Two weeks ago I saw my orthognathic surgeon for a 6-month (actually 7-month) check on my recovery progress. We are both thankful he wanted to see me then, instead of waiting for a 1-year checkup. Within moments of feeling my maxilla, he told me we’ll have to do another surgery. The healing process is not going properly, and it requires surgical intervention. We scheduled the surgery for this Wednesday, April 12, 2017.
As you may recall, the outcome we were expecting/hoping for after the August 17, 2016 surgery was the “bony union” in my healing. What he believes he is seeing is “fibrous non-union of maxilla”. Another way of describing this is to say that my hard palate and upper teeth can move independently of the rest of my bony skull, because the cuts have not healed properly. So, for example, if I’m chewing on something, my hard palate flexes according to the pressure I put on it.
The fact is, I’ve been aware of this phenomenon for months; it’s been continuous throughout my recovery. I did not know that it was not a normal part of the recovery. It had been gradually lessening, I thought, though my orthodontist had recently been concerned that it seemed more, not less, flexible.
I wish that I had known this was something important to report to my surgeon. (He wishes it, too – while not blaming me for not reporting it.) This does connect to what I feel is a larger issue in American health care: the disconnect in communication between health care providers and their patients. I hasten to point out that my surgeon has gone out of his way to communicate with me; he’s called me at home several times for really valuable conversations, and has been entirely open to my questions and thoughts in our appointments. But, I think there is a systemic discouragement (or, put more accurately, lack of encouragement) of patients asking questions and being in touch with their doctors. This is much more of a topic than I can address now – but it’s absolutely something I’ll be raising in the future.
I was aware something was not right with my chewing – and I have not been pushing my recovery by eating foods I shouldn’t, at least from what I understood was OK. I occasionally like to gross sensitive people out by describing how it feels in detail. For example, it feels like my hard palate is a sheet of plywood, warping - though in my case, the axis of the warp has something to do with where the cuts were made, I think. Those who follow me who have had this procedure and are feeling this symptom, be warned! (Talk to your doctor!)
Point is, I felt like it was not right, and I told everyone in sight – except my surgeon, the person who needed to know months ago. It did not occur to me that I should tell him; my understanding was, the recovery took a long time and I just had to be patient. That understanding did not serve me well. I don’t think it came from my surgeon, but I - a most motivated, curious, and frank patient – had that understanding nonetheless.
Long-term Patient Health Advocacy side note: How much more would a patient who is timid, less-educated, or lacking strong support be hesitant to report important symptoms to a doctor who is not as responsive and open as mine?
OK, it is what it is…
I haven't been angry, and mostly not upset, though my life certainly has been upset. In less than three weeks I have a pair of major concerts I’m conducting with roughly 150 on stage and (hopefully) 600+ each night in the audience. (Skagit Valley Chorale, come see it!) I just started a new quarter at North Seattle College with a choir of 73 students and an online “Music in the United States” course as well. It’s not a great time to go into surgery. My surgeon and I discussed the circumstances at length, and he feels strongly that it’s important we address this as soon as possible – for my very long-term health.
So, I’m making plans and hoping and praying for a quick recovery. Plans include careful eating, proper attention to medicines and recovery, care from others, colleagues helping, resting, and setting limits (in scheduling and in physical activity). I am concerned about how much I can handle, and how difficult the recovery will be. Last surgery, I was pushing limits a little to begin rehearsing 4 weeks after the surgery. This surgery will be MUCH less major, but I intend to rehearse 6 days after the surgery. How to balance the needs? What will be necessary? We’ll find out.
(It’s in my mind that I should actually be preparing in other ways than writing this, but I want to get this down before the surgery. Perhaps less editing and re-writing this time. :)
On the plus side, I have been able to see this as, "I get to go through the process again, knowing what I know now - and see what's different this time, what was helpful to have learned." I am (and Lorraine is) and expert on preparing the food I'll need, and feeding myself. I know how to deal with liquid medications and the syringe-catheter set up. I know that the second week will likely be the point when I get depressed. We've got lots of plans for how to handle it.
Finally, “What is this surgery?” In brief:
The mandible, chin, and nose surgeries are all healing well and require no additional surgery. In the surgery, the surgeon will remove the plates connecting my maxilla to my skull (sorry, anatomic shorthand, in haste). He’ll remove fibrous material that has grown, and implant (install?) a bone graft; a “cadaver ilium”. (Yes, I will have a dead person's hip in my hard palate. Um, part of it. Goes with the cadaver Achilles tendon in my knee.) Then he’ll install new plates slightly more forward/center of where they were, and sew me up. I’ll be in the hospital overnight, but should be able to go home next day. I’ll have several days at home, recovering.
I will not need to be in the ICU after surgery as I was last time; my sleep apnea is no longer a factor in the surgery since the last repairs. Trumpet fanfare: Just found out recently that my AHI (Apnea-Hypopnea Index) has been reduced from 37 before the surgery (severe) to 16 now – much more manageable. Thank you, Surgery #1.
I’ll hope to write again after the surgery. This time, I won’t have a lovely several weeks to write many times. (Wait, it wasn’t lovely last time…)
…No, don’t want to end the post that way. How about a new song? In honor of my upcoming bone graft:
Oh, the hip bone’s connected to the – jaw bone, now hear the word of the Surgeon.
(Pardon the anatomical liberty – the maxilla is not a “jaw bone”… But the line scans better that way!)
Dr. Adam Burdick has been a professional musician for over two decades. Teaching, conducting, and performing in various music genres, he is also a perpetual student with interest in a wide range of topics. He loves to ponder and share his discoveries with anyone interested!