Return of the TMJ

Oh noooo! It’s back! 

For those if you who aren’t familiar with Tmj, let me direct you to my old posts about my first diagnoses back in Florida almost 3 years ago (check out the tmj tag). 

But for those who are, I had surgery for it while I was in Florida (athrocentesis) which didn’t perfectly fix the issue, but I was eating and speaking just fine. 

Until recently. 

Because of the stress of teaching (I’m sure many of you are familiar with that tightness in your forehead and jaw when you’re pissed) and overusing my jaw because of constantly yelling to be heard over the noise, my tmj is making a comeback. 

So much so, I was in tears from pain and anxiety. 

I don’t want to go through this again. I don’t want another surgery, I don’t want to go 2 months on a nearly liquid diet, and frankly, I can’t.  Not in a job where my sole purpose is talking. 

So as my jaw clicks and pops at almost every movement, I wait anxiously for the day it totally locks again. 

Great. 

TMJ Update: Night guard

Yep, back on that TMJ grind…no pun intended (ba du CH!)

About a week ago I was waking up in the middle of the night due to a loud and painful pop in my left jaw (the side that was operated on).  Even with the muscle relaxer, the popping continued.  I thought it may be from night-time tooth grinding (bruxism) which I know I suffer from.

Because a dentist-made guard costs like…$500…I bought an over-the-counter night guard for 10$ on sale.  I’ve been using it for almost a week and I feel like it, coupled with the muscle relaxer, has made a world of difference.  While my opening is still limited like before, I feel like I am having fewer…i dont know…sensations (?) in my jaw.  Not necessarily pain, per se, but an awareness of something wrong. Anyway, I think it’s helped a lot.

Yet another TMJ update!

How long has it been now since my athrocentesis? I don’t even remember…it was in October, and my final check-up was in January so…a while!  On my final doctors visit they stated that my opening was still restricted and prescribed muscle relaxers (flexaril 5mg) to be taken before bed, thinking that the limited opening was self-inflicted and due to muscle tension.  I took the muscle relaxers every night for about a week or two, but wasn’t seeing any improvement.

But, ya know, it wasn’t worse nor hurting so…who cares?

I decided to stop taking the muscle relaxers (I really hate taking medication unnecessarily), and limit myself to using them only when my jaw is popping badly or I’m having some pain.  Allah shukur, I’ve been well thus far.  I still feel my opening is limited, but I can eat, chew, and talk without pain the majority of the time- and even the popping has decreased in the right joint (my surgery was on the left and it doesn’t pop at all anymore- only very very rarely).  I still don’t gnaw on handfuls of gummy bears, but I do treat myself to some chewy goodness now and then that I enjoy in moderation- and very carefully!

In case anyone was following my progress and wondering how it went- there you have it!  I probably won’t be updating this topic unless something dramatic happens after this.

TMJ update (15 week checkup)

For those of you who have been following my progress after my athrocentesis for TMJ, I had my final check up at 15 weeks yesterday!  From my perspective, I haven’t been having much pain for the past month and a half.  Every now and then I get a dull ache after a lot of chewing or talking, but it usually dissipates within an hour without medication, but its not a frequent occurrence.  Also, the clicking/popping/ squishing sound in my joints have also abated, and only occur sometimes.

Anyway, the doctors said that my range of motion is back to normal (jutting the jaw out and wiggling side to side) but the opening is even smaller than my previous check up (only by 1mm).  I explained how the opening varies by day but it is, on a good day, only approximately 2.5 fingers (I don’t have any other way of explaining it).  However, there’s no pain per se, but a bit of a stretching, irritable feeling when I try to open my mouth wide, on the side of my procedure (but as soon as I stop trying there’s no feeling).  Apparently, when I was sedated during the procedure, they were able to open my jaw 3 fingers wide, which is the norm.  Because of the lack of pain, they believe that the inability to fully open is possibly due to my own stress and the muscle acting up, as opposed to the jaw.  They prescribed muscle relaxers (Flexaril) to take at night and see if it improves the opening the following day. I did so last night, and this morning I can fit 2 fingers loosely in my opening, as opposed to a tight fit yesterday.  We will see if it improves as I continue taking the medication.

