Pre-Op Meetings with Dr. Q

Dr. Quaroni (aka Dr Q or Q) is my oral surgeon. This is the dude that will be cutting my jaw bones into pieces and then putting them back together with plates and screws resulting into a correct bite. I was referred to Dr Q by my orthodontist, Dr. Nelson. These two guys are the BEST in their respective fields, and I feel very blessed to have them as my doctors!

Cool little fact - Each of them has a daughter that has gone thru jaw surgery, and both are very up front with that info in the first visit. Which I think is pretty darn cool, and I found it comforting. Not only do these guys know how to fix your teeth and jaw, but they also have the first hand experience of what the recovery is really like. And Dr Q did his own kid's surgery. The dude is hard core!

At my first appointment with Dr Q, he told me that I had a couple issues going on with my bite. He explained that I would need my upper jaw widen to correct my cross bite, and my lower jaw moved forward to correct my over bite, and that he could help me with that. He told me that he is very good at what he does, and he always takes his time with his surgeries. So my first impression of Dr Q - Very confident in his abilities w/o being arrogant or conceded. I like that, I like that a lot. He has a very Zen like presence about him too. Very even keel, doesn't seem to get to overly excited or anything. He has a way of explaining things in detail, and putting you at ease about it at the same time. I like this guy.

Here are my notes (both written and from memory) from all my appointments w/ Q:

11/12/09 Appt - This was my first meeting w/Dr Quaroni. One of the first things he said to me was that this type of surgery is a big deal. The recovery is a marathon. You don't heal overnight, it takes a LONG time to fully heal and for all the swelling to completely leave, it's a MARATHON. Wow, this is a BIG deal. He told me that I will be nervous leading up to the surgery, about a month before a little more nervous, a week before a little more nervous, and the night before extremely nervous. He also told me that he and Dr Nelson had been working together for several years, and that they both had daughters that also have had jaw surgery so they both had the unique perspective of both the preparation and the recovery process. He said most surgeons do the surgery, then send you home and don't see you until a week later. "I've been there to see the aches and pains and emotional toll this surgery takes on a person." (paraphrasing since I don't remember the exact words)

• Off work 2-3 wks
• Braces off 4-6 months after surgery
• Surgery will be ~3 1/2 hrs long
• 1-2 days in the hospital
• Mouth NOT wired shut
• NO splint to wear afterwards, only used during the surgery (woo hoo! I had read from others had this done and were really uncomfortable, so I was excited about it.)
• Most of the swelling and bruising should be gone after about 2 wks
• DO NOT have this surgery to fix joint pain - It will not fix it (Q was very adamant about this)
• Frequent trips to see him and Dr Nelson after the surgery

1/14/10 Appt - This appt was probably the longest, and I actually had paper to take notes. :P I got LOTS of information at this appointment. I also learned that Dr Q has had over 700 cases of both upper and lower jaw surgeries. That eased my mind a lot. This ain't his first rodeo! :)

• Two main concerns that Dr Q had for me (Luckily, I don't suffer from either of these issues much anymore):
• Jaw Joint Pain - 70% have less pain, 20% have the same as before, 10% pain gets worse
• Of the 10% that have worse pain, Dr Q has had 3-4 patients that had to be referred on to have jaw joint surgery.
• Clicking Joints - 0% improvement, won't fix it.
• Recovery Timelines
• Jaw fully healed - 1 year
• 3 months - can eat regular food
• 1 week - can resume regular walking
• 4-6 wks - can lift weights
• 6 weeks - can start/resume running
• 2-3 months off horseback riding
• Rubber Bands on for 6-8 wks after surgery
• Support for the jaw and facial muscles from fatigue from surgery
• Force on the teeth to move and hold jaw in place
• 7 - my surgery's difficultly level on a 1-10 scale (1=easiest, 10=hardest)
• 2 wks crappy and cranky
• 4 hrs for surgery (The length of time is the only detail that varied some in each appt.)
• Surgery done inside the mouth
• Swollen for 4-6 wks
• Time for Numbness to go away:
• 4-6 wks - whole mouth area, nose and chin
• 4-6 months - chin and lower lip
• 8-10% chance of permanent numbness or diminished feeling in lower lip and chin
• 3% chance of Relapse - small revision surgery to correct that's done in the office
• 2 days - 1 week - Will need someone to take care of me, make sure my meds are taken and basically be at my beck and call. My words, not Dr Q's. :)

2/25/10 Appt - Just a few questions at this appt. We talked some about the info from the previous appt, and he checked my orthodontic progress. He also showed me where the cuts would be made in my jaws, and where they be moved to (he used a pic of my x-ray). I also learned that he will be moving my upper jaw slightly forward so that it supports my upper lip and will keep my looking younger longer. He said there'd be no noticable different in the look of my face. Nice! :) By now I'm really liking Dr Q and feeling pretty confident in his abilities. :)

• Donate my own blood?  Not needed, very, very unlikely it would be needed
• 1 % chance of permanent damage to upper teeth, Very rare for lower teeth
• Only 10 teeth in career had to send to root canal specialist
• Other doctors during surgery - 1 other surgeon, 2 assistants, 2 nurses...some others, but I can't remember since I didn't write it all down. Not really all that important, to me anyway.

