3 MONTHS POST-OP!!!

Today marks 3 months since my surgery. In 10 days, I will be recording my pre-screening CD for graduate schools. I cannot believe I have made it to this point. That's not to say that I am not EXHAUSTED. I have worked my butt off these past few months -- my teacher says I've worked harder than I think I have, that I sound much better than I think I do ... and that, as usual, I am over-thinking!

It has been a while since I have written, which is unfortunate. I am going to try to get back to writing in more regularly since a BIG part of starting this blog was to discuss the challenges of resuming a normal life as a musician after a potentially career-ending injury.

Let's see .... well, since I last logged in, I've expanded my food repertoire! I am on solids completely (with some exceptions -- I still find bread to be challenging because it is so chewy, steak would be too difficult, and I have a phobia about potato chips! And I still haven't had the Italian hero I've been craving for months). I learned that I am iron deficient (shocker), which is no big deal ... but I got my first taste of red meat a few days ago, and I swear, I literally felt my red blood cells getting happier. It was an AMAZING boost of energy ... although I would have preferred it in steak and not hamburger patty form.

I'm starting to exercise more ... still need to work on that. My weight is making it tricky. I should be about 115-117 (and I haven't checked lately) ... but my teacher thought I needed to put on a few pounds, so that must mean I'm a little under. SO, while I want to get my endurance back, I have to be careful not to lose too much Yona in the process! I started taking a swim class for people with arthritis. It is a good boost to my ego -- I am the youngest and most attractive in the class, lol. And it does help me to exercise in the water -- I don't get as sore, and so I am less discouraged.

All that being said, my endurance HAS improved ten-fold. I was running across Lincoln Plaza the other night because we were late to the opera (and I mean sprinting) and wasn't out of breath! It's not perfect, but my body is healing. My biggest challenge now is learning to deal with the pain that still comes from the damage I did to my neck (not to mention the arthritic stuff) ... doctors are very sadistic. Having to be on narcotics when my back freaks out is a major inconvenience. They give you the meds to treat it, but are of no further help ... "pain management" is a bit of a joke.

Otherwise, my life has revolved around lessons 3x a week, coachings, etc. People do not realize how difficult of a career music can be. I am even surprised sometimes! But the work is rewarding for me. I have had a LOT to deal with and still do (I am dealing with increased anxiety and PTSD symptoms surrounding the accident, and it can absolutely affect me musicall

y; I broke out in hives while singing a piece from Figaro!) ... and I'm not always sure I'll get ther

e. I'm blessed with a teacher who believes in me ... and I need that right now until I can believe in myself a bit more.

I've also used the time I have now to repair some burned bridges. I wanted to right some wron

gs that happened with some of my friends during my undergrad years and have been

so humbled and amazed at their willingness to forgive ME as well. I almost died in that accident -- 1 mm higher and I would have been a goner because I would have hit the soft tissue of my brain. Life is just too short, and this has been a really healing process. I thank the three girls who wrote me back from the bottom of my heart.

That's about it. There is still a lot of struggle. There is still a lot of work. But I am just keeping my mind focused on my music right now, as must as I can. Yes, I get lonely. Yes, I wonder if I am making the right decision. Yes, I am bitter that this happened to me in the first place. And, sadly, there is ensuing depression that comes along with that, despite my happiness that my surgery has been a complete success.

But I'm getting there. Slowly. I hope.

With many good wishes and love to all of you who care to read this ....

Yona

Pizza, pizza!

So I still can't eat traditional bread (naan, sandwich bread, rolls, etc.) because they are too chewy ... but I felt like taking a risk yesterday and had my first slice of pizza since MAY!!!! And oh man, it tasted good. No pain, just some fatigue ... like any injury, the muscles in my jaw have atrophied to the point that when I clench my teeth (for experimental purposes only!), I barely feel any muscle movement/contraction in my cheeks!

BUT the cure for that is getting back to a normal diet. Pizza was my first step. Behold the wonder:

Life is Good Sometimes

This was just a good moment in a hectic day in a month full of depression and more injury ... but even if it is brief, I try to really enjoy when I feel GOOD and happy. There's usually so much weight on my shoulders ... so this afternoon of "goodness" was one to enjoy ... even though I am starting to come down from it a bit now.

Coming attractions!: "Yona Eats a Burger" and other adventures in TMJ surgery recovery!

Why I can NEVER look normal in the opening shot of these, despite my efforts, I will never know.

I'm still here ... a Return to the Opera!

I'm still here.

I'm still awaiting MRI reports from the accident (which totaled my poor car!). I'm in pain, but walking and doing everything my body is supposed to do.

I went back to the Met tonight ... the first time I had seen an opera since the theatre I was injured at closed on May 31. The opera this evening was, "The Marriage of Figaro." It is so amazing to me that despite my many bad associations with that opera ... it still makes me smile and moves me like none other. I did break into hives and major tachycardia during the scene that I got injured in ... and realized how FAST it was! Gosh ... 5 measures? Maybe? Down and up?

I suppose part of what moves me the most about opera is that here is something that Mozart composed in 1786) that people are still cracking up at today. The blackberries and cell phones are turned off and everything is silent for a few blissful hours. And all we hear are the echoes of a genius being presented to us by the talent of today. The singer very often takes on the responsibility of the "deliverer" ... it's a role I enjoy very much.

