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.
One week check-in
15 AprToday 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.
Surgery
8 AprI 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.
Monday doctor visits
6 AprI 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.
Shock and Jaw 