Five months later

Here we are nearly at the end of the year. School finished for my son today and it's time to move into holiday mode, yay! It feels to me as though my surgery and the fallout dominated my year.

Things are looking good though. I still take the nortriptyline every night (25mg) for the pain in my left jaw joint. At first I took 10mg and not much happened. Then when I was told to increase the dose I went to 15mg. No pain... then a few days later it returned. So up to 20mg - no pain - then a few days later it returned. Then up to 25mg and the same thing happened. It was as if my body was adjusting to the increased dose.

Then I saw my physio last week. He did some accupuncture in my jaw muscles. Yes it hurt a bit! As a result, the pain at night disappeared again - WITHOUT any further increase in dose - and hasn't returned. It didn't seem to improve my range of motion though (which I must say is pretty good anyway!).

Now I can get 3 fingertips in my mouth at a squeeze (which is normal for some people but less than what I used to have). I can really easily get my incisors together, and once I am warmed up I can easily get my lower jaw out beyond my upper. I can move my lower jaw over to the right but not as far as to the left. (I had zero movement there before the drug).

The physio said I can put the dose up much further if I want. It's only at about 50mg that it has any real brain effects. I notice absolutely no side effects at this dose. 25mg is actually considered to be the minimum effective dose. I think I'd probably give it up if it was affecting me in any other way.

Braces: damn those ugly things. I saw my orthodontist last week. He said not to worry about there not being enough contact between my molars on the right hand side. Once my braces are off the teeth will move together of their own accord. Also he said he can put some rubber bands on to make it happen and it will only take about a week. And he said that since we're trying to move the upper teeth around to the left it's a good thing that there's no bite there to impede that.

This spring hasn't opened up gaps showing that my teeth are moving around, but my midlines are closer. However the top midline is still well off to the left (how could they make such a mistake?). I made it clear I would really like it to be in the middle of my face. He still doesn't know if it will work or not. It depends how much gap this spring can open up between my top back right molars and then he can drag the neighbouring teeth around but doing that is really going to extend my treatment time.

However, I feel there is no option but to just put up with it and wait. Six months more.... a big drag but worth it in the long run. I have spent SO much money and been through so much that it's worth getting it totally right.

Every day I think how neat it is that my lips come together at rest.

I notice a habit of rubbing my incisors together. It's like my brain is really still a bit wierded out by them touching. I try to stop myself doing it because I'm scared it might lead to a night time habit. My brain sure isn't missing that feeling at the back with only the back left molars touching at rest though. Talk about ANNOYING. Getting rid of that is the absolute best thing about the surgery.

I talk about my brain as if it's separate to me there. It's as if there is a kind of primitive bit of my brain monitoring my bite that is a bit separate from my conscious brain. Am I alone in this? That's the bit of the brain that the night clenching used to come from (and according to my husband still does but just one click at a time, occasionally, not repetitively like before the surgery). It was trying to grind out the annoying bit. There was no other way to get rid of it (apart from surgery! My primitive bit didn't know about that!).

Also, when I think about different things or move different parts of my body I can feel which part of my brain is being used. Hmmmmm. Can anybody else do that?

Enjoying my new jaws

Yes, I am at last feeling relaxed and happy with this new mouth. The pain in my jaw joint is 99.9% gone. My physio told me to up my dose of nortryptiline and the night pain has disappeared accordingly. My jaw mobility is awesome! Well, in comparison with what it was. I can jut my lower teeth out beyond my uppers, and can open 33mm (and have further to go yet, I know). I can also move my lower jaw out to both sides.

My top teeth haven't moved over to the centre much but then it's only been about 3 weeks since the spring's been in. I've realised that for proper chewing it'll have to happen. I can't slide my lower jaw over to the right with the molars together (ie chew to that side) because the canines bang into each other. They in fact need to slide over each other but can't because they're not positioned correctly in relation to each other. My ortho was talking about this from straight after the surgery and I didn't know why he kept going on about it. Now I am functioning normally again I realise why.

Will I ever be satisfied?

So what is my new problem.... oh dear... well it's been around since my surgery happened but I haven't really noticed it until now. I can only chew well on one side of my mouth because my molars don't touch on the right side. My orthodontist was worried about this from the start but I didn't care. Now that my mobility has improved so much (I can even incise easily now), I realise that chewing meat and hard stuff is only successful on my left side.

The surgeon told me before the surgery that after the surgery my incisors would meet but my molars wouldn't and the ortho would have to bring them down. When I asked him if he still had to do that he said 'That's happened now'. But now I will have to ask him again if there's anything more he can do. I'm afraid I have been more work for him than he bargained for.

My pain continues to decline and I am working REALLY hard on my exercises. I am forcing my jaw well into the pain threshold and it is yielding results. Coming up to the 3 finger opening.

Medication and new spring

I got the new spring in my mouth to pull the teeth over to the side. No big deal. Sore teeth as you can imagine! I'll put in a photo soon. It's hard to see unless I pull my lip to the side.

The crazy bit is that as soon as I got it in my mouth I knew it wouldn't interfere with my jaw exercises. Remember that I delayed having it put in by 6 weeks because I thought that would be the case. I could have had the braces off before Christmas, because it is only meant to be in 3 months. Grrrrr. However he did say it could open up some gaps that would then have to be closed with power chains so I am thinking I could still have more than 3 months to go.

Today I went to a GP to ask for a prescription for the amitryptiline. WELL. I ended up with a registrar and it was AWFUL. She wouldn't prescribe it, didn't believe I have a TMJ problem. I said how come my jaw mobility is so awful. It's the braces, she said. I've noticed braces mean children can't open their mouths properly. I told her that was absolutely WRONG.

I could rant on about her but really have been so wound up it would not be good for me!

I got home and rang my surgeon. He wrote a script straight away.

The $40 I paid the GP would have been better flushed down the toilet.

Physiotherapist

Had the physio visit today. I went to it in a lot less pain - things have been continuing to improve on that front.

The outcome really surprised me. I came away with antidepressants! Well, a recommendation for my GP to prescribe some. Called amitriptylline - which as an antidepressant is used at about 75-100 mg whereas I will take about 5 mg.

I'll try to explain why but can't remember all the details. He says it is my lateral pteragoid muscle not moving the TMJ disc properly, and at night time it gets worse due to build up of metabolites and that the pill will break that cycle.

What an honest guy... he could have kept charging me $40 a visit for many visits, and that's still an option, but he really thinks this will work.