This Cherubino (Isabelle Leonard) was fantastic -- she made me so happy. I was able to see more of what I really accomplished ... all that with a swollen left temporal lobe and a displaced jaw! :) It was exciting to think of maybe one day having the possibility of being on a stage with room to run on.

Otherwise, I've been working really hard to get myself back on track vocally and have been VERY focused on graduate school applications ... not sure if that is the next step from here, but we'll see.

I will try to update more often; a big part of recovery is getting my brain and confidence back together. My teacher told me this week that "Singing is the closest you can get to God." I firmly believe this; a magnificent singer is a spiritual one, in one way or another.

I also attached a picture included here is of MY moment as Cherubino at my curtain call (post-injury).

Love to all.

Setbacks

I suppose with any recovery, there is a set-back.

Mine came in the form of my very first car accident in 8 and a half years on Friday evening, the start of Rosh Hashanah, the Jewish New Year. I lost control of my car on a country road, went into the gully, hit a tree stump, careened to the other side of the road and crashed into something. Not sure what, but the airbags exploded, and I felt my face burning from the fumes and I just got OUT as fast as I could (couldn't tell where the smoke was coming from).

I walked away from my car. THREE CARS passed me on the road and did not stop. THREE. All dressed up for a holiday dinner (I live in a very Jewish neighborhood, so it is a safe bet). There's irony for ya huh? "Quick, the sun is setting! We can't stop to help this girl standing alone next to her smoking car!"

Someone did stop, and stayed until my parents, paramedics got there. ER for hours, the whole works.

I am structurally "OK" as far as the basics (no fractured vertebrae, etc.) ... but in SO MUCH PAIN. I am better today, and I got in for an emergency appt. with the pain management MD who did my epidural shots in my spine. I do not have a good idea of the full extent of the damage, as the emergency MRI machine was VERY old (how funny that I know the difference!!). All I know is that I hurt. REALLY BADLY. RIGHT when I was starting to feel more sure on my feet. I had just managed to get my body back into "child's pose" in yoga last week: now, it is excruciating.

Percocet makes me SO depressed that it is not a candidate. Vicodin works, but not great ... works better with a muscle relaxant, which knocks me out ... BOTH of these medications make it impossible for me to live a normal life.

I am sure you all can imagine what I am feeling right now, so it seems silly to state the obvious.

My jaw survived the ordeal in tact! It hurts right at the joints where the cervical collar cut in (I was in it and on a backboard for 5 hrs).

There must be some kind of universe misalignment or something ... I'm not sure. But it makes me more than a little wary. A reminder of what I have been saying all along: a major injury affects your MIND as much as your body. To heal, you have to treat both.

And so, here I am. Alive, yet this strange feeling of fragmentation.

Until next time ...

Yoga and a Return to the Bowery

This is my 30th post! I am OFFICIALLY a dork.

Well, I went to a yoga class yesterday. A "gentle" yoga class, mind you. And I am SO beat. 70 year old men were running peaceful, serene circles around me. I'm just ... not very strong. Maybe I'll get back to the gym today and work on lowering my heart rate ... at the moment, I can shoot right up to 160+ BPM within the first couple minutes of cardio work ... which isn't exactly great. On the other hand, at least we know it's ticking!

I also went to my first rehearsal at a new company that is just around the corner from "The Scene of the Fall." I can't even walk past that building without cringing. But it was nice to jump back into something musical.

That's basically it ... this is a totally self-involved post -- sorry for that. I'll try to post something more informative soon! Stay tuned.

Hi, I'm 24, but apparently secretly 80

Jaw opening continues to be GREAT, so that is a huge blessing. It is more painful when it rains, which I guess makes sense. I had a nectarine today (peel taken off) AND a frozen yogurt from Pinkberry with raspberries and kiwi. Things take a lot longer to chew. I have a good idea of what my limit is (it's about what I just listed for today! lol).

I am just getting frustrated at how weak the rest of me is. It's hard to get my energy up for a good singing lesson, which is hard to believe because I LOVE my teacher and am so eager to please her ... I've felt bad lately that I can't do things as well as I used to.

Exhibit A: I somehow threw my back out and have been in total spasm for three days. Nothing helps. I FORCE myself to keep moving because I refused to let injury/chronic illness control me ... as a reminder, as a result of May's disastrous fall, Dr's also discovered bulging discs in my neck, as well as arthritis in C5-C7. I was also diagnosed with fibromyalgia. But I REALLY try to forget all these ... I just feel like I keep running into them.

I've found some diagrams of the muscles in the neck and face, so you can see how pain/inflammation/tension in one place (ie: jaw) tends to radiate, causing headaches, backaches, etc. I am trying to stay away from medications as a solution, but often there is no choice. With time, these muscles will loosen (I can do things like yoga ... which will be frustrating until I can get my muscles strong enough to get me up off the floor!!!) ... I just don't know how MUCH time. It absolutely makes me more compassionate for people who are not as fortunate as I am, for people who are in accidents and suffer injuries from which recovery is not really possible.

