Surgery - T minus 2 days

I just received a last minute phone call from the hospital - my surgery was booked for Friday! This Friday (28th June)!

I'm checking in at the surgical unit tomorrow (time to be confirmed), as my surgery will be early Friday morning. From what I was told, if I recover well and fast and with my surgeon's permission, I may be discharged Saturday. If not, I guess I'll have to spend the weekend in a hospital bed... Snif...

I must recover from the shock of such short notice and stay focused, because there a lot of things I need to prepare and organise!


Wish me luck! I'm really scared...

Yet another TMJ surgery...

First of all, my deepest apologies for not posting anything for a long long time. The past few months have been quite difficult and emotionally exhausting, as several family, health and work-related issues came up. I just couldn't set my mind into writing about my current TMJ condition, with so many other things to concern. But all is better now, despite my TMJs...

Last February I had a fourth MRI scan to check both TMJs, as my symptoms changed significantly since the eminectomy (described here). Soon after I had a consultation with Mr. C. (my oral/maxillo-facial surgeon) to discuss the its results. Unfortunately my right TMJ could not be visualised due to scarring artifacts related to the latest surgery. On the left side the scan showed signs of slight disc degeneration, which explains the pain I've been having recently on the left TMJ. Because of these new findings on the left, Mr. C. requested blood analysis to test for rheumatoid arthritis. Thankfully the tests came back negative - the rheumatoid factor and the C-reactive protein values were quite low (more information here). So it's not all bad news! :)

Because the right TMJ could not be visualised on the MRI scan, Mr. C. asked for an urgent x-ray to at least check the bone structure. The results were inconclusive, although it seems that the outline of the condyle is slightly different compared to a previous x-ray. If this change of the condyle shape is real (not related to slight different perspectives between the x-rays), it may be caused by bone degeneration. This would explain the constant crepitus, grating and discomfort I have. It points out to a more advanced/late stage of deterioration of the right TMJ.

Mr. C. proposed a new surgery... He called it "exploratory surgery", as he can't really assess my current condition without opening the joint. What comes afterwards depends on the findings:

• if the disc and its ligaments are damaged, they will be repaired, positioning the disc back to its proper place (all my symptoms suggest that the disc remains anteriorly displaced);
• if there is bone degeneration, any inflamed areas will be removed and smoothed to prevent further deterioration;
• any scar tissue affecting the proper functioning of the TMJ will also be removed.

Mr. C. has no intention of replacing the disc with a graft, even if it is damaged. He thinks that the disc must be kept for as long as possible, because a damaged but repairable disc still works better than any graft. Total joint replacement is out of question - I am too young to start replacing joints, and he is quite confident this surgery will improve significantly my current condition and give me a good 10 years without any major issues.

I asked Mr. C. if this procedure could be done through arthroscopy, instead of opening the joint completely (arthroplasty). Arthroscopies are known for being less invasive and have reduced recovery periods. However, Mr. C. does not perform arthroscopies. He argues that an arthroscopy can actually be more "violent" to the TMJ than an arthroplasty. To insert the scope (camera) and other tools into such small joint (the TMJ volume capacity is only around 1cc.), it is necessary to inject a lot of fluid to create enough space to work. According to Mr. C., this forced fluid pressure inside the TMJ during an arthroscopy can actually cause more damage than opening the joint completely. Also, whilst injecting the fluid, adhesions and other scar tissues may be broken apart, making it difficult to visualise and assess properly the joint condition. He also added that more frequently than not intra-capsule fluid samples are taken to be tested during surgeries; the fluids injected during an arthroscopy dilute or wash the intra-capsule contents, making the test results less reliable.
Despite his recommendation against an arthroscopy, he offered to forward my case to a trusted colleague who would perform it, if that was my choice.

I accepted Mr. C.'s "exploratory" arthroplasty. I like his relatively conservative approach. Although I am aware this surgery won't resolve my TMJD for good, I prefer this to a more radical procedure in which my TMJ's bits and bobs could be forever removed. This was actually suggested by a surgeon in Portugal with whom I had a consultation to ask for a second opinion. If I was to be treated by this surgeon, my disc would be removed and replaced by a muscle graft made from a flap of my temporalis muscle slid between the joint... No, thank you - I rather keep my little disc for a while longer!

At the time of the consultation (March 2013), Mr. C. said the surgery was likely to be done in June (sometime this month). However, until now I have no date for it. I have phoned the hospital several times to request any information, but so far there is not even an estimate.

I guess I just have to keep on waiting and hoping...

Yet another MRI scan

Today is a big day for me - I'm having my fourth MRI scan to check the current condition of both TMJs.
This is the third MRI scan I have at Cardiff University Hospital, under the care of Mr. C..
I'm both:
- excited, because soon we'll know exactly how my TMJ condition is progressing and what is causing this rapid joint deterioration; and
- apprehensive, because TMJ MRI scans are so uncomfortable and painful, especially the second part when one has to be completely still, mouth locked open with a syringe between the teeth.

On a previous post (TMJ MRI scans, 2 June 2012), I described my experiences throughout the MRI scans I had. This time, I am sharing with you the information I was sent by the hospital, prior to this scan. It includes a 'MRI patient information' leaflet and a questionnaire to fill. I hope you can read all the information clearly.