Long story short, although I’m not 100% back to normal, the athrocentesis procedure helped me tremendously.  Anyone with TMJ knows that the pain can be excruciating… and honestly, I can live with a small opening but NOT with that pain.  So for me, it was a great improvement and the right decision to have the procedure done.  The healing process (especially the first 4 weeks) was a nightmare, and I was double guessing myself…but 15 weeks out I am very glad I did it.

Will update with the effects of the muscle relaxer in a few weeks

7 week TMJ update

Hey all, jumping on wordpress this morning very quickly to give a brief update on the jaw situation.  I have an appointment scheduled for late January with the surgeon to get the official word on my progress- but this is how it is from my perspective.

1.  I’m not sure about my opening (which is just over 2 fingers, please see previous posts about TMJ to understand what this means), but I have full side-to-side motion and jaw jutting motion, as far as I can tell.

2.  When chewing I do feel a bit of tightness in the left side, and sometimes the right side pops, but I honestly believe some of it is simply stress tension.  I am prone to stress headaches, which gives away how my face muscles react to stress.  Additionally, I actually pulled a muscle by my eyebrow so that it hurt as a sharp, stabbing pain in my temple when I raised them.  This cleared up in two days with ibuprofin, but this also gave me the feeling that I am causing some of my own symptoms.  Indeed, in the morning when I am not thinking about my jaw, I have no problems really.

3.  I am now chewing crunchy and chewy things- read kettle chips and english muffins- with little to no problems. Still staying away from gummibears…

While this is my perceived progress, I will update again after my appointment in late January!

TMJ athrocentesis 2 week update

Today was my two week follow up after having a TMJ lavage/ athrocentesis.  While I probably should have been describing my progress as it happened,  I was constantly upset by the information I gleened from the experience of others with this procedure/ disease and didn’t have the energy or strength to bother with much of anything- let alone my blog. However, I wan’t to share my own experience thusfar with my temporomandibular joint disorder and put another perspective out there for people to read.  All of this down-and-out business was NOT helping my recovery.  Personally, I believe wellness includes your own mental perspective of your condition as well.

Please note that I am a graduate student who has been seeing the doctors at the ajoining dental school, so the experience and education of these doctors may be different from others.  Actually, I was encouraged by this difference since I know that these doctors are still being educated.

Pre-surgery: Pain level was approximately 6-8 out of 10 depending on the day, stabbing pain in my left TMJ and radiating pain in my teeth and face.  Opening was 1 “finger” without pain, 2 “fingers” with stabbing pain. Couldn’t even chew eggs, very painful.  Even without talking/ moving I was in pain.

Day of operation:

On the day I had my athrocentesis I was very nervous!  My biggest concern, in all honesty, is that it wouldn’t help me.  I asked the doctor as they prepped me what the success rate was for this procedure.  The doctor told me that, in her experience, 80-85% of the patience she had seen saw improvement in their condition, while the rest saw no improvement. In her experience, she had not seen anyone get worse.  This made me feel a bit better and soon the “light anesthetic” knocked me out cold.

I was perscribed hydrocodone+acetomenaphine and ibuprofin for the pain and inflammation.  Since naproxen had given me a painful case of acid reflux I was told to take ibuprofin only as I could handle it (which was 200mg every 4hrs, come to find out.).  I iced the area non-stop for the first 8hrs after the procedure, as instructed.  The pain was manageable under medication, but I had to remain very straight, I couldn’t lay down without a lot of discomfort.  Needless to say, I didn’t get sleep that night.  (By the way,  I have completely recovered from the acid reflux caused by naproxen. It took a few weeks, but I can again eat high acid food! YAY!)

On the day of operation on, even now and for months more, I have been conducting “jaw exercises” that include opening as far as I can and wiggling my jaw side to side.  This should prevent scarring of the TMJ that could worsen my condition.