He did stick a needle in my muscle and I think there was some loosening afterwards.

Orthodontist tomorrow for the bizarre teeth-to-the-side-moving device. Since it has a spring as part of it, I can only imagine that it will take me to even deeper depths of foul food catching.

Feeling good

I am still waiting for my physiotherapy appointment next week but it is amazing how much my pain has reduced with time. My body is obviously working hard at fixing itself. My opening hasn't changed much, still at barely 3cm with terrible forwards and right-sided movement. But that is of small concern to me compared to the pain. The noise is disappearing too.

With summer coming on I am really really enjoying eating tomato sandwiches. Only someone who has had an open bite will appreciate what I mean. And I am very much enjoying the way my lips touch at rest.

Sadly two nights ago my husband heard me clenching in my sleep (just 3 clicks though) and I woke up with a terrible headache which lasted all day. Could have been stress induced cos my son has been really sick (chest and ear infection) and our car wasn't working so I couldn't easily get him to a doctor. Fortunately our neighbours babysat and lent me their car, they are so kind. Jack's much better now and the car is fixed.

He is the loveliest boy and such a joy to me. He made me a card for my birthday today that said "I love you so much Mama!"

I have lots of other stuff going on which I am loving. Our 3 Orpington hens are thriving, we have had them 2 weeks and they have almost doubled in size I think! They are SO funny and we love watching them and having them with us.

Also I have started Zumba dancing and yoga. These are fairly expensive hobbies. But they make me feel GREAT and of course are fantastic for the health and fitness. Zumba tonight, can't wait. Remind me NEVER to do another aerobics class. As my dance studio's website says, 'Ditch the workout, join the party!'. I love dancing!!

For 'before' photos, see the last July post.

(or the first July post for a summary of what was wrong to start with)

15 week photos

Here I am 15 weeks later.

Feeling pretty good. My chewing is improving I think. The changes are gradual so it is hard to know. The TMJ joint is still a problem but I have made an appointment with a physiotherapist for 11th November. He specialises in TMJ and sounds very sure he'll be able to fix it for me, probably in just a couple of visits. He says he'll probably do some accupuncture as part of the treatment.

I had an awful headache today. I had hoped they'd all vanish after my surgery but they haven't. I have had hardly any though. I think some, like todays, are migraines. I do feel a bit 'spaced out' during those ones.

These photos make me very glad I've kept the braces on to have the top teeth moved over to the centre. I get the necessary device put on on Nov 12.

By the way, my bite is still feeling GREAT. I really, really appreciate it, too.

My new blog

I have another blog as well, as of tonight! It's about our chickens, which arrived yesterday. We have three backyard chooks (NZ word for chickens). How's that for a good distraction from a mere jaw. It is lots of fun and I have been far too busy watching them to worry about my disc.

Here's the link: http://ourownchooks.blogspot.com/

3 1/2 weeks after arthrocentesis: update

The pain in my joint has returned a bit. Bummer. It's maybe a third of what it was before, so that's not bad, but it has got worse gradually and I am very scared that the decline will continue.

My mouth opening's a bit better now though. I can easily get two fingers in (but not two knuckles). I know it's still pathetic. I have slightly more side to side and forwards and back. Probably even more pathetic in those areas though.

It makes eating a bit hard. I can chew but not well. I am probably at 70 or 80% of full chewing capacity. Even fibrous stuff like an orange is difficult.

The scraping noise in the joint has been mostly replaced by something that sounds a bit like a thick gel with small crystals in it moving around. And even that is on the wane now, things are quieter in there (as the pain increases! Bizarre!).

It's hard not to get down about it. I do NOT want to be someone who had orthognathic surgery only to destroy her otherwise healthy jaw joint. This HAS to get better. It has been over 3 months since surgery now. But I guess that's really still early days.

On the bright side, my bite is still excellent.

Note to Cece: I know October 13th has been and gone. I wait in suspense and check your blog nearly every day!

Goodbye pain!

Yes, indeed, my jaw joint pain has all but disappeared! That arthrocentesis really did the trick! And my bite - lovely, centred, comfortable - I am blessed. I absolutely love the way my lips come together easily and my jaw can sit relaxed, nearly closed, and when I do close it all my molars fit together beautifully.

My mouth opening is a bit better now with hard exercising of it. I can get a big fat grape in between my front teeth without bursting the skin if that is any indication. But still forwards and sideways is fairly dismal.

I can still hear the bones in my joint scraping.

However, I think it will come right.

And Dana, yes the time does seem to have gone really fast. My life is full and busy and it is nice not to have my mouth totally dominating it!

These braces will come off!

I saw my orthodontist today. He wanted to take the braces off "while the going's good", he said! Yes indeed, that is how good my bite is! But no, said my vanity, this 'off' midline at the top needs moving over.

It will take 3 months and involve wearing a funny spring thing instead of a rubber band, which can't be removed. So we decided to wait 6 weeks so I can work on my jaw exercises without any restriction. On November 12 I will have it on, which means the braces will come off mid Feb! Yay! Hopefully my horribly sensitive upper teeth will have calmed down by then.

Also, he said it might not work and the teeth might not move. But I am convinced they will.

I'm a bit sad the braces will have to stay on for the summer/festive season and I will have to go through all those barbeques and general social things with the food-in-braces problem. But it will be worth it in the long run. It will mean I will be in braces for 18 months total - not bad.

My noisy joint

Ah, maybe I was too optimistic. The bones of my jaw joint still rub/scrape when I chew or talk or do my exercises. It is quite horrible know ing your bones are scraping together when they shouldn't be. And how do I know.... of course it's right by my ear so I can hear it!

If my disc was in its correct place, it would prevent the rubbing.

And I can only move my lower jaw forward about 1mm - seriously pathetic - which is apparently a classic 'disc is in the way' problem (because the disc displaces forwards and prevents that forwards sliding movement).

Still, my bite is great. I see the surgeon (a back up one, my one is on holiday) again in a week so I guess I will get the verdict then.

I keep swallowing the rubber band I'm wearing on my braces at dinner time!

My lovely centred bite

Great news, since the joint was flushed on Friday my bite has stayed centred right where it should be, all teeth fitting together like nature's jigsaw puzzle. And to touch the joint has lost its strange bump. These are excellent signs that the procedure has been a success.

It's still pretty sore though and my jaw mobility remains pathetic. I remain dedicated to exercising it.