The diagrams below are pretty self-explanatory. Note the ones that lead from the TMJ ... muscles are kind of like those old curly telephone cords - one kink, and the whole line is screwed up. Or a slinky. If the slinky gets screwed up, it won't go down the stairs as easily. You can then purchase a new slinky -- can't buy a new body.

On exam, ALL the muscles shown here are in spasm on me (there are probably a few exceptions but not much). Blows to the head put tremendous pressure on muscle.

3 weeks post-op and ....

I HAVE A NORMAL JAW OPENING!!!!! 42 mm .... up 16 mm from two weeks ago. What do you know, the stretching worked! I still have to stretch (3x a day, down from 4x) ... and, unfortunately, my diet options have not expanded tremendously: "I'd say light chewing ... but nothing like a piece of white bread or anything." *sigh* So, same stuff as always ... thin, soft fish was an option, so I am hoping that means I can do sushi sans seaweed? Not sure. All I know is that I have a definite milkshake gut, lol.

I DID successfully consume about 5 SMALL cubes of melon before my jaw started to hurt (that's basically the rule: if it hurts, stop)

I am so surprised at how weak my entire body has become -- no one prepared me for that. I'll get back slowly ... lots of work to do!

I see the MD again in 4 weeks, which will put us at 7 weeks post-op. I'll post some really cool pictures later.

Love to all.

Hello All --

I know I've been a little inconsistent with my blogging ... mostly because I find it hard to formulate my thoughts into words (and I am not in the mood to do another video at the moment, but thanks for all the positive feedback on that!)

I had a really great weekend. A very good friend of mine from college came up and we went to the beach, which was really, really gorgeous ... I did more driving than I had done since before the accident, so I was EXHAUSTED beyond belief. But it was worth it to get out. AND my headache held off until after she left this afternoon *phew*

It was nice being with such a good friend. It's easy to forget how much that cheers you up.

Otherwise, it's more of the same. I have my 3-week post-op on Tuesday. I hope to get moved to the soft food diet as opposed to liquid, but I am not sure. My jaw has gotten very painful to stretch. AND I had the great fortune of Ruth, my very powerful rottweiler, pulling me head-first into the dirt because she was so excited to get in the care!!! I hit my head and nose HARD (and snapped my neck back), but that goodness it was dirt. This is getting a little insane!

I keep talking about how the rehab process is hard, and I wanted to explain more of that. Aside from the time commitment, I find myself wondering if I am ever going to accomplish my end-all goal, or has this put me out entirely? The arthritic condition in my neck makes me feel VERY old because people keep telling me what I can and cannot do. The woman that is my pain-management doc's assistant (different from my GP) told me that I would "never be able to do anything high intensity ever again," which is an awful thing to say. She was talking about how she couldn't imagine being in my shoes and not being able to go home and hug her son and toss him up into the air every day. Great. Bitch.

But it is SO hard to work through. My body is really de-conditioned, and trying to get it back is hard. I went to the gym and got my heart rate into the 160's within 3 minutes! Oops. But I lasted for 20 minutes at that pace. I prefer outdoor biking.

I think yoga is going to be best. I have never been very limber, but now I am MUCH less so. I figure that will help with some of the pain.

Anyway, that's all my boring news. I have some pictures I will post soon.

xox ymc

Some pictures ...

I'm about to do my jaw PT and then head to the gym to see how de-conditioned I am, but here are some photos. The Hawaiian flowers are from our friend in San Francisco (and were actually shipped from Hilo, HI). I am never happier than when I am on those islands, where I practically grew up as a kid, so this was a very special treat!

Because I am too lazy to type ...

I decided to do another video entry this time; a lot of people seemed to like the format. Besides, when I get kind of down, I find it hard to type ... if I speak, then it's just out there, if that makes sense. SO, here is video update #2. Thanks to Katie for the encouragement on this, and thank you all for taking the time to read/listen.

A Video Post

Just something a little different. I can fit four fingers inside my mouth this evening (stacked horizontally). The downside is that it HURTS and I feel it in the back of my neck ... so we have a lot of work to do rehab wise. This is the very, very beginning that keeps scar tissue from forming (my surgeon removed a TON of scar tissue from the left joint that I fell on -- my jaw was literally glued together from the damage from that).

Rehab is mentally VERY hard, which I am not about to show on video!! But I am not always so chipper. I was not prepared for the emotional toll ... 

And my voice teacher would be kicking my butt because my tongue is not down in this the way a good little singer's should be ... but hey :)

Again, so lovely to hear from so many of you. When I get angry at all this, I tend to focus on the two or three people who haven't even written to ask how things went ... but then I can read facebook and be reminded of all the wonderful people who have kept me in their thoughts and kept me entertained, etc. Love to everyone!

Post-Op Appointment #1

This is the last thing I feel like doing, but it's so much easier to tell several people at once. I had my first post-op today and apparently, I am doing "OK." Not great. I'm bummed. The tension in my neck is so bad that I could cry. My face hurts to the point where I am not sure if I am having an ENT issue or if this is part of the deal (singers are constant hypochondriacs! lol) ... hopefully I can get in for trigger shots in my neck tomorrow and loosen some of this up. And perhaps get a stronger muscle relaxant.

