'E' is for ... EXERCISE

Exercise is a four letter word, isn’t it?

Well, some forms of exercise are ;)

- L-e-a-p, j-u-m-p, lift, flex… :)

Sound too energetic? How about swim? Or walk.

We all know that exercise increases fitness levels and helps you lose weight. But did you know for many chronic pain sufferers, exercise can improve mood, give a general feeling of well-being and actually help control pain levels?

The reason for this is Neurotransmitters, remarkable bodily control and functioning mechanisms. One of these neurotransmitters is endorphins - powerful hormone-like substances produced in the brain that function as the body’s own natural feel good chemicals and painkillers. And scientists have discovered that during physical activities - including sex -but exercise in particular, the body releases endorphins which can produce feelings of euphoria and a general state of well-being so powerful, it can actually mask pain to the same extent as morphine can.

In addition, exercise releases adrenaline, serotonin, and dopamine which work together to make you feel good, and it decreases stress hormones such as cortisol.

The problem I’ve had recently and alluded to in recent posts, is that I’ve lost my mojo and I need motivation to exercise. I won’t beat myself up that I’ve let it slide recently because I had a good excuse having major surgery. But it's time to get back in the saddle, so to speak.

This A-Z challenge has given me a bit of a buzz again for the first time in months. Positive thinking and laughter provoke the production of endorphins, the same as taking a walk during a sunny day or meeting an artistic person does. And I can see it’s the endorphins, my natural feel-good hormones that are kicking in. The challenge has got me focused and motivated, writing again EVERY day, and with the encouragement and support I’ve received from fellow bloggers, it’s really spurred me on. THANK YOU.

I believe in exercise and the power of endorphins. Exercise has kept me out of hospital for the last ten years. And it helped me tremendously last year while I waited for surgery. TMJ pain was the most incredible pain, like no other pain I've ever suffered. And I’m sure one of the reasons I coped so well and have recovered from major surgery so quickly was because of my level of fitness and the positive outlook.

My next step is to get exercising again. It can't be a marathon, or a run at all for that matter. I can’t do anything high impact - it must be strictly non-weight bearing or it causes flare-ups - and I can’t push myself too hard or too fast for the same reasons. I can’t afford to mask pain so I will listen to my body. I know from experience that all it takes to promote those endorphins is moderate amounts of exercise to get effects.

Swimming and cycling are my thing, and Yoga is perfect as it reduces tension and stress and focuses on stretching, breathing, and motion that release negative emotions in the body.

So, there you have it – my‘E’ is for Exercise... and Endorphins.

Until another day
Bye for now
xx

Progress II

Well I’m back. Not just back home but I’m me again. Mrs Doubtfire has left the room. It's five weeks since my surgery. And again for the benefit of anyone else facing total replacement TMJ surgery (see previous blog,) here’s my progress from when I came home...

The first couple of days out of hospital I’m as delicate as bone china. The pain is brutal. I can’t stand noise. I sleep like a geriatric, nodding off for minutes here, hours there. Unable to concentrate and read a book, I am content to flick through magazines.

Quiet Mousie grins broadly whenever I look at him, thrilled to have me home. Idle Jack has a few days off to ‘help.’ When I first hear this, I'm anxious at the prospect, and of him making his mess everywhere. While I was in hospital he didn’t visit and barely sent a message. First day home and he’s gone off to his girlfriends to stay over. It’s like he doesn’t care. That’s teenagers for you. When I eventually see him he’s sheepish. Furtive eyes. Then I realise. It’s not that he doesn’t care. He was frightened. And now I’m home and he can see me, he’s better.

I’m soon appreciative for his efforts. He makes soup and cups of teas, prepares food and does housework without me asking. We sit and re-watch the Harry Potter films 1-6together in anticipation of the launch of the latest film. By the time he goes back to work, I miss him and his good nature. I’m blessed to have my two boys.

7 days post op


The first time I go out is to have my stitches removed. Walking into my doctor’s surgery I grasp Hubby’s arm and everyone stares as if I’m Frankenstein’s monster. I apologise to the nurse for doing this to her on a Friday afternoon. It takes forty-five minutes to remove them. It could have been worse. But not much.

Stitches out - 10 days post op



I send a message to friends on Facebook and post photos. I think about writing but thinking is as far as it goes. Ideas stay locked in my head. A week later and I’m able to read a chapter of a book. Trouble is, I’ve changed the book about five times.

