my tongue, and it felt as though something might have been stuck in the cut. I wondered if it might have been the fragments of my chipped teeth. The nurse and doctor proceeded to examine the cut, and sure enough, I heard the doctor comment that it looked like there was something in the cut before the nurse exclaimed, “It’s his tooth! His tooth shattered in his lip.” She seemed genuinely excited, as though she had never seen a case like this before. Within a few minutes, the fragments of the tooth were cleaned out, and the lip was sutured. The nurse mentioned that I was almost ready to go home, before leaving me to call my mother, who had called while the doctor was stitching my chin, on a hospital phone.

A short while later, a nurse told me I could leave as soon as I had clothing. Fortunately, my shorts weren’t damaged, but I’d need a shirt to replace the one that was cut off of my back. They found a black shirt for me, although I don’t know where it came from. A nurse gave me several sheets of paper with information about my injuries, a prescription for Vicodin, and a note that I should take three days off from school. I was more than a little bit surprised that they were releasing me without even bandaging any of my wounds, but I was glad to get out of the hospital and into the taxi that would take me home.

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