Basically, I was not stretching my jaw enough ... I was stopping when I felt a pull (as per his written instructions), when in reality, I should be working this as I should any other muscle ... to the BORDER of pain, allowing it to relax, then push further.

Even I didn't anticipate what a pain in the ass this would be. And very trying on my mood.

I am down to 2 Vicodin (10mg) and 4 mg Klonopin daily ... and I could use more after today.

Foods I can eat: anything I do not have to chew. As in, my teeth cannot make contact. At all. I am so hungry!

Foods I am craving: steak, hamburgers, tacos, tortilla chips with guacamole, a big Italian sandwich, BBQ, french fries ... and the list goes on.

No picture today ... soon.

Love to all.

Days 1, 2, and 3 (aka: it's Friday already?)

I have lots of fun pictures, lol. I promised to make this blog as honest and truthful as possible. This is not a pretty process.

I got to take my bandages off on Tuesday morning, but I was much more comfortable with them ON believe it or not! The provided some cushioning, but what was underneath was not so bad ....

They worked far more extensively on the left side of my face (where I was injured) than on the right, but there was still plenty of inflammation to handle on the right (the resident just didn't clean off my face after -- nice). The bruising on the left is still quite extensive.

I am on a liquid diet. And my pain killer diet has been interesting. Luckily the pain in my jaw has eased ... but I was taking Percocet (craaaazy stuff -- works for pain, but I don't like the psych effects) ... then Ultracet gave me a headache ... so I have not been happy. Worst of all, my GP who promised to manage my pain is TOTALLY MIA and has no one to cover for him ... I think there may be someone I can call tomorrow and get some pain relief for my back, which is really stressed out (and they are all connected, as we know).

This has surprised a lot of people: my surgeon has had me stretching my jaw 6x a day from day 1. 10 minutes heat, 10 minutes stretching, 10 minutes ice.

And this evening, I was finally able to eek out my first smile ... 

Love to all ... more updates soon. It's a long, slow process ... and I am just totally exhausted. Plus, I am trying to figure out how to go out anywhere while I am stretching my jaw 6x a day for 30 min. at a pop?

Let's just focus on more sleep .... lol

Post-Op

Surgery went very well, so they said. The breathing tube went up my nose, which I was NOT prepared for, and was definitely not sedated enough when they were shoving about three q-tips per nostril up there to numb it -- in fact, that was the last thing I saw! Then I was out, and I remember waking up with the tube still in and not being able to breathe ... though it must have only been a few seconds, because no one was freaking out ... and then I couldn't stop coughing. The anesthesiologist was shocked that I remember this! But I do -- it's a pretty unique feeling.

My body started seizing up as a result of anesthesia withdrawal ... not a full blown seizure (again, no one was freaking out), but my head would shake back and forth and then my leg would go, then shoulders ... SO strange. I think it took about an hour to stop, but time is kind of warped in there.

Morphine is a sugar pill! It hurt my whole body as it went through my veins, relieved the pain for about 30 min, then I needed more. awful. Surgery was 3 hrs, and I was in recovery for 4 ... then they got fluid back in me, heart rate down, and back HOME.

What a day! I'm never having surgery again, I swear. I'm feeling really awful today (2 days post-op) and am up now because I have a headache ... so I thought I'd write.

I've been so touched by the number of facebook posts and e-mails I've received -- it means so much.

Tomorrow! Tomorrow! I Love 'ya, tomorrow!

Well, I wouldn't say love. More like "you scare me, tomorrow" ... I always hated that song anyway.

so YES! Tomorrow is the big day! I had my nerves under control until the hospital called with a time :-/  Seemed a lot more real then. I have to be there at 11:45, surgery at 1:45, and if THAT all goes as scheduled (unlikely, I am told), I will be ready to go home around 9pm.

It's so scary to have to put your trust in other people's competence so completely. I like to be in control (that shouldn't shock any of you).

Believe it or not, my insurance JUST (as in 8pm) approved this surgery!!!! We knew it would, but they sure took their sweet time! In total, this surgery alone (including medications, anesthesiologists, etc. would total between $14-15,000).

Below are the latest pictures of yours truly. I keep trying to smile in them so I look less weird but it's kind of hard to look normal when you are contorting your jaw! This explains the measurements I discussed in my last post.

The photos are a direct mirror of me. In the second picture, my jaw moves further to the right; it is the left joint that had the direct impact, therefore it is harder to move it to the left (2mm, minimum is 5mm)

Nothing profound to say: my brain is kind of numb. I just want to thank my parents first and foremost, for all of their help thus far. A big thank you to my wonderful voice teacher ... and my wonderful friends. I am a lucky girl.

Lastly .... Joyce DiDonato singing "Una voce poco fa" (from The Barber of Seville, the opera that she fell in). 

http://www.youtube.com/watch?v=SJcuqaelqwE

And a 10 second clip from The Simpsons with Dr. Nick Riviera (the neighborhood quack)

 http://www.youtube.com/watch?v=WTz8rKJk-Vw

AND "You'll Never Walk Alone" performed by Renee Fleming at Obama's inauguration

http://www.youtube.com/watch?v=jrhDWKrRGCo

 

General Musings ... T-minus 72hrs.