The jaw flushing

I had the arthrocentesis procedure yesterday to shift my left jaw disc back into place. I'm not sure it's worked.

They gave me iv sedation but I do remember at least part of it (not the full 45 min it took though). I specifically remember the surgeon grabbing my upper and lower incisors and pulling my mouth really wide open, and it hurt a lot. I cried. I remember everything at the end and when I came out.

The surgeon said the disc was definitely in the right place when he finished. But now my range of motion is just what it was before and the joint still hurts. I am meant to launch back into my jaw exercises now.

But my bite does seem to be centred, and not just when I lie down. So that is a very good sign - maybe the joint is still unhappy from being so manipulated. I have been given painkillers so I guess some pain is expected.

So, outcome is still pending.

10 week photos

Hey, my face has got even skinnier! And saggier!

It'll be good to get those top teeth moved to the centre. I shudder to think what the rubber band configuration for it will look like! I see the ortho next Tuesday.

But tomorrow I have my jaw-flush procedure. I am really looking forward to a normal healthy jaw joint again. 10 weeks of pain from the damn thing. And to be able to open my mouth more.... mmmmmm, lovely. Wish me luck.

My top teeth are pretty sensitive still, and some of them sore to touch. I couldn't bear to have my braces removed yet, even if it was option. I would need some local anaesthetic! And I still have the patch of numbness on my top right lip, near the centre. It itches at times.

Other than that, all is good. I am definitely happy with the cosmetic changes. Roll on happy chewing days.

To Darnsie

Hi Darnsie, I saw that you are following my blog and read about your jaw problems. But you have no blog that I could see?

I can see why you are following my blog because our cases are quite similar!

I always blow my nose too, and the bad news is that I still do after surgery. My surgeon opened my nasal passages somehow - by removing some bits of bone - and I wondered if that might help but there is definitely no improvement in the nose blowing.

Good luck for your surgery. When is it? Let me know if you do a blog.

Best wishes,
Andrea

A procedure to help with my jaw pain

I had a 10 week post op visit today. Basically the surgeon said he'd expected my jaw pain to be gone and my mouth opening to be quite big by now. My pain is as bad as ever and the opening is barely 2 fingers. So this Friday he will perform 'arthrocentesis' (also known as lavage) on my sore joint. This is because my displaced disc has become jammed, he said. Sometimes it gets suction-cupped onto something and it needs to have the suction broken.

He said the jaw exercises I've been doing so diligently are probably just aggravating it (it feels that way, too).

I nearly cried when I heard this but now I feel okay, and hopeful it will relieve my pain at nights, which sometimes feels like it couldn't be much worse to have a knife stabbed in there. He said it always works, but it's not always permanent. I am determined it will be!

So I will have it done in his office under IV sedation (which will be a new experience for me). He'll inject local anaesthetic then flush out the joint with saline via a needle (no cuts to my skin). He'll also manipulate the joint to try to get everything in place and inject steroid in there to knock back the inflammation. It's very non-invasive (just fluids squirted around, really) and there are no side effects apart from possibly a funny eye that evening.

The relief should be instant. I NEED that. Currently I have to sleep on my back all the time because it's so painful for my joint when I on my side, but this nearly kills my back. I consulted a physiotherapist today who is certain I have a 'tilted' pelvis, which I can get away with when I sleep on my side. But tilted pelvises complain bitterly when slept on from behind. Presumably it kind of makes the pelvis go straight when it's not really. I will be getting some help for this.

Also my bite will align itself nicely (which it does now at night anyway).

Another bit of wisdom the phsyio told me: the body's metabolism, which usually washes away swelling at a certain rate, is at its slowest at about 2-3am. This leaves things like injured joints more swollen and therefore sore. And tissues around cut bones etc too, I guess, for those fresh out of surgery who wake up at night.

I note that I have some new followers. Exciting! Hello out there!

Painful jaw joint

Oooh last night was a bad one. I have a cold and maybe that interacted with it, but I was practically writhing with pain in my left jaw joint many times. I kept going back to sleep and then surfacing again and again. It felt like someone had bashed my jaw joint with a hammer. Naturally I felt awful today.

Tonight I will take anti-inflammatories. Maybe I will take them solidly for a couple of days.

A new 'bump' had appeared below my jaw joint yesterday. It feels a bit jelly-like. There is a much smaller version below my right jaw joint. I think it's a muscle. I suspect I've been forcing my mouth open too hard during my jaw exercises.

8 weeks post-op photos and update

I feel good now. That said, I am exhausted tonight, but that's just having a busy life! Lots of my top teeth are super sensitive as the nerves come back. My top gums are totally numb still. My palate has a streak of fairly raw sensitivity on either side of it. My mouth opening is probably 2cm or so. I do my jaw exercises about 5 times a day. The last remaining 'outer' numb bit is the middle of my top left lip but the feeling is coming back. You can see that lip is still not quite closing the same as the right hand side. The surgeon said to massage it to break up any scar tissue. I remember sometimes.

My left jaw joint, with the slipped disc, still hurts, unfortunately. The pain got worse when the tightish bands came off after the last ortho visit a week ago. Just bad at night. I sleep on my back most of the time and it still hurts a bit, and hurts a lot when I sleep on my side (but I have to do that a little bit or I have a very bad lower back in the morning). Also it used to go into a nicely centred, aligned position during the night but it doesn't do that at the moment (although it gets a bit closer to the centre).

It is interesting for me to compare these to photos taken at 6 weeks. I can see that I have become even less swollen. I wonder if I have further to go, or is this it?

Yesterday I saw someone I hadn't seen in ages (and who I never knew very well) and he didn't recognise me and when I said who I was he looked at me strangely. "Have you changed your hair or something?" he asked. I just said no, I've got braces now.

I think the surgery has improved the look of my face. Almost no one has said that though, just a couple of people, compared to about 20 who have said I look different. Strange. I wonder if they are really thinking I look WORSE?

Here are some photos of the 'off to the sidedness'. It deviates more as my mouth opens wider. Unfortunately I can't see any change here since my 5 week photos.

In general I just live in hope that the joint will heal, the pain will go away, the bite will centre itself.

My orthodontist's last band arrangement, seen above, worked FAST, in less than 24 hours. Cusps all fit together nicely now (when I move my jaw over to its centred position).

