Regarding elastic bands.  You may remove the elastic bands if you are having to force air to breath; your description of the change in your breathing effort is concerning.  You can gently use tweezers or the scissors that were provided.  If you use tweezer, then keep the elastic bands so we can replace them in the front where the hooks are easiest to access.  When loosely applied, we call these guiding elastics. We can explore this on Monday’s visit.

You have your goal for oral intake today; Dr Sung will be reaching out later today to check on your progress.

Lastly, email is very efficient for communication...however...this is not the best way to communicate “urgent” concerns as there is no guarantee an email is to be read in a timely fashion.  The on call service through the hospital / oral surgery pager is always staffed for urgent concerns.  In the event of an emergency, then 911 is the first line of action.

DT

Sent from my iPhone

On Apr 13, 2019, at 10:12 AM, B Chan <bowen_789852@hotmail.com> wrote:
I will buy some shakes now. I will enforce several liters of water daily. For the blenderized foods, unfortunately doesn’t seem to work, and its just the gaps in my teeth are so small, anything beyond maybe milk(?) consistency just adheres and traps to the teeth. Even the  amoxicillin, hydrocodone, and ibuprofen barely trickles in and I have to aggressively wash it down.

The new jaw position doesn’t strain anymore, and certainly if we removed the bands and kept the splint, I can make a conscious effort to keep it on the splint and limit movement even if it means over a longer term recovery period.

Overall, the options of my liquid intake would increase as well if isn’t limited by whats is permeable through my teeth? Its not that I absolutely can’t breath but it has  just been very taxing on me mentally to constantly experience cold pains every time I breath. My breathing pattern has also changed from fluid breathing to huge inhales and exhales because I can’t move the oxygen otherwise. I preferably  want to take them but apprehensive to the ultimate consequence and results of the treatment. What do you think

Best,
Bowen


From: Trent, David <David.Trent@ucsf.edu>
Sent: Saturday, April 13, 2019 9:43:24 AM
To: Chan, Bowen
Cc: Sung, Janet
Subject: Re: URGENT Maxillary Advancement POST-OP

Firstly, I want you to know I hear your concerns.  This is not an easy recovery, and I absolutely understand your comment about major changes overnight.  You have a lifetime of nasal congestion, and this surgery certainly exacerbates that.

Regarding your oral intake, we need this to improve dramatically.  What you described is far short of where you need to be.  Your goal today should be at least several liters of water/liquids by mouth to remain hydrated.  Besides hydration, we need to consider nutrition.  You need fat, protein, etc for your surgical wounds to heal.  We discussed Ensure shakes at your pre-op visit...these area great supplement while you experiment with other blenderized foodstuffs.  If you cannot increase your oral intake, we will have to re-admit you to hospital to support this.

You already have fewer elastic bands than we typically use.  Of course we can remove them if you have no other way to comfortably breath.  The elastic bands are not holding you jaws in place, the plates/screws are.  The elastic bands immobilize your jaws to allow for the most predictable healing environment.

DT

Sent from my iPhone

On Apr 13, 2019, at 9:24 AM, B Chan <bowen_789852@hotmail.com> wrote:
Thanks for writing back. Nutritionally, anything with substrate, even trace amount, I can’t eat. It’s been very hard to swallow, I think food wise, I’ve had maybe 3 or so cups of ginseng soup for the entire week so far.

I’ve been using the decongestion medication but the habit formed through many years of oral breathing doesn’t really reform over night, particularly when sleeping. I can breath through my nose through very concentrated efforts while I am conscious and it still puts me out of breathe.

I want to consider and explore the alternative of recovery with the presence of less bands.

From: Trent, David
Sent: Saturday, April 13, 2019 9:07 AM
To: Chan, Bowen
Subject: Re: URGENT Maxillary Advancement POST-OP

Good morning Bowen,

I have been in contact with Dr Sung and I understand she discussed maximizing the decongestion medications that were prescribed.  This should help augment the efforts you are already doing with the humidifier and such.

You are correct that the elastic bands help with alignment.  Obviously, this is secondary to you breathing safely.  As you and Janet discussed, these may be removed if you are unable to breath through your nose or mouth adequately.

How are you doing with you liquid/nutritional intake?

Best,
DT

Sent from my iPhone

On Apr 13, 2019, at 3:43 AM, B Chan <bowen_789852@hotmail.com> wrote:
Hey Dr. Trent,

Its bowen, sorry to write in but I need an urgent address to a problem. The openings for me to breath are so small inbetween my teeth/bands, it requires such huge breathe for me to breath in and out  that it pressurizes cold air, making my mouth extremely cold and painful when I breath.
I thought it was something I could cope with but my gums are just gradually losing more color and  more painful.
I can’t breath through my nose because of congestion and just generally not really being used to it
I’ve tried buying a humifider but  have to make the room so unbearable hot for any effect because im taking ambient air and turning it cold

At the time of writing this email, I’m balancing it out by sipping and spitting the same cup of heated water per few breathes. I realize the bands are necessary for proper alignment but I need a different  arrangement because this is currently untenable.