It is very hard to find anything altruistic to post with surgery about 72hrs. away ... sorry about that.

T-minus 3 days (excluding today). 

I have gone from being so anxious that I feel like I'm going to be sick, to being so anxious that I am absolutely exhausted. Apparently, people can swing back and forth. Crazy amount of sleeping ... which is irritating because that is ALL I will be doing after surgery for a couple of days ... but I'm trying to "listen to my body."

I went out and spent a small fortune on bath stuff ... salts, bath bombs, bubbles, etc. I figure I can at least smell nice during this. It's the little things that I have meticulously planned to keep myself busy and not frantic. Bath stuff, check; new PJ's, check; puzzles/incredibly elaborate Lego set, check.

It's absolutely true that this surgery is more "serious" emotionally than it is clinically. Which I suppose is why the fear is SO DEEP. This injury has been emotionally devastating. And now, fingers crossed, there is a pretty good chance that I'm going to be given a SECOND chance at doing what I love. There are people who understand this more than others.

I keep trying to think FORWARD. I'm already cast in an opera in October (not a lead role, don't worry!) with a new company. Beyond that, though, I feel like I have a forward trajectory. I spent a lovely lunch with my former advisor from college yesterday; it's always great to be around people who believe in you!!! :)

I think that's it ... I wanted to leave you all with some funny opera clips. I know that not everyone reading this is an opera fan, but these are so universally hilarious that I am sure you will enjoy.

Renee Fleming/Sesame Street

http://www.youtube.com/watch?v=IPdP7XJdvlM&feature=PlayList&p=BB32D3924A31A021&playnext=1&playnext_from=PL&index=14

Beverly Sills/Sesame Street (3 parts)

http://www.youtube.com/watch?v=xBdCVJAPoSk&feature=related

http://www.youtube.com/watch?v=ScQHdEqp5DY&feature=related

http://www.youtube.com/watch?v=f4jXBpPwJv0&feature=related

Laughter is very, very important medicine.

xox

Mom, Dad, I have ... surgical anxiety

Yes, folks, the most exciting thing in my life now is that my hands shake uncontrollably even when my blood sugar is fine and I am not caffeinated. Even my dog doesn't want to be near me; I guess I'm giving off some vibe. ARGH. 5 more days .... 5 more days ....

I have tons of anxiety tricks (helpful) that I'll post on here tomorrow. My blog in fact IS being viewed by people other than my family and friends! I hope I am helping someone out there.

Had my final visit with the surgeon today. He's much nicer now that he doesn't think I'm a drug addict. I got questions answered, which was good ... basically, the worst that will happen is that I will stay the same. Which is highly unlikely.

My measurements are: 27-2-5

No, not those measurements. Clearly. Bad joke, Yona.

These mean that I can open 27mm high, shift my jaw 2 mm to the left and 5 mm to the right. Here are the averages for women (range): opening 42-75mm, shift L 5-15mm, shift R 5-13mm

Sooooo there's a ways to go.

I can't wait to bite into a huge sandwich. Or steak. Or caramel. mmm.

I'll be more interesting tomorrow. Thanks for stayin' with me.

Love

Famous Falls

T-minus 7 days ...

Since I woke up in an uncharacteristically good mood (I didn't realize just how pessimistic I had been feeling, I suppose). I decided to Google other people who have fallen onstage. 

Granted, they are famous people (and somehow didn't hurt themselves as badly!) Steven Tyler fell onstage just recently on August 6 (in fact, I believe he fell OFF the stage) ... Beyonce once tripped and fell down a flight of stairs onstage (head first) ... but the one I relate to the most is mezzo-soprano Joyce DiDonato, who took a bad fall recently during the Barber of Seville at Covent Garden. I can't compare myself to Ms. DiDonato in any other way, of course -- EXCEPT that she finished the show ... with a broken leg! Furthermore, she continued with the run (though I believe stopped early). 

There is a lot to be said for sheer will power. I have not spoken much about the accident that brought me here, or how in a split second, your life can change, or how if I had hit my head a fraction of an inch higher and hit my temple, I would have had serious brain damage (at best) ... I have delightful pictures of me in ER, but I will never, EVER post them online!!! I don't remember a whole lot, except my first thought being, "No way, Yona. You've worked too goddamn hard." And then I was up. And I finished.

Her ER photo-op is MUCH better than mine.

I suppose there are times when it is OK to pat yourself on the back. And perhaps I will meet Joyce DiDonato someday and compare horror stories. :)

Prayers, Fears and Welcome Realizations

In California, it is still T-minus 8 days, lol!

The past two days have blended together because I have been in so much pain with my head and neck. Has to be stress. Likewise, my cholesterol is also up!! What is this?! (ps, can't wait until I can partake in some of the candy in the photo to the right ... jawbreakers!! hahaha No one said anything about my blood SUGAR)

Despite blinding headache pain, I had a really nice day today. My voice teacher and I made a recording of a few lines of "Voi che sapete" from Figaro (the aria I performed right before the infamous fall!) ... and I was genuinely AMAZED and how much better I sound than I did in May. I just need to get that teeny extra opening -- it really did sound very beautiful. She does not give unfounded compliments, and it is nice to have this with me as I go forward for here. A MUCH needed confidence booster and a little something to hang my hat on before surgery.