Seven week mark - orthodontist visit and strange comments

Today I am 7 weeks post-op. Feeling good. I've been doing the jaw exercises my surgeon gave me 6 days ago and can now not only get one index finger in my mouth, but its big fat knuckle too! And the pain in my joint has gone down a lot.

Today I saw my orthodontist again. At the end of it he said he wants to SHAKE the surgeons for getting my top jaw off to the side, that they should be obsessive-compulsive about getting it right! And earlier when I said that I'd told my (main) surgeon 2 days post-op that I thought the midline was off to the side, and that he'd said it just looked that way due to swelling, he also made a comment about them just saying things like that as excuses (or to that effect, I can't remember his exact words).

Gosh. I didn't know what to say. I'm glad he shares my disappointment but I would rather not be aware of dissent between surgeon and orthodontist. I just want them to get it right. I wish they would sit down together and talk about it so at least I'd feel sure they were on the same track.

I got the feeling that he thought that the surgeon should have realised the midline was off when I pointed it out and taken me right back to theatre.

BUT I must point out: neither he nor the surgeon picked up on the midline problem. They only got onto it now because I pointed it out. That is WRONG!!! I could see it the whole time but stayed quiet because I forced myself to trust that it was just the swelling.

Really I am more convinced than ever that you can't just trust health professionals totally. I couldn't help anything here but we really have to look after our own health because there is no one you can totally trust to pick up the pieces.

Basically the orthodontist feels that he is left to clean up the mess, and has only very limited techniques at his disposal compared to a cut-and-shift.

So can he help get the midline thing right? He thinks he can improve it but it will take some time and wearing of a band configuration which is a bit of a pain.

He thinks that the top jaw is not just off to the right slightly (approx 1mm), but skewed around on its axis slightly. That is why when I close my jaw in its central position the teeth all fit nicely on the left but not on the right. There are a couple of cusps banging on the right. However I don't quite follow the argument that the skewing is the reason for the banging, because the surgeons fixed my lower jaw to my already newly fixed top jaw, so presumably the lower jaw is slightly skewed also and should therefore fit the top one. (I only thought of that while driving home).

So now I'm wearing one bizarre band only. I have a bracket on the inside of a top molar, with a band going from it to the outside of the molar below it, so when I close my teeth I'm biting on the band. This is meant to move the top molars on that side outwards a bit so their outer cusps no longer bang on the cusps of the lower teeth. He seems fairly confident that will work.

Then after that he works on moving the midline over.

Goodness knows how much longer I'll be in braces!

Recently whenever I've seen my orthodontist I come home feeling like there's a disaster. Then I see him again and it's somehow passed for him! I suppose that's just his personality.

Before this surgery I spent lots of time visualising a perfect outcome. Is this life teaching me that nothing is ever perfect? One of my main emphases (is that a word?) was lack of numbness. That worked well. But things happen that you'd never predict.

The people I've showed the off midline to all say you'd never ever notice it unless it was pointed out. Personally I could definitely live with it if I had to ... but not the banging cusps. I know they'd just wear away over the years and cause pain and dental problems. They have to be fixed.

Six week photos and some good news on the bite

My lips do actually touch. It will better without braces on.

This is probably the best place to see how my midline's over to the side. It would be really nice if the orthodontist could tweak that but I'll try to be philosophical about it if not.

Yellow/brown teeth eh. The mouthwash I was given did it, apparently. I will have to see my dentist after the braces are off to see what can be done.

I might not look 'perfect' but I can definitely live with what I have now!

Last night I slept on my back all night and NO PAIN in the joint. This is great. What's just as good is that my aligned bite, which always appears at night, lasted most of the morning instead of being gone by breakfast. Great. And I've been doing my mouth opening exercises. I'm meant to do them 6 times a day! Too hard! He said 4 would be OK.

6 week surgeon's visit

Results of visit today:
- my surgeon is still sure my jaw joint will recover, perhaps not until after my braces are off. He says I'm in a very different category to people with chronically displaced joint because this is an acute response to the surgery. He thinks it's a great sign that my bite goes back into place at night.
- tooth pain up top.... go see the dentist, basically! He said that when the nerves come back to the top teeth pain is normal because the nerves are immature and haven't developed their protective sheath yet, so they are oversensitive. But I need to see the dentist just in case.
- midline - yes he agreed it's about 2mm to the side, he said it's a pity and seemed a bit disappointed. I did say straight out 'Is this a mistake' and he agreed. He thought it was possible the orthodontist might be able to fix it.
- I have a set of exercises to do 6 times a day! eek! To get my mouth opening properly (it opens only 15-20 mm) and being able to go side to side and backwards and forwards (it can barely do those movements at all).
- he is very pleased with my lack of numbness.
- he said that the stitch they put in under the nose goes from the nose into a strip of bone behind the nose. They drill a hole into the bone to make the stitch. I thought that was very cool! That is why it feels so tight, he said. "Nice nose," I said, "I like it." He looked pleased.

I have been chewing but let me tell you, it is pathetic! So much for being excited at being able to chew. I really need these exercises. The surgeon is sure they will help my jaw joint too. Yay.

Sorry no energy for photos. Tomorrow, perhaps.

Six weeks post-op today

No photos tonight, but tomorrow I promise!

Six weeks ago I had been out of surgery for 6 hours or so and was full of promise and hope for a 'perfect' outcome (if a bit groggy with it).

Tomorrow I see my surgeon again for the first time since 2 weeks post-op. I definitely don't feel like it's all 'perfect' but I must appreciate the good things so here goes....

1. I think my headaches, which had plagued me for years, have gone. That's a BIG plus.
2. My open bite is gone. I started chewing today and it is great to have all my teeth touching. A much better system than just two at the back! I am yet to feel a proper bite into food because my movement range is so small I can't get my top and bottom incisors together or my mouth open far, but I will be given exercises for that tomorrow.
3. I think I look better.
4. My lips sit together at rest.
5. My septum is straight (I REALLY didn't care about that but I am looking for positive things!)
6. At night my bite is perfect and, as a result, I'm fairly sure I'm not clenching (I need an arrow back to the 'no headaches' point for that because I think they're related). That also is a very big plus.
7. My healing has gone really well.
8. I had minimal numbness and most of what I did have has gone now. I think there is still some numbness on my nose but I'm not sure. It's still quite tight, presumably because of the stitch they put in to stop my nose going wide and piggish. My nose is a bit different but I like it more than before. The inner part of my top right lip is still a bit numb. I wouldn't care if I remained with this amount of numbness forever, but I know I won't.