Could only eat broth

Days 1-4:

On the first four days I experienced a squishy-feeling, squeeky/crunchy-sounding sensation in my left TMJ (where the surgery occurred).  This was worse than the pain, since I am sensative to sounds and it was driving me crazy.  This was due to residual fluid after the flushing and is considered normal.  Each day the sound/sensation abated more and more and by day 4 it was pretty much gone, with some exception to occasional occurences (which stopped me in my tracks- like nails on a chalk board! but didnt hurt).  The pain was still there, but managable with ibuprofin only after two days.  I feel as though the right side of my face hurt more than my left, but this could be because I was babying the left side and putting all the pressure on the right.  NO clicking or popping at this point.
The biggest problem at this point was that I couldn’t close my mouth completely- meeting my molars together.  I felt as though a jelly bean was in my TMJ, preventing full closer and producing that obnoxious noise when I tried.  The pain was a dull ache. I was sleeping normally and fitfully, althought it took some adjusting to find a place that my jaw didnt align poorly.

My opening was a tight “2 fingers”, my range of motion for jutting my jaw past my upper teeth was minimal (couldn’t pass my upper teeth, a feeling a stretching) and pushing my jaw to the right was also limited (same sensation).

Could only eat broth and yogurt, but I had no noticeable swelling at the procedure sight and very very slight bruising.

Days 5-7:

Finally, on day five my mouth could fully close, although I felt some pressure.  Also at this point I noticed I developed a very obvious lisp.  At this point the pain was minimal, but I was still bound to ibuprofin , but now only one or two pills a day.  My opening was still a tight 2 fingers and my range of motion was limited as described before.  Now I could chew angel hair pasta, still very limited to soft foods.  Kept up my exercises, still sleeping well

At this point I was getting pretty upset. I had thought that this procedure, being minimally invasive, would heal quickly.  No, no it doesn’t heal quickly.  The follow up is scheduled for two weeks for a reason.

Days 8-10:

Everything was pretty much the same, but the pain kept becoming less and less. Same range of motion, occasional use of acetomenophin and ibuprofin as needed.  I had a spasm in the right side of my face on day 10, but I took muscle relaxors that night and everything was ok. Now I was carefully chewing well cooked vegetables like cauliflower.  If it took more than two “chews” it was a no go. Lisp slightly improved.  Moving jaw to the left sometimes creates a popping in my right TMJ, but opening is fine.  Occasionally I would feel a “stop” when chewing or talking, but I think I was trying to move my jaw past its range of motion without realizing.  This became less frequent throughout the days 8-10

Days 11-13

On these days I stopped taking medicine all together, I had no need.  I was able to chew soft foods such as bulgur, hot dogs, meat products, regular noodles, etc, and even the occasional hand-ful of peanuts.  Basically, if I could get it in my mouth I could chew it, but I would get tired.  Not pain, mind you, just a feeling of tiredness in my jaw.  Lisping only on certain words.  Range of motion was still limited but now I can align my bottom and top teeth, barely passing the top with some pulling sensation.  Pulling my jaw to the right a little bit more, but still feeling a pulling sensation.  Could open my mouth “2 fingers” comfortably, but this is not my pre-TMJ opening still. Still occasional right TMJ popping.

Today (2 week check up):

Today it was made official that my opening is the same as before my athrocentesis, but it is PAIN FREE and I think that’s a win.  Lisp is still improving and expected to further improve as my range of motion improves.  While I cannot jump into chewing gummy bears I have been advised that, if it doesnt hurt, chew it.  So I plan on trying some bread soon (soft bread is fine, but chewy crusts have been avoided up to now).  When I bit down on the tongue depressor to check for pain I had none, but this started my right TMJ popping when I opened my mouth.  I rubbed it, rested it for ten minutes, and the popping stopped.  I was advised to get a dental splint, but I don’t have $400.  The doctor told me, conspiratorially, that if I’m not having pain that it isn’t necessary, that I can try over-the-counter guards and if they don’t hurt me then it should be ok.  The problem is that, if the guards cause a misalignment, it can make my condition worse.  Since my occlusion and bite are perfect due to previous orthodontic work, the purpose of a splint would be to prevent grinding and relieve pressure from grinding that I may be doing (which I know I do on occasion).

In a disheartened state I shared with my doctor the horror stories I heard about TMD sufferers and how many people said they spent years with pain and problems.  I asked sincerely if I would be doomed to a life of limitations.  The doctor smiled and told me that, for many people, TMJ can resolve itself as long as you aren’t aggravating it, and hopefully I will continue to see improvements until I am back to 100%.  I have another follow up in 3 months to check my progress and be sure I am not worsening the issue.