That's about all ... not a very eventful day. Have my final pre-op on Thursday and then we'll get this show on the road .... but the nerves are really starting. :-/ All my memories of surgery are of my mother's breast surgeries (she had breast cancer); I remember how much they hurt her. I don't have good associations with surgeons ... I remember her being in recovery for HOURS for shorter procedures than I am having done. But I'm going to have to take it a step at a time.

It sounds SO silly, but even at 24 (and a half) years old, I am still afraid of when I have to leave my parents and it's just me and the doctors. I worry they won't call them right away when I wake up. I know that's silly ... I just want my family there.

And then, I want to be able to SING. I am not sure if my teacher was aware of just what she gave me today ... but I will treasure it always.

With Love,

Intubation: Concerns for the Singer

T-minus 9 days ...

The intubation part of general anesthesia is a little scary. A lot scary. After all, I'm having this surgery for the reason that I am a singer, I need my jaw to be comfortable and non-arthritic to sing, and I feel I have a future in the field. What if the anesthesiologist is scrapes my vocal cords?

I am also told that I need them to be very careful of my neck because of the various conditions there ... which may end up helping my cords in the end.

There is something called "fiberoptic intubation," which allows the anesthesiologist 

to look down the windpipe with a little camera in order to more carefully guide the tube. There is then a far lower risk of any damage to the vocal cords ... but I am going to be on the safe side and speak with my surgeon ahead of time on this to make sure the proper equipment is prepared. The image to the left shows what the camera sees as it is guiding the intubation. (Let's be mature, people! Those are vocal cords!)

As I've said before, it is more than fine for patients to demand the best quality of care.

I'm relying on this method and praying for a kind hearted anesthesiologist! These cords are my reason for being -- I know that must sound dramatic, but it is absolutely true. T

hey are my livelihood. Therefore, they must be completely protected.

Here is an informational video on intubation. It's not very graphic at all. It kind of makes me laugh because I am getting this image of an anesthesiologist using it as an on-the-job guide: 

http://www.youtube.com/watch?v=eRkleyIJi9U

Until next time ...

10 Days and Counting

Well, 10 days to go ... (technically less, because by the time this gets posted, it may be 8/10)

I'm starting to struggle with nerves. I don't like the general anesthesia idea. I suppose no one does.

I've been really blessed to have an amazing voice teacher who has been unrelentingly helpful and encouraging. We are moving on as we should be, making plans for the future, both eager to get this mouth of mine open (she would argue it never really closed ... :) )

I think it is so important to think positively. For me, it has been the hardest part. A jaw injury to a singer ... unreal. Completely ironic. Utterly unfair. It also happened just as I was starting to really gain confidence as a singer and felt that people were starting to really believe in me.

My teacher thinks God has a purpose for this, a purpose that we just haven't figured out yet. I don't see it AT ALL. I haven't gotten anything good out of this at all, and at times question my faith so deeply that it disturbs me.

But I do have my positive moments. Enjoy those. That would be my number one advice to singers in my position. Enjoy the positive thoughts, focus on them. Focus harder on them than anything else. 

On that note, I'm off ... and hoping for a better week!

The singer, the "Addict"?

I am not ashamed to admit that during the past several months since this accident, I have had to get a bit of professional help to deal with the ensuing depression and was put on an anti-depressant. 

Being a good little patient, I allowed my surgeon and psychiatrist to speak, simply because I figured the surgeon needed some sort of psychiatric clearance on me or something.

Instead, my psychiatrist (very soon to be former), who has a very professional title at Mt. Sinai, informed my surgeon that I am addicted to "opiates" and have used them in situations other than pain (therefore constituting abuse). As a result, my surgeon refused to treat me with narcotics.

I learned yesterday from the psychiatrist that I am an "addict" and have been "abusing" Vicodin. ALL I have done has been to call him to ask about interactions with Vicodin and the medications HE has been prescribing. I take Vicodin approximately once a week (sometimes not at all) for the pain that I get from my neck. My pain management MD AND my GP are aware of what I am taking. Doesn't sound like an addict to me.

I say this because patients NEED TO BE INFORMED OF WHAT THEIR DOCTORS ARE SAYING. Had I NOT been responsible, this crap would have stayed in my chart and become part of my record. Instead, due to the help of three amazing doctors, the situation has been corrected and the psychiatrist completely discredited. 

It is a fact that a surgeon will not treat you as well if he believes you to be some sort of junkie.

This is akin to identity theft and was a HORRIBLY embarrassing experience.

1) When you allow two doctors to consult, ask for a summary of what they talked about. It is also your RIGHT to request their notes from the conversation.

2) If something alarming appears, ACT. There is NO reason why a patient should be misrepresented. Call a physician who KNOWS you.

3) Have said physician smooth out the situation ... he/she can speak on your behalf and attest to your character, etc.

4) Make sure the erroneous information is stricken from your chart. Legally, it cannot be removed ... but the doctor can write "INVALID" or something like that across it.