Progress has stopped. Or it’s so painfully slow, it’s undeterminable. Everything hurts above the neck. Parts of my face won’t do what I want them to do. I have a new party piece - I can lift only one eyebrow. The other sits like an overstuffed caterpillar about to fall off a cushion over my eye. I scrunch my face up and will it to move. My brain’s playing silly buggers with the nerves. My consultant told me there was no point doing physio, it’s futile exercising stretched skin. I need to wait for the swelling to go down. It will take time. All I have is time.

Showering is difficult, especially washing my hair so I bath. I’m unable to manage without the morphine - something to do with brain receptors, endorphins and tolerance levels, and the awful pain I had before surgery. I mustn’t feel a failure. It’s most important to stay on top of the pain. Pain will hinder healing as will lack of sleep. Just get through the days, and nights; the incredibly long nights. It’s hard to sleep propped up high in the Princess and the Pea bed next to hubby but it will reduce the swelling quicker.

Patience has never been one of my virtues. Where's the day on day improvement?
I count the days since surgery. My consultant told me it might take six months to get my jaws working. It's two weeks. I'm being negative. I am my own worst enemy, creating such high expectations. After eighteen months of TMJ pain, I thought I’d feel the difference straight away. I don’t. I need to stop this. Frustration will only set me back.

At last, a breakthrough. I try a different strategy. When people tell me how great I look, I musn't think they are simply being kind. One look at the photographs and I can see the progress for myself. With the stitches out, the scars are fading fast. When I wear my hair down it’s hardly noticeable. I look amazing, considering. Stop the negativity. Concentrate on the P words; PROGRESS. POSITIVITY and pat myself on the back daily with any progress, however small.

I thrive being more positive. I notice my jaws are not clunking when I eat or talk; the sound is more of a quiet rustling, like fabric or newspaper. I can get a toothbrush into my back teeth. More progress. I don’t spend all day watching Escape in the Country on the Home channel. I remove my pillows from the sofa and put them back on my bed. It’s best to keep sleep for night time. I start thinking of Christmas and open my organiser. I can clean my ears out. I prepare dinner and stick it in the slow cooker. And slowly, as I accept my limitations; that it’s normal, and all part of the process, I find it liberating. Before I know it, I don’t need morphine in the mornings. I care about getting Take That tickets for next years tour and spend most of the day, trying to secure them. I walk round to my neighbours, my first time out. I blog, my first blog post op.

Somewhere around the 20 Days post op mark, I turn a corner and venture down to the bus stop to collect Quiet Mousie off the bus. Driving is tricky but it’s good to be behind the wheel. With Hubby back to work I have to push ahead with domestic duties; getting Idle Jack to and from his shifts, putting washing in, hoovering. It’s slow. But I’m doing it. Every day I see progress.

A week later and I’m back to the Consultant for the post op check up. My mouth opening, 2cm is good for four weeks post op. My bite isn’t right - it was something he flagged before the op - but it's the nearest he could get it. It feels worse than it looks. To my mind, I'm Janet Street Porter wearing a pair of false plastic teeth that are about to pop out. And my teeth won't bite together so it’s impossible to eat salad or spaghetti. But it's troublesome, not insurmountable. At some stage I might see an Orthodontist to see if they can correct it without further surgery because it would be much better to avoid that. If any bacterium gets into my replacements, the only action is to remove them, have them sent off back to the USA, cleaned and put back in. By the time he's finished emphasising the perils of infection, I am clear that it's something I must guard against for the rest of my lifetime, including infections from deep back fillings or tooth extractions.

We talk about other concerns; the drooping eye, lazy forehead, numb patches, etc etc. He can see movement so he thinks it will come back; it may take days, weeks, months, maybe a year. It's normal. So are the occasional electric shocks that spasm from my jaw line down my neck. They are muscle spasms and should ease eventually. It's the same with the swelling. He expects that to take another couple of months or so. I'm progressing as he'd hoped, if not better. And he’s delighted I’m off the morphine.

Now the hard work really starts. He gives me a box of wooden tongue depressors. Five or six times every day I need to place a clutch of sticks in my mouth to increase my jaw opening. Do this for the next two months and gradually increase the number of sticks. I start at thirteen. I’ll see him again in another two months. Then six months. Then annually. Forever.

I go back home and ram the sticks in my mouth. Within three days I’m up to eighteen. It’s been slightly slower this week. I’m managing twenty-one but that's good. It's still progress.