4/08/10 Appt - This is the appt that my surgery was scheduled. Dr Q checked my orthodontic progress which he said I was setup nicely for the surgery. We talked again about the risks, I need lots of reassurance that the risks are small compared to the benefits, that Q is as good as they say, and that I'm going to be OK. I'm sure inside Dr Q was like "Seriously we have to talk about this again?", but he never once said or showed any such thing. At this time, one of my biggest fears was the permanent numbness in my lips. Q explained that there was a 10% chance of it happening, but if you were to flip a coin that you knew was the same on both sides, 9 out of 10 times you knew what you had every time, you'd make quite a bit of money at it. Not sure that's exactly what he said, and it doesn't seem to make as much sense to me now as it did at the time. Whatever it was he said worked, because something clicked and I realized 'this guy is good, no the best, he knows what he's doing and how to do it right, stop worrying so much. Focus on the positives.' Easier said than done, but I wasn't as worried anymore about the numbness after this appt. :)

5/11/10 Appt - This was 2 weeks pre-op. Dr Q took molds for the models, took all kinds of measurements, and an array of x-rays. He asked how I was doing and if I had anymore questions for him. Of course I did. :)

• Gum damage - 1% chance potentially on the top canines - can be fixed w/gum graft
• Diet - 2 wks liquids, 6 wks soft (mashed potatoes, scrambled eggs, etc.)
• Zip'nSqueeze Bags - out of business, but there are other options to eating - syringe w/a tube, can use a straw, can drink from a cup, etc.
• Nausea - Will I throw-up?
• 10% chance (I'm thinking my chances are more like 100% solely based on the one other time in my life that I've had general anaesthesia, and I puked my guts out.)
• Anti-nausea meds given before, during and after the surgery in the hospital.
• Prescription meds include anti-nausea meds to after I go home.
• How soon can I walk? (Because I don't remember that you already told me that. ;P) - Walk small amounts in hospital and during first week, then slowly resume normal walking after 1 wk
• When can I brush my teeth? 1 wk, Prescription mouthwash will be enough for the first week to clean teeth
• What happens if I cough, sneeze or get the hiccups?  Should not have any cough or sneezing, but if it does happen shouldn't hurt anything, Unlikely for hiccups
• Will you cut my wires? - Yes on the top. No since Dr Nelson has broken wires in already.
• Back to see the ortho 1 wk after surgery

5/18/10 Appt - Last appt w/Q before the surgery. One week pre-op. HOLY COW this is approaching fast and I am nervous!! I'm freaking out a little, because I feel this is my last chance for questions...and I'm worried about the questions I don't know to ask. Dr Q gives me his cell # so that I can call if anything else pops into my head. That makes me feel better. :) So He takes my medical history and talks to me about ASH (Austin Surgical Hospital) and what time to be there. Tells me I will need to call them and schedule a time to have my blood drawn and pee in a cup so they can check some things and make sure I'm healthy and all.

• What do I bring to the hospital? - Slippers, PJ's w/button-up shirt, movies, ipod...I also took q-tips (use to clean my nose), facial wipes and moisturiser, change of clothes to wear home, the prescription mouthwash, shower stuff (shampoo & body wash), lip balm (try to get a roll-on or squeeze dispenser), and my notebook for questions while in the hospital. I got a lot a good info from this page - Jaw Dropping Blends
• What am I going to look like afterwards?
• Very swollen - will take about 2 wks to go away
• More defined jaw and chin in my profile (yea!)
• Tip of nose will be very slightly turned up - This happens, because when the top jaw is cut, whatever holds your nose in place at the bottom is cut too. So Q will retie the corners at the bottom so that my nose doesn't spread out which he said is "quite unattractive." He said most people don't notice the difference.
• Can I have my teeth cleaned in early July? - No, postpone until at least 3 months out from surgery
• Is there anything I can do to prepare for the surgery before/after in terms of exercises or vitamins to heal quicker? - No, just good health. Walking, good nutrition and keep hydrated. No new foods.
• Will I be able to talk right away? - Yes
• How soon can I shower? - The next morning (awesome!)
• What happens to the gap in my lower jaw after you move it forward, do you fill it with something? - No, it bleeds and clots which turns into bone in 4-6 months. (That's freaking cool!)
• What if I completely freak out next week? - "If it's at the hospital, there are things we can give you to relax you :), if you freak out the day/night before you have my #, call me and I will talk you off the ledge." (I do really like him :))