TMD and The Workplace (Surgery, time off, Covid-19)

 TMD and the workplace

 Many people ask how TMD affects people at work, especially post operation.  The truth is it really depends on the job, the healing process, and the procedure.

 For me, here was my average time off by procedure:

1)Arthrocentesis-minimally invasive procedure to clean the joints-2 or 3 days

2)Open Joint Arthroplasty-an incision is made to repair, replace, or reposition the articular disc-3-5 days

3)Discectomy-an incision is made and the articular disc is removed (and sometimes replaced with something-in my case it was replaced with a plastic type of material which was removed in office 5 weeks later-I spent the night in the hospital (23 hours per my insurance) and was at my friends bridal shower a few days later.  Maybe a week off work.

6)Total Joint Replacement of the TMJ-this surgery requires two incisions on both sides.  An upper incision is made over the joint area in front of the ear.  A lower incision is made in a skin crease (if present) in the upper neck.  The fossa (socket) is smoothed down with power tools.  The condyle is cut off to allow room for the metal replacement.  The fossa prosthesis is placed into the natural fossa and held in place with wires or screws.  The condyle is then fitted into position and attached to the lower jaw with several screws.  Most patients receive arch bars and are banded shut-most people take 3 weeks to several months off work. 

 After TJR I took 3 weeks off from work; however, I am a teacher and only returned for final exams.  I then had summer vacation. 

Day 1 of the 2020 school year

TJR and work

Because I was an English teacher, I talked most of the day.  The incessant talking was increasing my migraines, tinnitus, and muscular issues.  After one year, I switched careers and became certified to be an Exceptional Student Education (ESE) Support Facilitator. 

 I notified my school when I passed the exam and added ESE.  They assured me that they understood my TMD and would work with me, but they didn’t.  In fact, I had to switch schools and jobs mid-year. 

 

What I learned from this situation?

Because of my disability, I should have gone through the Equal Employment Opportunities Commission and filled out paperwork with the Americans with Disabilities Act.  I didn’t know this, and my principal didn’t advise me to do so.  In fact, she sent me an email during my planning to tell me that a teacher who was supposedly being surplused got the job she had been promising me since the start of the school year.

 https://www.eeoc.gov/

https://www.ada.gov/

 

What was the result? 

Because of the administration’s lack of empathy and refusal to change my position, I was forced to apply for jobs in other counties.  Luckily, I found a school that was willing to hire me even though I had never been an ESE Support Facilitator in my life.  Nothing was sweeter than the day my current school called my former principal for a letter of recommendation. 

 How has COVID affected my TMD?

 I’m officially at a new school and enjoying my new position.  I work with students but in a different capacity.  It is much easier to manage my pain.  Of course, everything changed with Covid-19.  Teacher were working remotely until the schools opened.  Then teachers could apply through the ADA to remain virtual and/or an accommodation.  I recognized that the school board was only approving teachers/administrators/staff who had Type 2 Diabetes, COPD, Cancer, autoimmune diseases, and were obese.

 I applied to either remain virtual and/or receive an accommodation where I could have space to take a break from my mask.  I don’t mind wearing a mask; however, if I wear it too long or on days when there is low pressure, it hurts…BAD. 

 I was denied by the Equal Employment Opportunities Commission.  I wasn’t surprised, but I was slightly taken aback because it was clear that they didn’t read my paperwork because they didn’t even acknowledge my request for a reasonable accommodation (mask breaks). 

 Here is the actual denial letter:

Lee, Minda
XXX High School

RE: REQUEST FOR REMOTE WORK ACCOMMODATION

Thank you for taking the time to apply for a remote work accommodation.  Your request for a remote work accommodation has been denied.  Based on the information provided by you and/or your physician, your underlying medical condition does not present the strongest and most consistent evidence of the likelihood of a severe case involving COVID-19.

Because your request for a remote work accommodation has been denied, you will need to report to work no later than 10/14/2020.  Should you choose not to report to work, please inform your Principal/Supervisor prior to  10/14/2020.   To explore other options that may be available to you, please contact the Leaves Department at XXXXX.

This completes the EEO Department’s handling of your request.

Respectfully,

District Review Team 

 

Luckily for me, my Assistant Principal called me the next day and told me that even though I was denied, the school was going to give me an accommodation.  I am in a room where I can remove my mask so that it doesn’t cause me MORE pain. 

My new office (for now)

Covid-19 Rules

This was extremely gracious, and I appreciated their efforts.  I did not fight to remain remote as I’m not unreasonable.  I’m currently back and working.  I actually ENJOY being at work. 

