We were not supposed to see Dr. Roser until Tuesday, but he had an unanticipated opening in his schedule and asked us to come in. He is pleased with how things look at this early stage. No sign of infection--just the expected amount of swelling. Other than the swelling restricting my mouth opening a bit, I am very comfortable--just one Oxyconin a day for...oh, yeah, pain. Well, that's my story and I'm sticking to it. No joke about that--I do not want to have to go through withdrawal for a fourth time.
Thanks for your Team Mike Good Vibes. They are pulling us through once again. But do keep them coming--the next few weeks will give Dr. Roser the signs of what will come next, and when.
Happy New Year and have a safe 2015.
Mike
Friday, December 26, 2014
Tuesday, December 23, 2014
Quick update
We got home around noon and I slept a bit. Terry was till too wired for that.
As is often the case with this, a mix of good news and bad news. The good news is that the jaw/fibula area is healing well on a visual inspection. The surgeon had clear margins with the dead bone tissue, so that was easy to scrape out. He extracted two teeth, not just the one that was planned. The procedure needed a bit more effort than planned and that's the start of some potentially bad news. Three screws were infected as was one end of the titanium plate. The screws were easy to replace, but a plate replacement was beyond the scope of this procedure. The plan is to up the antibiotics in hopes of the infection healing, but that appears to be a long shot. In all likelihood there will be another procedure to replace the plate, but no way to know when that might need to happen.
So, I am home eating ice cream and we are binge watching "The Good Wife."
Merry Christmas to all and I'll update more when something changes.
Mike
As is often the case with this, a mix of good news and bad news. The good news is that the jaw/fibula area is healing well on a visual inspection. The surgeon had clear margins with the dead bone tissue, so that was easy to scrape out. He extracted two teeth, not just the one that was planned. The procedure needed a bit more effort than planned and that's the start of some potentially bad news. Three screws were infected as was one end of the titanium plate. The screws were easy to replace, but a plate replacement was beyond the scope of this procedure. The plan is to up the antibiotics in hopes of the infection healing, but that appears to be a long shot. In all likelihood there will be another procedure to replace the plate, but no way to know when that might need to happen.
So, I am home eating ice cream and we are binge watching "The Good Wife."
Merry Christmas to all and I'll update more when something changes.
Mike
Friday, December 19, 2014
Deja Vu, All Over Again
So, class, before we move on, let's do a quick review of some things we've discussed in previous lectures.
First, can you say "Osteoradionecrois"? That would be Os-tee-o ray-di-o ne-cro-sis. Who can tell me what that is? No peaking at previous posts, Harv.
The correct answer is "Dead bone from radiation therapy treatments." If you got that right, give yourself one point.
Next (gimme) question: What is the acronym for Osteoradionecrosis?
Several students raise their hands and shout, "Ooo, Ooo, Ooo I know that one--call on me"
Answer is ORN--everyone gets a point for that.
OK--now put your thinking caps on--this is a toughie. What causes ORN?
Several seconds of wait time passes--no answers.
Mike says--"It's when a bone area doesn't get enough blood supply, and the bone tissue dies. Anyone who had Sister Mary Latin at Walsh should know the root words: necrosis (dead) osteo (bone) from (from) radio waves (radiation treatments--the gift that keeps on giving). Everyone say 10 Hail Marys and do 3 Stations of the Cross for not knowing that."
Mike proceeds: What happens when ORN advances too far?
Pre-Med Paully takes a shot and answers--"The bone dies from a lack of blood supply and gradually separates from the healthy bone as a shard. The biggest ones are called Trophy Shards."
Good answer, Paully--have a brownie
Let's moves on with the review. When you have a lot of ORN in your jaw and it won't get better, what do they do?
Several students answer:
(Phantom): "They take out your jaw bone and stick one of your leg bones in there. I'm a chiropractor, I know the right anatomical terms for ALL of this. Just ask me"
(Mike): "Sure, I'll ask you to sit down and shut up"
(Alisa): "They put you in ICU and induce a coma for several days"
(Andy): "Yes, while your friends make bad jokes about you"
(Jeff): "You see 6-legged swimming lizards, and think you've been on a plane ride with me"
(Terry): "Then they move you to the 9th floor so that a nurse can scan your billing bracelet while you are urinating. After about two weeks they let you go home so I can stay up all night giving you IV antibiotics and hand baths"
(Mike): "Yes, you are all correct. Have an Oxycontin--two for Terry."
Susan Catherine Wheeler impatiently raises her hand and asks, "I thought this was from three chapters ago in the book. Why are we going over this stuff again?"
(Mike): "Well, class, it appears that some of this shit is about to get a replay, so you need to make sure you have a good understanding of the chapters from May of 2014 and the next few months to understand the next chapters in the book."
Back to the present--I had a CT scan this past Monday and we met with Dr. Roser the next day. The news was not the worst it could have been (a major re-do of the May resection), but it also was not the quickie office procedure we had hoped for. I have an infection in the left side of my jaw, next to the union of the remaining original jaw bone and the grafted fibula. This is caused by new ORN since the May procedure, which has led to some funky stuff and blood draining out under my chin for the past few months. After a long period of wait-and-see, Dr. Roser is sure it won't resolve on its own, so he will cut down one of the original incision lines, do a debridement to scrape out the dead bone, replace one or two surgical screws, and take out one more tooth.
I spent a few hours today going through the pre-op routine at Emory and having some bad Deja Vu from the same sequence of events for the May procedure. Even though I know this time should be much less of an ordeal (about 2 hours in the OR, not 12--and home that evening, not 13 days later), I had this awful feeling of being sucked into the Vortex again (bonus points for whoever can find that in an earlier post), after thinking I would never be in that place again. Well, guess what--I have a return ticket to the Vortex, dated December 23, 2014.