But the bad bits....
1. My left jaw joint obviously still has the displaced disc that arose after surgery because my jaw HURTS all night. It's enough to wake me about hourly but not enough to keep me awake. The pain spasms occasionally during the day. Also my bite skews off to the right. Chronic pain is a big negative! So is a badly aligned bite!
2. I have some really sore upper teeth as they get their feeling back. This might be normal, I don't know. I'm terrified one or more will be damaged and I will need root canal(s) and crowns.
3. I am convinced my top midline is off to the side. The surgeon said it only looked like that because of my swelling but that's almost all gone now. I could live with it, but it seems like a bad thing to have got wrong.
4. My speech isn't normal. I think I sound like I have a bit of a speech impedement. Surely that will come right though.

Anyway, I await my surgeon's visit tomorrow. Mainly I want to know why he is so sure my joint problem will resolve itself. I've spent too much time searching for info about it on the internet, to repeatedly read how it is often a chronic problem. One of the reasons I went ahead with the surgery was because my surgeon said with a bite like mine I was very likely to get joint problems as I get older, and I'd read how awful the pain can be. Now I know and I don't want to know!!

Will update tomorrow.

Overnight improves the bite

I can confirm: When I lie down at night my bite aligns. Last night I got a mirror and could see that even when I open my mouth, the deviation to the right is minimal, it almost opens straight. I guess it's gravity making the jaw settle in better.

My jaw joint aches a bit at night. Not badly.

Five week post op: photos

I think my bite is getting better - midlines getting closer. During the night and when I wake up in the morning, my bite feels perfect! The top photo is with teeth closed and the bottom one when I am opening my mouth a bit. You can see that as I open my bottom jaw swings more and more to the right, away from the joint with the displaced disk. But I really take heart from the nearing midlines when my mouth is closed. That has to be a great sign!

I think my jowls are shrinking!

To me it still looks as though my top midline is off to the left, but it could definitely be an illusion created by having more swelling on the right than the left.

I'm feeling good. Heaps of energy most days. Numbness continues to reduce. My cheek feeling is back. Lips are normal apart from the top right (that still sneers a bit), and it is giving me lots of tickles.

My backmost right upper molar has feeling and HURTS. I can barely brush it with my soft baby toothbrush without pain. All the rest are numb. I hope like heck it's just supersensitivity as the nerves come back - although that also scares me because if all my teeth feel like that I am going to be a bit miserable until they settle down. The only other thing I can think of is a damaged root during surgery but there is no hot/cold sensation problem, and it doesn't hurt to bite down on it. It could still be that, I know. Funny how it's not numb like the rest.

Almost everyone I see comments on how my looks have changed. Most of them make no comment on whether it's for better or worse! One did today, said it looked good. Most of them just say 'so when can you get your braces off' - they think it must be the worst thing ever! I would love to know, and to have them off, but it's low on my priority list.

The splits in my lower jaw, which were really sharp at the corners to start with, are nice and softly curved now.

I have NO pain apart from the odd twinge from the troubled right tmj joint. I have stopped taking my anti inflammatories as of yesterday (because I ran out) and stopped rubbing in the voltaren gel (because it said to use for no longer than 2 weeks).

I still feel pretty tight under my nose, especially when I wrinkle it up, and talk. I guess it's the stitch they put in there. It's more on the right side than the left.

Another slightly depressing orthodontist visit

My orthodontist did not scold me for wearing the bands differently but told me not to do it anymore. He said I am on the tightest bands he has and two is too much.

But he was impressed with the improvement in the bite. Now I am back on one band either side I fear my lower jaw will swing over to the right again.

He did say I could change them twice a day, because they get loose and saggy after a while. Certainly I can tell that by the end of the day. So that might help.

I know I clenched again last night. My teeth hurt this morning. I clenched on my improved but not perfect bite position - on my left hand side, the outside cusps of my lower molars clash against the inside cusps of my upper molars. Only the lower ones hurt (the top ones being dead numb still).

Just another 1mm over and I would be there.

He also suspects one of my canine teeth has died and I'll need a root canal. He went to do his test of putting cold on it and I had to point out to him that my upper teeth are completely numb so it was pointless. I can't believe he didn't know that! He might as well have been spraying a hunk of wood for all I could feel on any of my teeth and that is how it is with everyone who has upper jaw surgery for a while (longer than my 4 1/2 weeks post-op, anyway). However the reason he suspected it is that my tooth is discoloured and it might just be the savacol mouth rinse I had to use after the surgery, because that puts a brown colour on teeth.

He said there is nothing orthodontically he can do to fix my bite and if it doesn't 'settle in' then the only option would be another surgery, but he doesn't think it's bad enough to justify another surgery. However he says he really DOES think it'll settle in - yet his demeanor doesn't match the optimism of his words. So I was pretty disappointed to hear there was nothing he could do to help if it doesn't happen by itself. I don't know why he can't just drag all the teeth over slightly. But he's the expert.

4 weeks today. This surgery is great!

My top right lip isn't so sneery anymore, it's definitely improving. The numbness isn't so 'solid' feeling either, but it's still there. I do have a kind of light sensation on the very surface of the top right lip and the skin above it now, but there's a numbness deeper down.

I am still pretty swollen on the right hand side.

Below I am opening my mouth slightly, which shows the bite better:

But check out what my bite used to be like! (This one is me trying to get my front teeth together - my backmost left molars were touching). I LOVE my new overlap. And I haven't even got to use it yet.

Wow. Seeing these photos, and comparing to the before photos (see more in July postings), makes me realise what a MAJOR improvement there is! It's just so amazing that the surgeons can do such things. And the way it happens in the space of a few hours, after years of wishing for that nasty extra bone to be gone. It is still hard to hang in there and wait for my bite to be aligned - wait for the midlines to line up - but it really helps to see the overall improvement.

Clenching update: on Saturday night I put 3 bands on either side and I was clamped tight so hard I couldn't do a thing! I did it so I couldn't clench/grind. But I woke up in agony, it was like my teeth were being ripped out of their sockets with the tight bands. So now I'm wearing two on the left and one on the right. It feels like it improves my bite, and the pain is all gone - well sometimes there is the slightest twinge in my jaw joint that scarcely enters my consciousness. Could it be the band configuration or the anti-inflammatory pills my surgeon has me on again? I don't know.