 

 

I know I could have fought to remain remote, but honestly, I recognize that many teachers/administrators/staff were denied.  Many of these people have underlying conditions as well.  It would be ridiculous for me to complain when the school is working with me.  Yes, the teacher’s union stated that if you don’t have students, you can work remotely if your school approves.  But I’m a team player and recognize that it is not fair for me to remain home when others cannot.  I’m sure that some people are taking advantage of the policy, and that is something that they have to live with as that is bad karma. 

 

 

 

Happy 3rd birthday to my Bilateral Temporomandibular Joints (TMJ) Total Joint Replacement (TJR)!

Happy 3^rd birthday to my Bilateral Temporomandibular Joints (TMJ)  Total Joint Replacement (TJR)!

Pics from surgery:

My memory of the actual surgery is hazy, yet I can look back at the blog and see how painful it was.  Luckily, I had a fabulous support network of family, friends, coworkers, church, and TMJ support groups to get me through it.  I was prepared ahead of time for how long and miserable recovery would be. I was cognizant that this was an extremely risky procedure and that the risk for complications was great.   I also understood that there was no such thing as a completely being healed, as most patients post bilateral TMJ TJR are NEVER completely healed…at best our quality of life has improved. 

Here is my blog post about why I had surgery and the actual surgery:

https://positivelytmjtmd.blogspot.com/2017/04/detailed-explanation-of-my-upcomng-tjr.html

https://positivelytmjtmd.blogspot.com/2017/05/the-actual-surgerys.html

Here is my blog about Post Operation appointments & Expectations vs Reality:

https://positivelytmjtmd.blogspot.com/2017/06/post-surgery-appointments.html

https://positivelytmjtmd.blogspot.com/2017/06/tjr-expectation-vs-reality.html

Symptom/changes	3 years post op
Function-Opening	Pre surgery, I opened anywhere from a 5mm to 15 (on a good day).  Now I can easily open to a 35-38.  Besides my new joints and surgeon, I give a lot of credit to my physical therapist who played a pivotal role in my recovery.
Food/diet	Technically, I can eat “whatever is comfortable for my jaw.”  The truth is not much is “comfortable,” so I am on a soft food diet.  At times, I move myself to a liquid diet but only when I am in severe pain.  Of course, there are times I cheat on my soft diet (and usually regret it).
Migraines	My migraines are consistent and EVERY day.  Some days are better than others.  For instance , if I do something where I am laughing or smiling more than usual, I usually end up in major pain the next day.  It sucks because I often end up in bed (or wishing I were in bed) the day after I have fun…sometimes the same day.
Tinnitus	I still have pulsating tinnitus in my left ear.  The definition of this is the sensation of hearing a rhythmic noise, such as a heartbeat, swooshing or whooshing, from no external source, is, at best, a little unsettling; for many, the near constant sound exceeds annoyance and becomes completely debilitating.  At times it is so loud I can almost feel my ear pulsating.  I also have a lot of pressure in that left ear.
Muscle spasm/twitches	My left eye droops and often twitches. This is extremely annoying and affects my eyesight, but Botox often freezes the muscle.  My cheeks can also twitch, though I don’t feel them twitch, other people notice it.
Sleep apnea	I have this off and on because of the position of my jaw.  If it gets worse, I will seek a doctor.
Dry mouth	This still occurs, but not as frequently.  When it does occur, I use a dry mouth rinse.
Sleeping	Besides the tinnitus, sleeping can be difficult because I can sleep the wrong way.  Or I can sleep on one side too long and it feels like that side of my face is on fire when I wake up.
Weather	I’m still a human barometer.  I can accurately tell when it’s going to rain approximately 30 minutes before it does.  I can also feel when there is a drop-in air pressure.  These changes increase my migraines.
Flying	Before surgery, I thought I was going to have to give up air travel all together.  Landing was often extremely painful.  It felt like my eardrums where going to burst.  I tried everything to get this symptom to go away, but nothing worked.  Now, I can fly.  On occasion, it’s painful.  Now I am back to traveling and trying to see as much of the world as I possibly can!  It’s a passion of mine.
Allergy	Right as the COVID-19 craziness really began in Florida, I developed a scaly spot right where my left jaw joint is.  I’m not going to lie, it scared the crap out of me as I understood that worst case scenario was that I was having an allergic reaction to my joints (and we all know what that means).  Luckily, I was able to get into a dermatologist before everything shut down and she said it was cells that were just growing out of control and it was NOT an allergic reaction.  I was put on a steroid cream, and it’s gone.  Thank goodness.
Dentist	I will have to take antibiotics two hours prior to any dentist visit for the rest of my life.
Exercise	I walk (almost) every day.  I have also started practicing yoga again.  When it comes to exercising, I just monitor and modify what I am doing to make sure I do not aggravate my jaw.  I do not participate in any sports or exercises that are high impact.