So here I am up to date with this, my second blog post op. I'm encouraged when I see the photos of the surgery and what I've had done. I know I'm getting there. Staying positive has not always been easy. TMJ replacement surgery is complex and the recovery is a slow process. I've needed to keep some goals in mind; to have something to aim for, even when I couldn't see how I could possibly achieve them and I look forward to the time when I can sit and write the days away once more; probably in the New Year. I still have my eye on getting the second novel critiqued on the RNA New Writers Scheme. And that non-fiction book about living with chronic illness or pain and staying positive. However as I sit here, writing this, feeling more like my old self, I am simply looking forward to Christmas. A few months ago my Consultant told me that I might, only might, be able to eat a little Christmas dinner, but I wasn't to build my hopes up. Give it time. Be patient. It seems a theme, patience and TMJ problems.

The surgery is behind me and I have no regrets. I am thankful to my wonderful family, the best friends in the world and of course, Mr Bernard Speculand, one of the best surgeons there is for this type of surgery, and the excellent care and attention I had from him and his team.

Bring on the Christmas dinner and carol singing, that’s what I say.

So until another day

Bye for now

xx

Progress - I

I tried to keep notes while I was in hospital and am posting this to help anyone else who has forthcoming total TMJ replacement surgery.


Wednesday 13th October

As we drive to the hospital texts ping on my phone continually, goodwill messages from lovely friends and family. I take deep breathes - in, out, puhhhh - blow it away, like I am in labour. Calm me. I don’t want to panic. Help me to stay in control. Hubby reaches for my hand and crunches it tight.
'It won’t be long now. Soon be over.'

We arrive at the hospital for 1pm and it’s a flurry of activity as my Consultant wants to make an early start. He’s booked me into the main theatre for 2pm. No time to think about it. I rush to gown up and put on my stockings. Two nurses swish into the room, label me and check paperwork. The Consultant visits. The Anaesthetist visits. I regret putting my full face of makeup on and quickly set about removing it with a wet wipe.

I don’t recall hugging hubby or saying goodbye but I know I must have. By 1.30pm, I am walking down the corridor to theatre with a nurse who will be looking after me when I return to ITU. Six blue clad people greet us. The lighting is bright. One of the young men is excited at the prospect of seeing my surgery.
'You don’t get to see this procedure very often. I’ve been looking forward to it,’ he enthuses.
My gorgeous calm Anaesthetist comes in and starts tapping away at my hand, trying to find a vein. I know I am in safe hands.


When I came round in ITU I am sick, sick, sick - not good when you have two new jaws. Yet despite the sickness, I feel surprisingly well. The pain is tolerable, better than I imagined.

Hubby is beside me. I can’t see him but I hear his booming voice. ‘It’s all done – it took six and a half hours. You look incredible. Well done darling.’


Moments later - or hours later – I’m not sure, I open my eyes and look across to the ITU nurses who are sitting and chatting. One is eating a biscuit. There are no windows in ITU. I think it’s night time. They can’t see me looking at them. I can’t communicate. I am asleep but my eyes are open, staring at them.


Thursday - Day 1 post surgery

Suddenly it’s busy. There is a clock in front of my bed and I see it’s 5am. Two nurses arrive, bowl and towels in hand, place clean sheets at the bottom of the bed. They give me a bed bath – wash gently from top to toe and sprinkle me with talc. All the time, they chat away. For the life of me I can’t remember what about.

Less than twelve hours later Rob, a gorgeous American nurse in navy blue scrubs (must be a 'sister’) tells me I am ready to leave ITU and go back up to my own room on Colmore Suite.
‘You look fabulous,’ his accent twangs. ‘There’s hardly any swelling or bruising. Now don’t you go getting into any fights.’

He must know what's to come.

I sleep until hubby returns. He’s still enthusing about my face; it nothing like as bad as he thought it would be. His words are reassuring. I know I’ve done really well. The worst is over.

As well as the morphine which I control myself with a pump, they pump drugs into me; More painkillers. Antibiotics to stop infection. Voltarol and Diclofenac, anti- inflammatories. Blood-thinning medication is ‘stapled’ into my stomach for good measure. I feel punch drunk with drugs. But by tea time on the second day I am alert and able to eat small amounts of soup and a couple of mouthfuls of cottage pie.