I have answered 'yes' to a few items of the questionnaire. I rang the Radiology Department, but they said it was fine for me to get the MRI - my last stomach endoscopy and blood tests were done more than 6 weeks ago. Regarding my tattoos, I was told the tattooed areas could warm up a little bit due to the metals present in the ink, but it wouldn't be a problem.

I've got to go now - having the MRI in less than an hour! :)

Inflammation & cholesterol

We spent Christmas holidays with our families, and we had the most wonderful time!

I took the opportunity to visit our family doctor (GP) who requested a few exams, just as regular check-up. These included blood tests which came back normal, apart from the cholesterol results...

Total cholesterol should not go over 190 mg/dl. Mine is an astonishing 267 mg/dl!

It is even higher than both my mother's and grandmother's cholesterol, who take regular medication to reduce and control it. This was quite of a shock, especially considering my diet. I don't eat much, and my diet consists mostly of vegetables, fruit, rice, pasta and cereals, with very little fat (only olive oil, which is considered healthy). We have meat or fish once or twice a week, and they are either grilled or stewed. I seldom eat bread or cake, and I don't appreciate pastry creams/ganaches (the simpler the cake, the better). Sporadically we treat ourselves with a dessert, such as ice-cream, tiramisu or cheesecake. I rarely snack, I do not eat fried foods, and I don't even like cheese. I do love chocolate, but I don't have it everyday. And until very recently I was eating only soups and milkshakes!
Clearly my stupidly high cholesterol does not reflect my diet.

I haven't had the opportunity to show the blood test results to my family doctor (in Portugal) or my GP (in Cardiff). But I asked B. (my wise chiropractor) his opinion on my cholesterol values. He was not surprised.
Our liver produces excess cholesterol in response to inflammatory processes. It is a natural defence mechanism of our bodies to fight inflammation and promote healing. My body has been fighting the inflammation surrounding my TMJ for years now - no wonder my cholesterol is high!
B. recommended not to take any medication to reduce my cholesterol, as it may decrease my defences against the inflammation and consequently worsen my symptoms.
In any case, I will show the blood test results to my GP and ask for her advice.

You can read more about the link between inflammation and high cholesterol here.

New year, new symptoms, new diagnosis?

Most of us start a new year with our hearts filled with hope of better times, with resolutions and promisses of doing whatever is in our reach to improve the things that were not that good in the previous year. I am no exception.

But, what can be done regarding those things we have no control?...

Up until now, my new year days haven't been any different from the old ones: I do my best to work at least a good couple of hours per day on my PhD studies, I rest as much as I can, I spend most days at home and rarely venture outside (overcast and cold weather increase my TMJ pain and discomfort), and I am always looking forward to the evenings when Davide and I can enjoy each other's company.

As for my TMJ symptoms, I didn't have any improvement since my last post. If there was a change, it was for slightly worse. So you can imagine how anxious and excited I was to have my oral-maxillofacial surgery appointment last Friday. I was hoping Mr. C. (my surgeon) would decide to go for another surgery to recapture my right disc, alleviating all the pain and discomfort on my entire jaw and both TMJs. Above all, with this surgery I was hoping to get my life back.

Davide and I went to the University Dental Hospital of Wales (Cardiff) mentally prepared for both a positive answer ("yes, let's do the surgery!") and a less favourable solution ("perhaps it is best to wait a little more time..."). But we didn't prepare ourselves for what was to come...

As always, Mr. C. was the nicest and kindest person throughout the appointment. Although we could see he was having a really busy day, he was with us all the time necessary to go through my complains,  check the function of both TMJs, review my previous two MRI scans and their reports, think, re-think and evaluate my current condition, and then answer all our questions!

The appointment started with me explaining how much worse I was feeling since the last consultation (in September 2012), with considerable increase of pain and discomfort on the right TMJ, loud clicks, pops and snaps. But the new symptoms were what concerned Mr. C. the most: the constant awful crepitus and grating of my right TMJ, and the onset of similar manifestations on the left side. He was not happy with my progress. In his words, "it sounds and feels really bad, as if you're having bone-on-bone". Clearly my right disc is still anteriorly displaced, but now I show signs of significant bone deterioration. On previous MRI scan reports it was mentioned some alteration of the bone signal which could suggest some bone wear and tear, together with flattening of the condyle head. However, at the time I didn't have this kind of crepitus and grating, which is evidence of joint degeneration.

I asked if the recent symptoms on the left TMJ could be related to a jaw imbalance caused by removing the articular eminence on the right side (maintaining the left one). Mr. C. said it was a nice theory and it made sense, but he wasn't convinced it was the cause for them.

Looking desolate, Mr. C. said it he was about to do something he never did before: requesting a third MRI scan for someone. He added it was the first time he saw this kind of symptom progression to worse in such short period of time. Both my TMJs need to be re-scanned in order to check their current condition. With new scan results, Mr. C. can evaluate what is exactly going on and what may be causing this deterioration. Although it is still very early to jump into conclusions (especially not having any recent scan to support), Mr. C. said there is the possibility of having a joint degenerating disorder, such as rheumatoid arthritis. After the results of the new MRI scan, Mr. C. may ask for other exams to confirm or exclude this possibility, and plan a surgery accordingly.

I am back on a waiting list for a date to do the MRI scan.

And so, I have a new wish for 2013: not to have rheumatoid arthritis (or something similarly bad).