Covid-19

I can't write this blog post without mentioning the pandemic, as it is devastating much of the country.  South Florida is going on it's 9th week of lock down, with cases rising every single day.  How does this affect TMJ?  Well, those who have to wear a mask for long hours say it causes migraines and pain in general.  Since I teach, I'm waiting to see if we will return to traditional schools next year, and if we will have to wear a mask.

 Changes

Old Job

New Job

I was an English teacher for over 19 years.  For a little over 6 years, I taught at a local high School.  Because of my surgery, and not being able to give direct instruction for hours on end without being in severe pain, I became certified in Exceptional Student Education.  When I requested to change my position at the end of last year, my principal was extremely unsympathetic.  I tried to explain my disability, but to no avail. Because of many circumstances that were a direct result of my request to change positions,  in the middle of October 2019 I left the district and my job as an English teacher.

I currently work at McArthur High School as an Exceptional Student Education Support Facilitator.  I monitor and help students who have learning disabilities.  I enjoy my new job and appreciate the fact that I do not have to talk as much, which helps me immensely.  This opportunity also means that I did not have to apply for disability, so I am incredibly grateful that the school took a chance and hired someone (midyear) who had never held this position before.

Like so many of us with fake joints, whenever I do something, I always have to think about how it’s going to affect them.   Will this hurt me?  Am I going to do any long term damage to the joint?  

I never regret my decision to have my old joints removed and replaced with new, titanium ones.  I understood that the surgery was lengthy and was going to be the most painful experience of my life (thus far, and hopefully ever).  I also knew the recovery was going to be long and arduous.  Even though I am still not 100%, I am happy with the progress I have made.

Soft Food Recipes #2

Post surgery everyone ends up being hungry, and at times...HANGRY.

Here are a few more soft food recipes that are quick and not too labor intensive to make:

1) Chicken Salad:

Ingredients:
1 Chicken breast cooked
2 tablespoons plain Greek yogurt
2 tablespoons mayo
salt to taste
pepper to taste

Instructions:
Place chicken breast into food processor (I don't have one so I just chop it or put it into my blender)
Grind chicken until it's a fine consistency
Stir in all the other ingredients

2) Baked Ziti

Ingredients:
Ziti noodles (2 cups)
1 container ricotta cheese
marinara sauce
1 1/2 cup of mozzarella cheese
Italian seasoning to taste

Directions:
1)Boil the ziti noodles according to the package
2)Mix noodles,  a bit of the marinara sauce, ricotta cheese, seasoning, and 1/2 cup mozzarella cheese in a bowl
3)preheat the oven to 350
4) put a layer of marinara sauce on the bottom of a casserole dish
5) next, put the ziti mixture into the dish
6) Add the rest of the marinara sauce to the top
7) put the remaining mozzarella cheese on top of the sauce
8) bake for 45 minutes.

 3) Meatloaf

Ingredients:
1 box stove top stuffing (any kind)
1 pound ground beef
2 eggs
1/2 cup ketchup
1/2 cup water

Instructions:
1) preheat the oven to 350 and grease a bread pan
2) In a bowl, mix all the ingredients, but set aside 1/2 of the ketchup for later.
3) fill the pan with your ingredients.
4) Top it with the remaining ketchup (or you can you bbq sauce)
5) bake for 44-60 minutes
6) helpful tip: add onions, garlic, spices, herbs, or anything you want

4) Chicken or turkey soup

1) 1 carrot (chopped)
2) 1 onion chopped
3) 1 1/2 cup noodles (your choice)
4) 1 pound cooked chicken or turkey
5) 1-2 cups chicken broth
6) garlic to taste
7) salt and pepper to taste

Boil the noodles in the broth according to package
Add all other ingredients and simmer until soft

5) Crockpot Tortellini


Ingredients:
1)1 bag of frozen torelinni
2)1 small bag of fresh spinach
3)2 cans of Italian diced tomatoes
4)1 box or 4 cups vegetable broth
5)1 block of cream cheese

Put all ingredients in the crockpot.  Cut up the cream cheese.  Cook on low for 5-6 hours.

Post Surgery-Sex

Love is in the air, but physical acts of love can be extremely different post TMJ/TMD surgery or TMJ TJR.  