I feel like a renegade doing the different band configuration without my orthodontist's approval. But I can't bear to harrass the poor man anymore, and I see him on Thursday anyway. I wonder what he'll say. Has he ever had a patient who takes matters into her own hands? Will he scold me? Am I being silly doing it? It feels very right so I will just trust myself.

My speech isn't great because the bands are tight. I am still mainly on mush but can jam things like noodles, chocolate brownie and bacon and egg pie through the small gap in my teeth, and mush them with my tongue, so I am managing to eat plenty.

Today I was tired. Very hard to get out of bed and had to have a sleep in the afternoon. But this has become unusual and I'm fairly good most days. Although I can't do as much as I used to. I know that will return.

My sleep is acceptable. I sleep all night but surface quite often. There is a slight discomfort to my jaw. Not really pain. Often a headache still, but not a really bad one. It usually goes when I get up.

I definitely have less numbness. The spot on the right hand side of my nose that hums in a warm fuzzy way when I wash my face has a fair bit of surface sensation now although seems numb underneath the skin. And the exploding tight feeling under my nose has eased a lot.

Clenching

A terrible realisation came upon me this morning. I woke early and lay in bed half asleep. Then it happened - a big fat grindy clench. This was a huge problem for me in the years before my surgery.

This time, I was clenching together my two canine teeth on the right, then grinding them past each another down into my bite.

Before, I was clenching and grinding on my two back molars on the left that touched. My teeth are badly badly worn at the back as a result (and as a result of normal chewing on such badly positioned teeth/jaws).

So this is good and bad. Good because there was no guarantee that my clenching/grinding was due to my bad bite. Apparently studies have shown people with perfect bites grinding their teeth, and bad bites with no such problem. It was having a bad impact on me because of headaches, the tooth wear and having to wear a splint every night to protect my teeth.

However I always felt it was due to the bad bite. I feel this proves it. Now I have a different bad bite and the crazy subconscious part of my brain that wants to get rid of the 'incorrect contact' goes to town when I go to sleep. And it does it in a way that it specific to the bite - clenches down on the 'wrong' bit. Today's was quite a different movement to the old clenching.

Also it is good because this bite with the canines too close is expected to be temporary, so it's not like I need to worry about doing it long enough for the teeth to wear away. And it's good because it does suggest that when the bite is aligned there won't be the stimulus for me to do it.

Bad because it must be really hard on my injured jaw joint and indeed I wake - or more like slightly surface - fairly frequently with pain in it, even though there's no pain before I go to bed, or no similar pain during the day. During the day it's a stabbing, fast, brief pain.

Also, if I'm not meant to chew yet, what will this be doing to my bones etc? Apparently the force that goes into night time clenching far, far exceeds anything that can be done voluntarily during the day. (Although as my surgeon has said a couple of times, he had to detach the muscles to move the jaw, so the muscles very much lack strength to start with.)

Strategy: tonight I start sleeping in the same bed with my husband again (I've been in a different room scared I'll wake him). He is the best one at monitoring my clenching because I am very lucky to catch one. He hears it while I'm asleep. Then I'll get some idea of how much it happens. (Hopefully for me he doesn't sleep too heavily to make him a decent clench policeman!)

Then: muscle relaxants. I can't take the one my surgeon usually gives out because I get these horrible jerky full body muscle spasms. I can talk to my sister in law who's a pharmacist to see if there are alternatives.

Then with this info I can ring the surgeon. I dread doing it becaue I do feel like I've harrassed him a lot. But I may have to.

Nerves nerves nerves

My nerves are speaking to me! The nerves I refer to are the ones in the big numb patch on the right hand side of my nose. When I wash my face, or rub that part of it, I get a very strong, warm tingly feeling there that lasts for a minute or so. I quite like it. The first time it happened (about 3 days ago) it was followed by the whole area doing some bizarre spasming - actually twitching and moving so it could be seen! Something is coming to life!

I have full feeling everywhere in my lips except the right half of my top lip. I feel very lucky about that, because I know in the top lip and upper jaw the feeling always comes back.

I rang my surgeon today because the shooting pains in my jaw joint continue. He spent quite a while kindly explaining things - the exact same things he'd said to me last time he saw me (he probably just thought I needed the reassurance of hearing it again). Basically that it's due to everything being in a different position and he's surprised it's not happening on both sides, and that the big pain I felt in the hospital was the disk moving outwards and that's still causing pain etc. I knew all that, but the orthodontist had said to ring him and tell him about this different kind of pain. Anyway he left some anti-inflammatory pills with his receptionist so I went to pick them up. I was meant to take one tonight with my meal but forgot... the pain has actually been much less today! They're really expensive little beasties, those pills, I think, so I don't want to feel like I'm wasting them. (Not that I pay for them, it was all included in the fee.)

More comments today about how different I look, including from a friend who I hadn't mentioned the surgery to.

I've felt great the last couple of days. I planted a plum tree yesterday! The weather has been stunning, great to be outside and hard to believe it's winter. And today I walked my son to and from school (the children biked, I walked). I don't feel particularly tired tonight at all. Running is not good - I had to run after my daughter on her bike - makes the face bounce and increases the pressure.

I feel my speech is still impeded but I'm not sure that others notice it.

Unplanned orthodontist trip

I rang my orthodontist this morning and asked, via his receptionist, if I could put my elastics back to the 'box shape' he had them in before my last visit, because my jaw joint was sore. He asked me to go in, which I did, and he and agreed that the box shape would be a better approach right now.

He seemed disappointed the midlines are still so 'off'.

As soon as he put the elastics into a box shape my bite felt better. It touches on both sides now (even if only at one point on each side!).

But I am still getting unpredictable shooting pains in my left jaw joint. Horrible. Mind you it's only been about 3 hours since I was there. I must give it time!

He said that if the pains don't stop I should let the surgeon know what's going on.

Three weeks yesterday

Nice jowl. There is still a lot more swelling on my right side than my left.

Can you see how my top midline, between my two front teeth, seems to be off to my left? However on an x ray it clearly isn't, everything's symmetrical - it's an illusion created by the soft tissue, which will hopefully disappear when the swelling does.

The bite's not much better. However I have done some internet research and found out that what I am waiting for is 'disk recapture'. This is when the disk in my right jaw joint, which is bulging out of its proper home, returns. That is what is thought to be pushing my lower jaw over to the right at the moment.

So now I have the language to give instructions: joint, recapture your disk! Disk, be recaptured!

