The graft and the gift
During my recovery the past nine months, there have been some events and occurrences that defy explanation. Almost all of them have been good. And two more of them came this week — helping balance out the fact that Kacey has been confined to bed and couch with a horrible case of what appears to be “Montezuma’s revenge” from our Mexican voyage last week.
Big news first: Today I drove for what felt like the 15th time to Harford County to see my oral surgeon. The appointment was for a second bone graft on my top jaw, one that was necessitated by the fact that bone grafts on the jaw are harrowing processes made even more difficult by the tendency of the body to absorb the bony material (in this case a mixture of cadaver and synthetic bone) as it is placed onto the existing jawbone. For me, the top jaw was a more difficult rebuild than the bottom jaw because, as the doc said during previous visits, it appeared that some bone had been knocked out by the sheer force of the impact. Think about that for a moment: Bone was actually ripped off my jaw. When he told me this a few months ago, it took me a few seconds to process that fully.
This lack of bone, a problem on both the upper and lower jaws but specifically on the upper jaw, was the problem, and the grafts would solve it. I had a graft on the lower jaw in February, and that took care of the issue there. Sounds simple when I ignore the fact that I had a claustrophia/anxiety attack in the middle of the hour-plus procedure.
On to the top jaw. The first graft there, in late April, added a good deal of bone to make a platform for the eventual implants, but as the doc said during follow-up visits — and after much back-and-forth with a fellow top-rate oral surgeon — one graft most likely would not be enough. Then, during a visit on Sept. 17, he confirmed it: A second graft was most certainly the best, and safest, option.
These grafts are a psychological challenge more than a physical one (and having another person numb your face, slice your gums and play Donatello with your mouth is a physical challenge), so I braced myself this afternoon as I swallowed two gargantuan amoxicillin pills and a tiny steroid tablet. The doctor dabbed anesthetic gel above my canine teeth and carefully inserted a hypodermic into the work zone.
Then he did something unexpected. He asked his assistant to help take an impression. This is essentially a 3-D model of the mouth made using a thixotropic (that’s the first time I’ve ever typed that word) gel and a bite tray. I’ve had many impressions done, including this year. But today? Why one today?
As the gel hardened, the doc peered into my mouth. He placed both of his thumbs against the top of my upper gum, where the inside of the lip ends. He pushed. He prodded. He pressed. His brow furrowed. The wheels in my head began to spin wildly hopeful thoughts.
He looked at the impression mold. He looked again at my jaw.
And then he said, in his homespun, kindly way, one of the most surprising things I’ve heard this year: “I don’t think you need another graft.”
He motioned for another surgeon at the practice to come into the room. Doctors love second opinions, and today, so did I. The colleague came in, took a careful look at the impression, then at my jaw. The drama built. What was the answer?
He agreed. Surgery, a certainty a few months ago, was now off the table entirely.
So, what happened? Why was there a big difference between what X-rays and molds taken months ago show, and what the doctor saw today? Did my doctor make a mistake in his initial verdict? Did the first graft, done nearly six months ago, work better than he expected? Did bone somehow regrow where it hadn’t before?
For now, it defies explanation.
In other updates on long shots, I went for a follow-up to the hand doctor yesterday. You may remember that in May, this doctor told me that the fracture in my right middle finger wasn’t healing properly, with scar tissue filling places where bone should be. At points after that, he considered surgery. He later decided to put that off, and he offered electrical stimulation as an option. He was candid in saying that he did not believe in this type of therapy, and that no hard data supported it. But once I found out that my insurance would pay for it, I decided it was worth three-plus hours of my time, every day.
A little over five months later, the bone has gone from a “nonunion” to nearly fully healed. I could still see the fracture lines on the X-ray, but they looked so normal that the doc gave clearance to stop using the stim device.
So, what happened? Did the electrical stim work? Was it the power of positive thinking? (Stop laughing and look at this post about the placebo effect and hair regrowth in a study done by … wait for it … the maker of Rogaine.) Why did bone somehow regrow where it hadn’t before? Is it possible that the stim device not only worked for my hand, but also my jawbone? (Seems to be the least likely explanation, but no good possibilities should be discarded.)
In five days, Kacey and I have gone from drinking margaritas and rum, to narrowly avoiding a catastrophic injury (more on that later), to dealing with a horrible stomach virus/infection/revenge, to celebrating The Graft That Never Was.
Oh, and one other note about that: The word “graft” comes from the Greek “grapheion,” meaning “to write.”
And that, my friends, is how to bring things full circle.