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 ....