All the medical staff tell me I look wonderful, considering.
'I told you,' says Hubby, snapping some photographs. I read somewhere and my Consultant told me that taking photos of recovery can be good for moral with this type of surgery when progress can be slow. It helps to see improvement when you think there is none.

It’s an effort to talk, open my mouth or eat. My jaws clunk and pop as if they’re the internal locking system of a car. But I’m eating. It’s progress.

My Consultant is really pleased. He thinks my forehead looks ‘lazy’ - a bit like I’ve had botox - but apparently it’s normal. People pay a fortune for this treatment. I’m glad he’s pleased. Like a child, to please makes me feel as if I am doing something well.


Friday – Day 2 post surgery

The nurses keep checking me. ‘Are you sure you’re okay? Is your pain manageable?’

I'm trying to be a good patient. I was never a moaner until I had these jaw problems and now they are replaced, I want to go back to being my old self – the happy go lucky, cheery girl who sometimes has pain but gets on with it and doesn’t let it control her life.

It's painful, but a different pain to pre-surgery. I know the discomfort will improve. My nose feels twice the size and is numb. I could slice it off and not feel it. And my ears, and large patches of my head. I was told to expect numbness, maybe for months.

I ask for the catheter to be removed so I can start moving around. Progress. They duly oblige. A couple of hours later, they also remove the Bet Lynch chandelier drains that dangle from my head and neck. Progress. Hubby returns later in the day. I think I see him shudder as he walks into the room but when he speaks, he’s as positive and encouraging as ever.
‘Your face has swollen a bit since earlier,’ he says, still sounding positive. ‘But you still look great.’

He takes more photos of my progress.

I glimpse them and don’t think I look too bad either.

However by the time he leaves an hour or so later I can hardly see out of one eye. The drains must have been stopping my face from swelling. The eye tears permanently.
The inside of my mouth is exquisitely sore. Everything feels over-sized. Running my tongue over my gums I can feel grooves, like a cheese wire has cut into them. It’s where they wired my jaws for a few hours post op. I don’t remember them being removed.

I ask a nurse to help me to the toilet. Progress. It’s my first time out of bed on my own even if I think I'm going to pass out as I sit on the commode. My face is about to explode, it's so stretched. But I want to get a shower and my Consultant asks the nurses to try and wash my hair to keep infection at bay.

I will always remember that first glimpse in the bathroom mirror. It isn’t me. Tiny, tiny eyes filled with pain stare back in horror. They're not even my eyes. Mrs Doubtfire is the first person to spring to mind. My face is an enormous pastry, doughy mixture; my neck, more swollen than when I had mumps. I manage a shower but not to wash my hair. I have a constant urge to keel over. Small steps. I managed a shower – that’s progress.

My best friend visits and I want to cover myself over with the sheets and hide away. I don’t look as bad as she thought. She is kind.

My little boy, Quiet Mousie visits. I expect to see horror, even fear in his eyes. But his gaze never once averts. He sits chatting away and smiling, a huge beam that brightens the room. He’s simply pleased to see me. All I see is his cheerfulness and love.
‘You’re still the same Mummy underneath there. And I can see your eyes.’ He kisses the top of my head ever so gently with cushioned lips.

My little golden nugget of treasure. He can still see my eyes, when I can’t. It gives me hope, and something to cling to because when I look in the mirror, it doesn’t get any easier seeing Mrs Doubtfire staring back.


Saturday - Day 3 post surgery

I crash.
Too unwell to do anything. Can’t eat or shower. Don’t wash until past 11am.

I feel sick, so sick. My wrist has swollen. My nose oozes gunk. My veins are shutting down on the intravenous drips. They have to re-do them in case it’s an infection. My consultant thinks it's viral. Have I had chickenpox? I won’t be able to go home until at least the end of the weekend. They pump yet more antibiotics. My mouth flares with ulcers. I have vaginal sores. I think it’s thrush, perhaps from the catheter.

My neighbour calls in to see me but only stays a few minutes when she sees my state. It’s too much effort to talk.

Later, I perch myself up in bed to look outside. Autumn had it’s foothold on the leaves of the trees in the car park. The yellowing leaves of a Beech swirl and fall to the ground, and simultaneously tears fall from my eyes and splash onto my nightie; tears of self pity that I feel so unwell mixed with a realisation that I have a long, long road ahead of me.

Hubby and Quiet Mousie arrive. I try to talk but give up. They gibber about footie scores and the Shrewsbury Town Match they’ve been to in the afternoon. Idle Jack is working. Hubby asks if he’s sent a message. He hasn’t. I wonder if he’ll come tomorrow as it’s his afternoon off.

