...

very bad weather = very bad pain + worsening of (tmj discomfort + blocked ear + tinnitus + clicking) =
                                  = no sleep + no rest + no work...

Click click click

This is my little companion.
For the past month wherever I go, the little fella goes.

Call me crazy, but I've been keeping a record of the clicks and cracks of my right TMJ.
On my last medical appointment with Mr. C. I was told that if my current condition does not improve until January, another surgery may be considered to recapture the disc. Straight after that appointment I started paying more attention to my TMJ clicking and crepitus - what kind of clicks it makes, when does it click, how many times it clicks?
If I want to know exactly how my TMJ is evolving (if it is getting better or worse), keeping track of the two main symptoms - pain and clicking - may help me understand. However, pain is very subjective and quite hard to quantify. It depends on a long list of factors, and each person feels it differently. Taking pain medication constantly makes pain quantification even more difficult, as it masks the real symptoms. Quantifying clicks is a lot easier and requires only two things: a tally counter and a notebook. Every time my TMJ clicks, I click the counter. I take note of the number of clicks before the two main meals (lunch and dinner) and in the end of the day, covering the morning, afternoon and evening periods. For the same time intervals I classify my TMJ pain from 1 to 10, according to this table.

Because my disc is anteriorly displaced, the TMJ clicks upon mouth opening. This doesn't mean that whenever I open my mouth, the TMJ clicks. A lot of times it doesn't - it depends how wide I open my mouth, how much pressure I am putting on the TMJ, what I am doing (biting, chewing, swallowing, talking), what I eat, etc. However, taking into account that my days are pretty much the same, following the same routine, soft-food dieting, talking and laughing roughly the same amount each day, the daily sum of clicks should remain around a certain value. It is only based on this assumption that I can compare different days and trace an evolution trend.

There are different kinds of clicks. The ones I get the most only I can hear them, although they are easily felt when pressing a finger on the joint. Louder clicks (or pops) are less frequent, and can be heard by anyone standing up to a few meters away from me. They sound like fingers being cracked or chicken leg bones being broken. The loud clicks produce an immediate relief on my TMJ discomfort, just like a dislocated bone being brought back into place. Unfortunately it is a temporary relief. Crepitus is always present whenever I move the lower jaw, a continuos grating sound - the reason why mouth movement is not smooth and feels like a old wooden door being open. I only count clicks, not crepitus noises.

So far it looks like this:

Fitting a trend to the data, it appears that the amount of clicks is increasing with time. But what is the significance of this? Could my TMJ be gradually getting worse?
As for the pain, I am slowly increasing the amount and strength of the medication. Sometimes it aggravates after a major click - I feel a pulsing electric pain spreading from the TMJ towards the rest of the face and head. Could be another sign of worsening... Could be due to the "great" british weather...
What do you think?

Recovering

In the past months I haven't been the best blogger, or the best company, or the best person to reply to any of the lovely and supportive messages I have been receiving... Shame on me...
However, I have a good excuse - I have been "too busy" recovering! HA!

I did my best to maintain a small diary in which I wrote everything regarding my post-op experience. I had great expectations about this little fella - it would be the most extensive and complete post-op report of all times!...
But three days after... I surrendered to the tiredness, general drowsiness, and lack of inspiration and willingness to do anything at all that is so common (at least I hope so!) after surgery. *sigh*

Have I ever mentioned that despite being the best guy ever, Davide is also a bit hypochondriac and a chronic worrier? Well, I found out that all his hourly questions of "how are you feeling? how's the pain? where is the pain? how much is the pain? why are you making that face - is it hurting?" were only to fill in his own diary. Oh, bless him! He's the best! ♥

Post-op day 1

The past months can be summarised by a single word: tough. In every way...

I arrived home from the hospital at around 10:30. I felt lost at home. It felt like I had been away for weeks, although little more than 24 hours had passed. I was feeling quite well, as the pain was being controlled by the medication, and I was surprisingly alert. The last thing I wanted to do was spending the day in bed, resting and being bored to death. But that was exactly how I spent that day, and the ones after.

The pain kicked in on day 2. The whole right side of my head was aching terribly - some of the severest pains I ever had to endure. It remained like this for the following three days, and I was only able to cope thanks to my good old friend tramadol (8x 50mg daily) and strong ibuprofen (3x 400mg daily), combined with paracetamol. Slowly the pain started to ease, but TMJ discomfort and swelling increased significantly. The swelling was pushing the lower jaw forward (creating a slight underbite) and to the left, affecting my bite. I could barely open my mouth (12mm maximum), it interfered with my speech, and swallowing was very hard.

Post-op day 5

A week after the surgery I felt a lot better. In fact, for the first time in 380 days I felt I didn't need to take pain drugs. And so I didn't. That was the stupidest thing I have ever done.
Being addicted to tramadol, my body didn't react very well when I decided not to take it. Especially taking into account that only a week had past since the surgery... In the end of the day, my body started to shut down. I was unable to stand, my speech was incoherent, I was shivering, soaked in sweat, and extremely sick. Soon I was throwing up all the contents of my stomach and much more... Needless to say, the TMJ pain came back must worse, and I was in bed again for the next couple of days, taking each pill as a bless.
On the ninth day after surgery the stitches were removed, and it was such a relief! With all the swelling, they became really uncomfortable as if my face skin was being pulled backwards. Although the stitches stung from time to time, the wound and the tissues surrounding it were completely numb. As time passes, I am slowly recovering some of the sensations around the scar, but the skin is still pretty much numb to the touch. The scar however has healed beautifully! It is almost impossible to notice it.

Can you see it?

A month after surgery, the pain had decreased, the swelling was gone, my mouth opening increased slightly, and I was eating normally again (although mostly soft foods). It was time to reduce my tramadol intake - this time gradually. This proved to be quite a struggle. It has been a long and stressful process, and I feel it may have slowed down the whole recovery, as it is one more thing my body has to cope with, heal and adapt. Currently I am taking only 50mg of tramadol a day. I wish I could decrease the dosage even further and eventually withdraw it completely, but unfortunately it is impossible at the moment...

Six weeks after the eminectomy, a consultation with my surgeon (Mr. C.) confirmed my fears - the disc is still anteriorly displaced. The diagnosis improved from without reduction to with reduction (explained here), but the disc is still out of place. Hence the constant pain I still feel (although far more tolerable and manageable than before), the extreme discomfort inside the TMJ (I feel as if my lower jaw is out of place, not fitting properly on the right side), and the pretty bad and annoying TMJ clicking and crepitus. If my current condition does not improve until my next medical appointment (January 2013), another surgery may be considered to recapture the disc. It is frustrating to think that all could've been solved if my surgeon wasn't so conservative during the eminectomy, if only he had opened the joint capsule to check the disc. But that wasn't the goal of this surgery. Despite it all,  I must say the eminectomy improved my condition significantly, and that for me was a great achievement!

I still feel pain and still take pain medication. In bad weather days I stay at home, as they make me feel terribly. I get tired very easily and can't do anything physically demanding. I can't bite an apple or chew a steak.
But I'm back to work and I ate pizza just the other day. :)