As livid as I am, I hope SOMEONE learns something from this experience. Doctors do NOT have all the power; patients need to know their rights. I am not just a collection of cells and tissue and bone. I sought help because I was depressed. I was HONEST. And I get labeled an addict. I am by no means suggesting that people lie to their doctors; just use caution and DOUBLE CHECK WHAT INFORMATION THEY HAVE RECEIVED.

The Living Will

Yea. Woa. I know I am going to be FINE and that this is procedure, etc. But it still freaks me out! I'd be pretty pissed off if something happened (KNOCK ON WOOD). And I'm in perfect health, blah blah blah. 

My mother knows my wishes. It wouldn't be appropriate to repeat them here, as they feel very, very personal. 

I just don't like being asked such questions! Or signing off on them. Or putting them in writing.

I have more of a will to LIVE, thank you very much.

How It Works

First off -- if any of you are having trouble posting under "anonymous," (*ahem* Mom) click "preview" first and then post.

OK, on to the rest of my post. I wanted to describe the type of surgery that I am going to be having. It is called arthroscopic TMJ surgery, and as far as jaw surgeries go, this is about the least invasive as they get. Until the early 90's, this procedure was done as an open surgery, with a much longer healing and recovery time. With the advent of arthroscopic surgery, the procedure has increased in safety and outcome (my doctor helped pioneer this method -- which is reassuring). The above diagram gives a very loose idea of what is wrong, if I were to explain it with crayons and fingerpaints.

Now, I'm knocked out for all of this, but because I am curious, I looked up the procedure and everything. It is done under a general. As a side note, general anesthesia is a particular challenge for singers, for obvious reasons -- I am a tiny person, and therefore, my throat and vocal cords are 

tiny. If they are not gentle, the cords can be damaged ... but it is unlikely in a non-emergency scenario.

My doctor will insert a laproscope into the TMJ via a pencil sized incision. 

He will literally have a look around and see what kind of 

gunk is in there (bone debris, inflamed tissue, other damage).

 The joint gets "cleaned out" and all the rough surfaces are smoothed down, making it easier to open, eventually, hopefully, please God. We know already that my left TMJ is arthritic, but no one really knows the full extent until they go in.

It supposedly looks something like the diagrams below ... and since I clearly will be be taking pictures in the OR, these will suffice. 

That's basically it. He will "scope" both sides. Then I go to recovery, and then I go HOME! No overnight stay, which is wonderful. In addition to attempting the recapture the meniscus, though, as the diagram shows, he will be doing the procedures listed above. Nothing will be replaced (ie meniscus, etc.).

And yes, I am happy I will have no pictures of myself with all these things sticking out of my face!!

SURGERY UPDATE!!

My surgery got moved up by three weeks and is scheduled for August 17th. I am REALLY excited. I definitely paid (in pain) for opening that wide over the weekend ... it was so awful that it woke me in the night, which never happens. 

So, I'm going to go with it. I sat awake this morning practically in tears because of the pain and just silently prayed for God to just take the pain away .... and not even 3 hours later and I get a phone call from my surgeon's office. Too many things are happening at once. I can't explain it, but I finally have this little voice in me that is saying, "It's OK, Yona".

Not a good day pain-wise, so I need some rest ... need to keep these muscles loose.

ps - passed my pre-op physical with flying colors :)

Openings ... SERIOUS openings

I am completely in awe (awe-struck! ha -- sorry). I wasn't sure if I wanted to blog about this because I am superstitious ... but ... the pictures tell the tale. At some point yesterday (8/1), I opened my mouth ... and it just kept opening. No stopping and 2 fingers. Now, I've had this before, where I can open large briefly (a few hours) and then it goes back to nothing ... but I have been able to maintain an even larger opening for 24 hrs. now. I am seeing my MD tomorrow, as per our weekly meetings, but I need the surgeon to see this as well.

I have no idea what this means for surgery/no surgery (and my guess is, no one will make a call on that just yet) ... tons of thoughts running around in my head, which is why it is good that I am not my own doctor. There is still pain. But it's opening. 

I suppose I am being cautious because I know how awful this has been, and I have to tell you, it is a pain in the butt going around breaking your OWN heart by believing things that people tell you that end up not to be true.

The above pictures are hideous of me (and yes, I do own other sweatshirts, this just happens to be the same time of night) ...

I'm hopefully seeing my teacher on Tuesday so I can get a feel for this ....

.... and, if all is right and well by some miracle (please knock on wood for me as you read) ... well, let's just say that my crisis of faith will be having a crisis of it's own.

Pain "Management"

I find this to be one of the worst phrases ever, because really, how do you manage pain? Even with treatment, you cannot determine when and where it will reappear.

Perhaps I am particularly gru

mpy because I am in a particularly annoying amount of pain today. I had stabbing pains in my jaw yesterday during a voice lesson (it was the opening and closing thing -- if I could just stay open ...), which threw everything off and landed me with a headache today ... which wouldn't go away and is still nagging.

Sorry. Complaining.

So, let's return to TMJ pain management (for lack of a better phrase). I take Clinoril 

NSAID (non-steroidal anti-inflammatory)) for the inflammation in the joint and other tissues in the jaw. NSAIDs are pretty much standard for TMJ problems because they involved inflammation, especially when the joint is arthritic (which mine is). 