So, to all those considering an athrocentesis:

1.  It helped me.  While my range of motion isn’t back up to where it used to be (approx. 3 fingers I’m thinking) I can eat WITHOUT PAIN  and for me that is the most important thing.

2.  Don’t be disheartened, with patience you can improve.  Honestly, after the first week I was in a very dark and upsetting place about my condition, and I think that hindered my progress more than my actual physical ailments. You will find more people complaining about a problem than praising their recovery, so don’t be overwhelmed by all the negative reviews you may find.

3.  It WILL take the full 2 weeks to feel better.  The first few days will suck, you will definitely need to confine yourself to your home.  Talking will be hard for the first full week, but after day 3-4 you can get back to work if it is not a very physically exhaustive job (office work-yes, construction- no)

I’ll keep ya’ll posted as I continue to progress! Inshallah I will be back to normal!

Temporomandibular Joint…and surgery on Tuesday

So, how do I start?  Well, I’ll start where IT started.  In May my jaw suddenly, and without warning, refused to open when I was eating lunch with my colleagues.  No, I wasn’t gnawing on taffee or chomping on peanuts, I was eating a fish taco- relatively soft with easy give when chewing.  I could barely open my mouth a fraction of an inch without feeling a clamping on the left side of my face.  In a tizzy I went to the campus clinic, and the nurse suggested I put ice on my jaw and take some sort of anti-inflammatory (read: ibuprofin).  I went home and did that and, several hours after it happened, I could move my jaw with some stiffness and pain.  In a few days, I was back to normal.

Then, in the middle of the night in August, I woke up to my jaw being locked again.  I got up, iced it, took some ibuprofin, and went to sleep when I was able to move my jaw more.  The next day it was still a little sore and chewing was difficult.  And day after that was the same.  And the day after that. And after that. And after that. For a week.  With constant ice and ibuprofin I was still in a good deal of facial/neck pain and I couldn’t chew without my jaw getting stiff (left side again) and aching tremendously.  One night the pain was so severe I felt like I was suffocating.  The next day I went back to the clinic and I was referred to an oral surgeon for TMJ.

TMJ refers to the temporomandibular joint.  This is the hinge and sliding joint where your jaw bone connects to your skull and, suprisingly, there’s a lot going on there.  A small disc takes the impact of chewing, talking, and general mouth movements, and several muscles like to hang around there too.  It seemed as though something in that complicated area had gone awry.  Anyway, I was perscribed a large dose of Naproxen (aleve) to help with the pain.  This worked for a while, until I began having side effects.

Apparently stomach problems, including heartburn and indigestion, can be a side effect to Naproxen that requires you stop taking it.  In the middle of the night I woke to a burning pain near my sternum.  The next morning it happened again.  This pain was deblitating and with some quick googling I found out this pain was associated with Naproxen use.  I called the physician and she agreed I should stop taking it immediately.  This was a few weeks ago and I am still scared to eat tomatoes (a common cause for heartburn) and I can’t eat too late at night.  After this craziness, I called the dental school (to which I was refered) to have my appointment moved up.

So, I went to the oral surgeon and they measured my mouth opening, palpitated my face, took some Xrays and poked and prodded…thank God for insurance… and they determined that the little disc I was talking about, well, it seemed to have slipped out of place and cause all kinds of disfunction in my jaw.  They scheduled me for a lavage/atherocentesis (a procedure of flushing out the joint, removing any adhesions, and working the disc back in- it requires two needles and is minimally invasive)…in three weeks.  In the meantime I had lost 11lb in the matter of weeks, been severly limited in my diet, in constant discomfort, and depression over all of it was beginning to set in.

Now finally….FINALLY… the surgery is Tuesday (5 days).  While I had been wishing the day to come I am now very nervous.  My biggest concern is that it won’t work.  While most patients in this scenario, no history of TMJ, sudden jaw locking, good occlusion (bite. I’ve had braces in the past) etc see great success with the procedure, I’m so scared that it isn’t going to help.  This constant pain and being unable to enjoy the food I used to love so much is heartbreaking for me.  It may seem trite and silly to those who haven’t been through it but…imagine a toothache that never stops and you can only eat liquids.  Yeah, it isn’t any fun.

Prayers and good vibes appreciated.  INSHALLAH I’ll be back to normal by the week after my surgery.