Progress. After they leave I drag myself up and pull back the vertical blind to look out to the car park below to try to wave them off. The car park glows orange from the street lights until I see their shadows flit across. Hubby walks with a purpose and Quiet Mousie skips to keep up. He catches sight of me and waves madly, his delight obvious. My little lad doesn’t take his eyes off me as the car reverses out of the car park, indicates, and turns into the adjacent road. He's still waving.

I shuffle back onto bed, relaxing my aching jaws from the perma-smile position and grimace in pain. It’s a long night ahead. It must be bad - I snooze through X Factor. Hubby’s text stirs me. He and Quiet Mousie are sitting in the car waiting for Idle Jack to finish his shift. They’re eating fish and chips. I text back. What I wouldn’t give for ‘fee & chee.’ Give Idle Jack my love. Xx Sending a text. Progress.

A few minutes later my stomach collapses inwardly and I have to dash to the toilet. It cramps and I’m doubled up. I fret. Maybe it’s an infection. Maybe my body is rejecting my jaws; I’m allergic to the metals after all. Maybe I’m overdosing on all the drugs they are giving me.

I receive a text from Idle Jack. It’s a lovely text. He says he’s missing me and hopes I feel better... and the house is tidy. I know his Dad has cattle prodded him to send me a message.

Preparing for the night ahead, the nurses bring me a drink and my drugs, along with the dreaded warfarin that she staples into my already sore stomach. She sees the pain I’m in and asks if I need to see the on-call doctor about my colitis.
'You must shout if you need anything else. I'll leave the door open and keep an eye on you.'

She’s very kind. They all are. As I lay, trying to find a comfortable position to nod off, I tell myself to be patient. It’s only been five days. I was told it would be a long, slow process. For such complicated surgery, I’m doing well.

I’m back on the toilet within an hour. As I sit, I realise that the sores ‘down below’ are ulcers not thrush. Ah, it’s just my friend, Behcets syndrome, reminding me that it hasn’t left me. I have to respect it. And listen. It’s bigger than me. After twenty-five years I know when I have to back down and take notice. I don’t need to prove anything or be superwoman. Behcets is the reason I’m here.


Sunday - Day 4 post surgery

The tea trolley clatters down the corridor at 6am, and I know it’s going to be a tough day. So it’s a pleasant surprise when I rouse and don't feel as bad. One moment I'm tired. The next I am in pain. But in between I feel strong. Feeling is beginning to return to parts of my face and head. My ears pop and crack like fireworks going off. My teeth are on edge. The pain is more in my cheeks than my jaws. The swelling hasn’t worsened.


The nurses manage to wash my hair which makes me feel better. My neck hurts more than my head.


The physiotherapist comes. He wants to make sure I’m not getting a chest infection. He asks me to do the stairs with him. The consultant needs to know I can do them before I’m allowed home.

Two close friends come to visit. One of them brings a packet of Rolos and Fruit gums as a joke. I can’t stop laughing. It still makes me laugh, thinking about it. After they've gone I flick through a magazine, more progress.

People are so kind. I’ve had some lovely cards and messages of support by text and e-mail. Progress. I start to send some replies.

I sit up and move to the window to see Hubby and Quiet Mousie arrive. I want to show my little lad how I’m improving. I’m disappointed when I see Idle Jack isn’t with them. Quiet Mousie runs around the car park to me and in no time is sitting beside me as before, lighting up the room with his smile, stroking my bruised hand gently. I ask about Idle Jack. He’s at home, Hubby he plays it down. I suspect they’ve had words and drop it.

They are only gone an hour and my best friend comes again. She can’t believe how the swelling has improved since she saw me two days ago. She sits with me and we watch X Factor together. I don’t fall asleep this time. Progress.


Monday – Day 5 post surgery.

I wake expecting continued improvement after yesterday but am weak and listless. I hardly slept last night with pain and my stomach. My high expectations make me feel I've stepped backwards.

My Consultant calls in early. He agrees that it’s the Behcets. With any auto-immune disease, my body is bound to react after such surgery. He asks if I am ready to go home. Am I sure?

Home. Where my heart is. To see my boys and the countryside. And so much easier for everyone than stuck over in Birmingham.

'Yes please, I’d like to go home.'

I’ll make better progress when I’m home.


Until another day
Bye for now
xx