Dr. Roser says there is some small chance of finding more ORN than what he thinks is there, and having to replace the plates in my jaw, not just the screws. If that happens, then we will yet again be victims of SFL (more bonus points for that--and don't look for it on Wikipedia) and all out-patient bets are off. I told Terry that if I go under sedation on the 23rd and don't wake up until Santa has come and gone, I'll be really pissed.
So, what does Team Mike need to send Good Vibes for this time?
(a), get my insurance company to approve the procedure on short notice so it can happen on the 23rd;
(b) make the procedure safe, with no surprises;
(c) give Dr. Roser a steady hand;
(d) make the recovery as short and uneventful as possible.
Answer: All of the above.
If all goes well, I'll post the next day to let you know. If it doesn't go to plan, then I'll ask Terry to keep you posted for me. If I don't wake up for Christmas, please don't open my gifts or take stuff out of my stocking.
Santa, the Roxicet and cookies are for you. Enjoy.
OK, class--that's it for today.
Mike
First, can you say "Osteoradionecrois"? That would be Os-tee-o ray-di-o ne-cro-sis. Who can tell me what that is? No peaking at previous posts, Harv.
The correct answer is "Dead bone from radiation therapy treatments." If you got that right, give yourself one point.
Next (gimme) question: What is the acronym for Osteoradionecrosis?
Several students raise their hands and shout, "Ooo, Ooo, Ooo I know that one--call on me"
Answer is ORN--everyone gets a point for that.
OK--now put your thinking caps on--this is a toughie. What causes ORN?
Several seconds of wait time passes--no answers.
Mike says--"It's when a bone area doesn't get enough blood supply, and the bone tissue dies. Anyone who had Sister Mary Latin at Walsh should know the root words: necrosis (dead) osteo (bone) from (from) radio waves (radiation treatments--the gift that keeps on giving). Everyone say 10 Hail Marys and do 3 Stations of the Cross for not knowing that."
Mike proceeds: What happens when ORN advances too far?
Pre-Med Paully takes a shot and answers--"The bone dies from a lack of blood supply and gradually separates from the healthy bone as a shard. The biggest ones are called Trophy Shards."
Good answer, Paully--have a brownie
Let's moves on with the review. When you have a lot of ORN in your jaw and it won't get better, what do they do?
Several students answer:
(Phantom): "They take out your jaw bone and stick one of your leg bones in there. I'm a chiropractor, I know the right anatomical terms for ALL of this. Just ask me"
(Mike): "Sure, I'll ask you to sit down and shut up"
(Alisa): "They put you in ICU and induce a coma for several days"
(Andy): "Yes, while your friends make bad jokes about you"
(Jeff): "You see 6-legged swimming lizards, and think you've been on a plane ride with me"
(Terry): "Then they move you to the 9th floor so that a nurse can scan your billing bracelet while you are urinating. After about two weeks they let you go home so I can stay up all night giving you IV antibiotics and hand baths"
(Mike): "Yes, you are all correct. Have an Oxycontin--two for Terry."
Susan Catherine Wheeler impatiently raises her hand and asks, "I thought this was from three chapters ago in the book. Why are we going over this stuff again?"
(Mike): "Well, class, it appears that some of this shit is about to get a replay, so you need to make sure you have a good understanding of the chapters from May of 2014 and the next few months to understand the next chapters in the book."
Back to the present--I had a CT scan this past Monday and we met with Dr. Roser the next day. The news was not the worst it could have been (a major re-do of the May resection), but it also was not the quickie office procedure we had hoped for. I have an infection in the left side of my jaw, next to the union of the remaining original jaw bone and the grafted fibula. This is caused by new ORN since the May procedure, which has led to some funky stuff and blood draining out under my chin for the past few months. After a long period of wait-and-see, Dr. Roser is sure it won't resolve on its own, so he will cut down one of the original incision lines, do a debridement to scrape out the dead bone, replace one or two surgical screws, and take out one more tooth.
I spent a few hours today going through the pre-op routine at Emory and having some bad Deja Vu from the same sequence of events for the May procedure. Even though I know this time should be much less of an ordeal (about 2 hours in the OR, not 12--and home that evening, not 13 days later), I had this awful feeling of being sucked into the Vortex again (bonus points for whoever can find that in an earlier post), after thinking I would never be in that place again. Well, guess what--I have a return ticket to the Vortex, dated December 23, 2014.
Dr. Roser says there is some small chance of finding more ORN than what he thinks is there, and having to replace the plates in my jaw, not just the screws. If that happens, then we will yet again be victims of SFL (more bonus points for that--and don't look for it on Wikipedia) and all out-patient bets are off. I told Terry that if I go under sedation on the 23rd and don't wake up until Santa has come and gone, I'll be really pissed.
So, what does Team Mike need to send Good Vibes for this time?
(a), get my insurance company to approve the procedure on short notice so it can happen on the 23rd;
(b) make the procedure safe, with no surprises;
(c) give Dr. Roser a steady hand;
(d) make the recovery as short and uneventful as possible.
Answer: All of the above.
If all goes well, I'll post the next day to let you know. If it doesn't go to plan, then I'll ask Terry to keep you posted for me. If I don't wake up for Christmas, please don't open my gifts or take stuff out of my stocking.
Santa, the Roxicet and cookies are for you. Enjoy.
OK, class--that's it for today.
Mike
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