Many patients appear before middle aged and aging male surgeons.  Most of us come prepared with a litany of questions and concerns, yet blush when it comes to the more personal aspects of our recovery.  As I’m writing this, I’ll honestly tell you that I did not heed my own advice which is: Don’t be embarrassed, ask your surgeons. They have heard it all (& probably thousands of times).  Always consult your doctor!

The truth is, after most jaw surgeries you don’t feel well, your jaw is swollen shut, and you have a bobble head.  In fact, most of us are tired and lack energy post op.  You probably won’t even care about kissing or sex or anything physical for quite some time.

Now if you’re having TJR, all those symptoms are amplified by a million.  I left the hospital with a giant pumpkin 🎃 head and in pain.  Most people are banded shut, but I was not. Nevertheless, when I came home post op I was in pain and didn’t  feel even the slightest bit pretty, but I did feel like a survivor  👍 ; therefore, anything other that healing was out of the question for me.  

Here are the questions many of us have:

1.  how long after surgery should you wait to kiss? 😘 💋 
2. How long after surgery should you wait to have sex?
3. How long after surgery should you wait to have oral sex?

These are such intimate questions, but a healthy sexual relationship is a natural part of life. With that being said, most people said they resumed sexual activity when they felt like it or when their doctors told them they could (and that length of time varied depending on surgery and/or doctor-several months for more minor surgeries and six months-one year for TJR).

Most people post TJR wish that kissing were easier. For whatever reason, the post TJR jaw just doesn’t work like it use to. In addition, many patients are wearing braces  which can be painful and make kissing more difficult. As for oral sex, most women said they waited quite a bit of time and don’t perform it on a regular basis because it hurts.  Sex resumed when the patient felt better.  Men seem to not have as many aches and pains in regards to sex, kissing, and oral sex.

Post TJR I was more focused on my new normal than any type of physical/carnal activity.  My face was so sensitive that my cat 🐱 walked by me and his tail brushed (not even hit) up against my face and caused pain.  That’s how sensitive my face was 

An Opportunity to Make a Difference

An Opportunity to Make a Difference

In March of 2019, I, along with approximately 10 others, were given the opportunity to speak in front of a panel of dentists, doctors, and surgeons in Washington DC.  Each of us was given two minutes to talk.  I called in remotely from my classroom in Florida.  Luckily, the time slot given was during my planning.  Here is a copy of my actual speech:

Hi, I’m Minda Phinney. I’m speaking to you remotely from my high school classroom where I’m an English teacher in south Florida.  I’ve suffered with TMD since I had my tonsils removed at 16. I'm about to turn 40. My jaw was dislocated and locked shut during surgery and didn’t resume its function until several months later with medical intervention. Both the dislocation and the barbaric methods used in attempting to pry my mouth open is where my TMJ nightmare began.  At that point, irreversible damage had occurred.  Through the years my TMD became worse: increased migraines, special diets, pain when I breath, pain when I walk, my opening was at 15 on a good day, muscle spasms,etc.  unfortunately, most professionals don’t know how to deal with a dysfunctional temporal mandibular joint. They don’t understand the debilitating pain it causes. Prior to going the surgical route, I tried conservative methods: splints, braces (for a second time), muscle relaxers, etc.   After the more traditional methods, I had 5 bilateral TMJ surgeries, some of which were unnecessary and caused irreversible damage, but I didn’t know it at the time.  My last surgery was bilateral TJR/orthographic surgery.  Dealing with insurance companies is infuriating and miserable.  They look at jaw procedures as cosmetic surgery. I assure you. It is not.  This, along with my nickel allergy, and waiting for FDA approval bolstered my depression and anxiety.  At one point I felt as though my life was spiraling out of control. 

Most people, including dentist, doctors, insurance companies, etc  lack empathy towards TMD sufferers. For example, I teach English and next year want to teach something different so I don’t have to lecture as much. I studied and passed the new certification test.  I was told I’m too valuable as a teacher to switch positions; hence, my principal doesn’t value my health because she doesn’t understand how a jaw works, the health issues it causes, and the pain I’m in. Unfortunately, this kind of reaction is not uncommon, and this is not the first time I was treated in this manner. As a society, we need more tmd awareness and understanding.  We must find a way to educate doctors, insurance companies, and society as a whole about this debilitating disease. As a TMJ community, we need to find was to inundate the public with correct information about this topic.  Knowledge and understanding is key to creating change and empathy. I’m literally the face of TMJ, but what people fail to understand is I fake normalcy every single day. I fake being alright. But in reality, almost everyone in the room that I’m speaking to and everyone who has called in is the face of TMJ because we all have this disease in common.  We are among the few that truly gets it.  Hopefully this will change. Hopefully together we can create change. Thank you for listening.