I also take Amrix, a muscle relaxant. They're supposedly addictive, but I couldn't tell you because I take them at night and then hit the pillow.

I also use a TENS unit, which uses electro-stimulation of the muscles to relieve tension and knotting. It is a very odd sensation, and I find that it actually does not go deep enough on me! Most people feel the current at around five ... I'm closer to 9. At least I was today, anyway. I can carry it around with me in this dorky little plastic box that resembles a walkman. Perhaps I should paint a walkman on the front of mine. Would I look like less of a dork? 

One of the loneliest aspects of this is that people do not understand pain., certainly not people my age. The pain may not always be directly on/in my jaw ... but may manifest in my neck or shoulders. It is very very draining. I am so thankful for the good days. It's not cool to have too much in common with old people!!! I've always been told I have an old soul, but come on.

But, I can't dwell here ... that's a fine balance: giving in to pain and resting or pushing through. I tend to go or the former, lol ....

Openings

This is not a very attractive picture, but it shows what my real jaw opening currently is: two fingers in my mouth, or approx. 22cm. The goal with surgery is to triple that opening (more or less). I am not sure how long that process will take.

I am trying to get myself into as good of shape (physically) as possible before the surgery. The more flexible I can get myself NOW, the easier things will be post-op. In that spirit, I went bike-riding today (over 5 miles!). Exercise is important to ANY singer, with out without TMJ problems! It keeps muscles limber and keeps the blood flowing to them. GET OUT AND DO SOMETHING!! Make it fun (bike-riding, dancing, etc.) ... but I am positive that anything is of benefit. 

Despite my teeny tiny mouth, I continue to take voice lessons. Why? What's the point anyway? My teacher and I spend most of our time now on breathing and intonation, which can be done without opening the mouth very much. And in the larger picture, it gives me some amount of hope that this will all be better someday SOON and I can move on with my life.

I've started to wonder about the role of the singer in silence. How does she maintain her persona? Is her instrument all she is? What other depths of life are there? Just some musings for the evening ...

The Pin Cushion

The muscles surrounding the jaw are directly impacted by the trapezius and other muscles in the neck. These literally run up the neck or over the skull; tightness in this muscles can further problems with the TMJ. 

Of course, with any injury, there is pain, and pain leads to muscle spasm (of course the disc damage to my neck did not help either. I receive trigger point injections every week from my MD, and cervical spine epidural injections every other week, all in an attempt to relax the muscles as much as possible before surgery.

 A trigger point injection involves the doctor palpitating the sore/tight regions of the neck and feeling for the extremely painful knots (trigger points). He circles the area with a pen and then injects a mixture of a small amount of medication with lidocaine directly into the muscle. The patient feels strong pressure and pain as the medicine is injected. The goal of the injections is this: when muscle is in spasm, no blood supply is going to the region. By poking them with a needle, blood rushes to the area, thus relieving (or partially relieving) the spasm.

My MD was very into my blog project, and allowed me to take pictures of the procedure.

And yes, it hurts! But it provides immediate relief (and helps release the muscles in the face). It is important that people with TMJ problems explore ALL their options for relief of muscle spasm. Surgery is less successful with muscle tension. Pre-op, patients should get themselves in as good of shape as possible ... again, so that the muscles can relax.

How to Comment ...

Not like I've had anything interesting to say yet, but whenever you wish to comment, simply click on comment and type in any of your addresses under the categories listed (ie: if you have a Google account, type it in) .... OR click OpenID and just type your name.

Hope that makes sense!

A Brief Anatomy Lesson ...

This is the tempro-mandibular joint (TMJ for short). Unlike other joints in the body, it slides back and forth. As a result of my accident, the meniscus (in blue) was dislocated, which can block movement. Anything that disturbs the sliding motion of the joint reduces opening (duh).

Purpose

I am a young mezzo-soprano and was recently injured during a production of the Marriage of Figaro, where I was singing Cherubino. Due to a collection of small mistakes (by management/production), I tripped and slammed the side of my face full-force against the stage wall.

Apparently, I bounced right back up and didn't miss a cue ... I just remember exiting into the closet and feeling blood coming from my ear!! I finished the production (I am quite stubborn).

That accident occurred on May 16. Over two months later and I am still needing medical intervention for three bulging discs in my neck and other issues. Yes, I do whine from time to time. It's not easy.

But the worst injury by far was to my jaw. The main impact was on my left tempro-mandibular joint (where I needed stitches to close the wound in my ear), and my jaw has not healed properly. My opening is less than half of a normal persons opening ... and much less than what I need as a singer. I am scheduled for surgery on September 10, which will have a 6 week recovery period, then more rehab.

I never blog, but I've started this in the hopes of sharing my story with others. Having an injury that directly affects a musical talent/emerging profession is particularly heartbreaking. My depression worsens with each day that I can't sing ... I feel silenced, and I wonder what I am supposed to do during these muted moments.

So that's the deal -- I hope to post updates as well as research on TMJ disorders ... we'll see what happens. This is so much more than an injury; because of this, I have been forced to conquer personal demons, question my faith and spend endless hours wondering WHY and HOW this happened.

Thanks for reading.