Two nights ago I woke up to find myself pushing my jaw over into the correct centre position and repeatedly clicking my front teeth together. Fun, such a novelty having not been able to touch them for years! BUT What actually woke me was the pain in my jaw joint - it was very angry with such behaviour and punishing me severely.

This week I am walking my son to school in the mornings but relying on others to deliver him home. I can walk to school fine but get really tired on the way home. It's about 1.5km each way I think. Yesterday I lay down and slept after lunch (while my daughter pulled out every toy she could find) only to be awoken by a man in my house saying 'Andrea!'. My friend's husband had unexpectedly done the picking up. Gave me a surprise! I must start locking the door.

I am generally having good sleeps at night now. All my stitches are gone from what I can see and everything's healed really well. I have energetic times but there is definitely a tiredness and lack of energy still.

Generally I feel pretty good about the whole thing, I just want my bite in the right place and my sneery lip to drop. Oh, and my nose numbness to end. Given that all these things are bound to happen, I am pretty lucky!

This is my daughter. She will be three next month and is coping SO well with me laying around a lot! She often asks me 'Are you better yet?'.

Energy UP

Gosh. Did nothing whatsoever yesterday and had a horrible headache all night. Decided that lying around all day was not that helpful after all.

Today I just did normal things. Went for a 40 minute walk with my daughter - no problem! I was only slightly tired. (I had a big rest half way.) Then did weeding and digging etc in the garden in the afternoon. It made me hungry, and then I had a 'normal meal' with the family - fried fish, mashed potato, peas. Mushed it up with my tongue and lots of tartare sauce. I was the only one eating it with a teaspoon.

On Friday I took my daughter to a dancing/music thing that happens at a local church (not that I am a church goer). I missed out the jumping bits! Afterwards I went to get a cup of tea and the man serving the tea said to me "Hi, I'm Jack, what would you like?" Well, I have been going there for four years and he's been there nearly that long too, I see him nearly every week! Crazy.

Then I talked to one of the ladies that takes the classes who knew I was going to have the surgery (her cousin's an orthognathic surgeon). She didn't know I'd had my surgery and looked at me and said "So, what have you been up to recently?" as in normal conversation, she didn't notice I was any difference! Funny how different people see different things. I notice this very much since having children - one person will say 'She is exactly like you' and another will say 'She is the spitting image of your husband'.

I'm not sure that I've mentioned my neck. It was quite sore to touch from day 1 and that is where all my bruising was. I also had a cough from the beginning due to whatever they ram down there during surgery so you can breathe. A loose horrible one. I still have a slight cough. But to cough is so painful! My neck is so tight at the front. I can look side to side fine but to look up - it is all tight and painful and on the right hand side there is a cord/tendon type thing that sticks out and runs from my jaw to my collar bone, it feels hard as iron and won't let my head go up further. I had never even seen this beastie before the surgery. So every day I look up as far as I can and stretch it until it hurts. I am sure it will give in one day.

Better dash. Have to put my son to bed (who also looks just like me or just like Ian depending on the beholder) and order seeds for our summer vegetable garden.

Tired and often despairing

Yes, tired. Sleep fine at night but still so tired! I remember last weekend when I did fairly heavy gardening for hours on end and cleaned the house! What was I ON?

Only my right top and bottom canine teeth touch again. It feels awful. I can just get two teeth together on the other side but that's with a very hard squeeze (which I shouldn't be doing). So it seems like things are getting worse not better. I could not physically chew if I was allowed to. I am hoping it's because my orthodontist has moved the canines back. He told me he was going to do that. If I'd realised it would create this situation I would have asked him not to!

So this is how I'm coping: I'm trying to pretend I'm someone who's never had a bad cold before and has no experience from other people either. I catch a bad cold and feel miserable. Then I am my surgeon, assuring me that the illness goes away! Then the novice with the cold (me with my swollen jaw joint) has much trouble believing the surgeon-me. But, as a rational adult, just has to believe him.

Certainly all evidence suggests he is right. On a post op panex shot he sent me (hard copy I'm afraid, I can't put it up for you), there is a big gap at one side of the ball at the top of the left joint. And the joint spasms occasionally and complains loudly when I yawn. The other side is pain free. And my surgeon is in no doubt at all that it will heal fully.

Of course the despair is there... I envisage another surgery.... all the what-ifs in my mind keep churning around.

So then I fret about why this had to happen, it would all be so perfect if it hadn't. But hey, there's hardly any point, is there, this is real life. I would probably be so positive about the whole thing I'd be mouthing off on the yahoo orthognathic support website and annoying other people.

Strangely the eating is no longer bothering me much. We make our own bread and I arose from my full morning back in bed asleep to find a loaf my husband had made. It was fresh and warm. I had to try. Smeared on lots of butter, cut it small, inserted it in the small slot between my teeth, and mouthed it down. I had 3 slices. YUMMMMM. I had really bad pregnancy nausea esp with my second child - sheer torture and absolutely nothing to be done about it. This is easy compared to that. It takes me ages to eat enough to get full but once I am at least I have several hours off even having to think about it. Compared to 8 weeks of feeling horribly sick all the time and vomiting every day.... I would choose this over that any day. Mind you the pay-off was better for that, if much delayed! She is the yummiest little girl! In many ways I write this blog for her in case she needs the surgery one day and it helps her... her lower jaw.... cross bite, on a slope... not a good legacy to pass on. But she is gorgeous, she looks a bit like Drew Barrymore with curls.

I'd better go to bed.

17 days - some before/after photos

Still lots of swelling, readers, especially in the right cheek, upper lip, and under and around my nose. Plus that funny little sneer which kind of lifts my top right lip, fortunately also temporary. But it's already clear that my surgeon's chopped out a fair bit of my top jaw and brought my chin forward. I like it.

I have had an interesting range of reactions. Lots of people just say how swollen I am. Only couple of people have said I look quite different. One said my chin looked good, the other just said "Does that take a bit of getting used to?". And today the orthodontist's receptionist said "I wouldn't have recognised you walking down the street, I can't believe how different you look". I think that's a bit extreme. I guess she just gets used to recognising people by their mouths, perhaps it's an occupational hazard.

I just feel I look like I should - more like I used to when I was younger. After my extra jaw growth happened I used to look at photos and couldn't believe it was me. So it's a return to normal, really.

In a month or so I will be meeting up with someone who has only seen me once since I was in my early twenties. It will be interesting to see if she notices any difference - I doubt she will.