This was the response I got a few days later: 

Good afternoon Minda,

Thank you so much for sharing your experiences with TMD over the years. We’re sorry for the pain you’ve endured, but appreciate your willingness to speak about it. With your permission, we’d like to include your comment our project’s public access file and share it with the committee. The committee’s report will be released in Spring 2020 and we look forward to alerting you when the report comes out.

Thanks again,

TMD Study Staff

____________________

Senior Program Assistant

Health and Medicine Division | Find us at nationalacademies.org/HMD

The National Academies of Sciences, Engineering, and Medicine

500 Fifth Street, NW

Washington, DC 20001

Phone: 202.334.3129

TMJ the Invisible Illness

Not all disabilities are visible, and it’s difficult for people to empathize with someone who may “appear” normal.

The dictionary definition of the word disability is “a physical or mental condition that limits a person’s movements, senses, or activities.”

I appear normal.  I credit my fabulous surgeon with the fact that unless a person looks very closely, he/she will not see the scars that surround my face and neck.  In total, I had close to 100 external stitches.  Four of the bones in my face were removed and at least eight muscle were cut. In addition, my nerves were affected.  With all of this facial trauma, I recovered physically and look just like any other person.

My normalcy fools many of my friends, family, and colleagues.  Even though I am doing fantastic by bilateral Total Joint Replacement (TJR) standards, I still have my struggles.  The surgery is to improve function, and it did.  I can now open my mouth to a 38 which is amazing. I still teach and appreciate the fact that I’m able to work a full time job, and teaching English which involves much lecturing and class discussions. There are many TJR patients who aren’t able to work.  Though I do recognize that my time teaching English is limited as I can't take the pain and the stress it causes my jaw.  Even my doctors are surprised I am still doing it, and recommend that I change my position within the school.

Attempting to fit in and be like everyone else can be physically demanding and exhausting.  Talking too much causes migraines, so I’m in intense daily pain.  In fact, even if I go out and am laughing with friends, I typically end up in bed miserable. Having fun comes at a cost.  Sometimes it feels as though happiness comes at a cost.

My left implant is not functioning at 100%. I have pulsating tinnitus, and over using my implants causes my muscles to swell and the  noise to increase. It’s difficult for me to sleep without the aid of a sleeping pill.  When I talk too much, I become distracted by the noise because it’s loud. Granted, I’m the only person who can hear it. 

I also have chronic dry mouth. This may seem minor, but have you ever tried to lecture when you’re mouth feels like sandpaper? Try reading to a class so they can enjoy a story when you don’t have an ounce of saliva? Some might suggest drinking more liquids, but that won’t help.  This is a side effect of the TJR.  I sometimes stumble over my words and it’s like my mouth is not working the way I want it too.

And, of course, the worst of the pain is the never ending migraines.  Talking, lecturing, laughing, and crying increases the magnitude and frequency of my pain. It’s excruciating.  When I don’t use my jaw as much, I feel much better.

Obviously, I am on the never ending soft/liquid diet. Every so often I cheat only to end up in bed regretting that decision.  People often ask how I maintain my weight, and it’s my TJR diet.  I only chew one meal a day. Lunch is typically something extremely soft/liquid and dinner is soft food. I tend to be hungry. I’m use to it. It’s my new norm.

The integrity of my implants is of the utmost importance to me; therefore, I will do everything in my power to make them last as long as possible.  I recognize that when it’s time for a new set, the old ones will be removed and my jaw will be wired shut. Because I have FDA approved titanium implants, I’ll need to be placed back on the list and wait for approval yet again.  This will take months, and I will be wired shut and without joints in my face.  Once approved, I’ll have to endure another lengthy, painful surgery.  Other patients who have had multiple TJRs state that the pain and healing becomes worse with each surgery. Honestly, I’m horrified at the thought. The entire explant and reimplant process is terrifying.  Even though I hope that I’ll never experience this, I understand that I probably will. Implants aren’t meant to last forever. And from my understanding, titanium jaw joints don’t last as long as the nickel.  I will do everything in my power to help the integrity of my implants.

Luckily, I’m on several websites with other severe TMJ patients and I know that I’m not alone.  We support each other with kindness and understanding, which is fabulous.  I also travel to maintain my sanity and inner peace.  I just got back from Barcelona :)

The point of this is to not judge a book by it’s cover. Many people are struggling with ailments that may not be visible.