Today was good. I slept all night, and had no rests today, I felt fine. My son was home from school with a runny nose so I kind of had to keep going, but it didn't bother me.

My divine children sat quietly while the orthodontist bent over me today. Apparently after I saw him last (on Monday) my surgeon rang him and told him that the reason my jaw is over to the side is because of my jaw joint misbehaving. I surmise that after I told the surgeon how the orthodontist had made a slightly disparaging comment about the bite - that it may never be perfect - he thought a phonecall was in order to stop the man scaring me like that!

So today the clear message was that he thinks my jaw will gradually drift back over to the centre position. He put a looser arrangement of bands on me which has actually allowed it to drift more over to the SIDE which I hate, but I must have faith.

Basically he was very very nice to me and told me he was giving me preferential treatment because "you're special". Basically he got rid of all my upper surgical hooks apart from the required ones. This is a new approach, I wonder if he felt bad about worrying me.

I still don't sound that good. I think it's mainly because of the fat upper lip.

I'm off to put heat on my face and massage in my anti-flam ointment (which is kind of like Deep Heat, if you know that cream). I did it last night and it felt divine. I swear my bite got temporarily more centred afterwards, for a while.

Two weeks and two days

Here's my rating of the first two weeks: not too bad! Compared to having a baby, the pain is nothing. I have had two babies with no pain relief. Then you really get to know what 'bearable' means (or that in fact it means nothing because you can bear what you previously thought was unbearable, and retain your sanity (just)). Also, there's no one waking you during the night and other people do most of the work around the house for you. And you get to have heavy drugs when you need them. The emotional angst is minimal, whereas with a new baby I found there were emotional extremes never otherwise experienced. And I have NO regrets about the babies. Or the surgery.

Also three years ago I got a really bad flu type virus and slipped a disc in my back at the same time. Coughing and sneezing were agony. I'm finding this much easier than that.

That said I'm up and down. Not feeling so good today - tired, sore back, headaches at night. But I sleep in a bed again and it is bliss!

I saw my surgeon yesterday. He is really happy with my progress and amazed at how good I am for this early on. He pressed various muscles all over my face and expected them to be sore and tender, but they aren't.

I am almost off pain killers - the only two problems are headaches (which he said are common and a result of everything being in a different position and various feedbacks to the brain being very overstimulating, or something to that effect) and my teeth moving. The rubber bands the orthodontist put on my back teeth on Monday are already doing a great job of pulling them down out of their sockets so that they touch, but it HURTS! The same kind of pain as a regular braces tightening.

He said my sneering top right lip is definitely temporary, a result of things being tight, swelling, nerves etc, and he's seen it lots of times before. He still feels really confident that my lower jaw will move over when the swelling in the joint subsides but that it will take "quite some time". Until then I have a cross bite.

I can eat any soft food I want, but I can't chew for another 4 weeks. This is still very restrictive I am getting skinny. My hip bones stick out. I have to try to get more in.

I can brush my teeth. Excitedly, I removed my rubber bands and brushed the front and sides. Then I went to open my mouth to brush the surface of my molars and.... nothing. My mouth wouldn't open. It's like the joints have fused and there isn't enough of an opening to get a toothbrush in there. I will try a child's brush. I did a rough job with the little interdental brush I have.

When I see my surgeon again at the six weeks mark he will give me jaw exercises to do. In the meantime my job is to put heat on my face and massage it.

Today I am going to take my daughter to her gymnastics class. I won't be able to do all the skipping, hopping etc that the parents do with their children at the beginning, but I want her to go. I'll probably doze all afternoon again!

Two weeks today

I planted trees, dug and weeded in the garden for many hours in the weekend and generally felt great - but today all I could do is lay in the sun and dozed most of the day! My little girl just kept clicking 'Play' on the DVD.

My friends are being so great and I am not having to get my son to school and back again, he is picked up and delivered. I might do it myself later in the week.

I rang my orthodontist this morning because although I'm seeing the surgeon tomorrow, I was so concerned about the hook digging into my top lip. Also, with droopy hooks, there was nothing left for the surgeon to work on anyway. And the pain of the rubbed mouth was starting to break through the numbness. I went in and he took off the very tight bands, fixed the hook and put some elastics in on the sides instead.

My bite is still well over to one side. At first he said things like "I'm not too concerned... once the swelling goes down these things tend to come right...." And then at the end he said "We might not be able to get your bite right, but at least you'll be able to incise and chew". OHHHHHHHHHHHh. I haven't done all this for 'at least'.

My sleeping is quite light and I am DITCHING the reclining chair tonight and moving into a bed. I'll just use lots of pillows. I am very sick of sleeping in a chair.

I can tell that hunger could get to be a bad problem as I feel better. Making a new soup each day gets to be a drag and there are only so many bowls you can swallow. My appetite is growing. My bands are a bit looser now but I know it will still be about 4 weeks before I can actually chew. I already have lots of recipes lined up for when I can. In the meantime, I cook for my family then sit down to gruel.

Swelling going down - day 12

I can't figure out why my top right lip does that - is it because of the saggy surgical hook and power chain underneath it? They do jut out. My lip is numb, that hook might be eating away at my lip and I can't feel it.

What a day! I am totally exhausted and shaky cold tonight but today I did two loads of washing, took the children to the library (and even SPOKE to the librarian with my clamped-shut mouth, it is embarrassing), gardened for about 3 hours and had a bath with my daughter. A good day.

I did have a horrible headache all day which is becoming pretty normal for me. Not the headache I used to get, in my right temple, more of an all-over one.

The swelling is WAY less. There is still lots under and around my nose though, even if the more obvious cheek swelling is on the way out.

Still waking up at night with the joint pain, darn it.

There was an interesting article in today's newspaper concerning my surgeon. I knew part of this story but not all of it. A month or two ago a man was in town and saw what seemed to be a woman getting beaten up. He went to help her and the woman and her friends turned on him and beat him up very badly. One of his eye sockets was broken and his eye dropped 2cm. Unbelievable. My surgeon, Brian Whitley, operated on him and had to put titanium mesh under his eyes. The man spoke of how wonderful Brian is. Then, five days after he got out of hospital, he got swine flu which led to him being in the intensive care unit, unconscious..... The man is training to be a police officer and will continue his training when he's better.

SO basically I have NOTHING TO COMPLAIN ABOUT. I am absolutely fine.