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3 surgeries at 30

Rebecca threw me an early surprise birthday party — she loves this photo.

30 is one of those milestone years that people dream about having done certain things like climb a mountain, buy a home, or even just get that first tattoo. It also happens to be an age that your body starts invoicing you for all the damage you did to it in your later-teens and twenties — the latter was certainly the case for me.

My 30th birthday marked the half-way point of a month-long liquid diet as prescribed by my doctor after wiring my jaw shut. You see, two weeks earlier I had what was to the first of three surgeries over the next 14 months. To sweeten the deal, I’d also get to enjoy braces for 2 years.

If I had to write a Haiku about what my 30s were looking like, it’d go something like,

High school mouth once more,
And geriatric shoulders,
So, this is 30

I wasn’t exactly “stoked” when, at 29 years old, doctors told me I was staring down the barrel of jaw surgery, 2 years of braces, and 2 shoulder reconstructions, but if 2020 has taught me anything, things could have been much, much worse.

On that note, I really don’t want this post to be some whoa-is-me thing about how my life has been really difficult because the truth is relative to the majority of people on the planet — especially in the last year — it hasn’t been; and to be even more truthful, the things I endured were 100% elective — albeit to prevent further damage and larger issues down the road. The fact that I live in a place with free healthcare and access to surgeries is a whole other story of my privilege — not to mention my attributes for skin tone, gender or sexual orientation. I’m sure you can guess…

The truth is, part of my experience these last 2 years of working through recovery has been feeling guilty for struggling because I know that relative to most, I have it really good. Like 1% good. I have a partner who loves me, a job that pays me, a non-threatening skin tone, and I live in a place that has, to date, done a really good job of “flattening the curve.”

But life sucks sometimes and it’s important to take time to reflect on your struggles so that you can learn how to better cope with the many other things that are in store for you — it’s inevitable. I’m hoping that by writing this piece I can better process my experience and have something to look back on for future reflection.

That, and I’m also just really sick of having to tell people where I’ve been for the last 2 years.

DISCLAIMER: IF you’re still reading because you think I may have had some gnarly accident or crazy thing happen to warrant what i endured, I didn’t.
TL;DR I have bad jaw and shoulder genes. The end.
Read on if you dare.

So, I was turning 30 and my body was a hot mess…

For my jaw/teeth, I was told I had an underdeveloped upper jaw, resulting in an underbite that was causing jaw pain and a slow erosion of my front teeth.

Now, I had had braces once before — at 21 — to try to correct my bite, but unfortunately, my lower jaw continued to grow; since I had a permanent retainer, my teeth did not shift to accommodate. This meant that my bite slowly shifted until my front teeth were sitting edge-to-edge.

Imagine, if you will, that the only teeth that touched while chewing were your two front teeth — that was me. As a result my teeth are now much smaller and quite blunt from the constant wear and tear.

This wasn’t really something I wanted to put off any longer.

After meeting with a couple orthodontists I was given two options: braces for 2-3 years (and it may not be a permanent fix) or surgery first and then braces for 12-16 months. With 30 steadily approaching, I opted for the more expedient and invasive approach: surgery.

Enter stage left: Lefort 1 Maxillofacial Advancement—aka jaw surgery.

Lefort 1 Maxillary advancement Jaw before and after

The procedure was described to as, “we’re going to cut straight along your gum line, pull your teeth forward like a dresser drawer, screw in some plates to keep it in place, and stitch you back up. I suggest you get a really good blender.”

I picked up a Vitamix that day.

Obviously I wasn’t feeling very good about this but after talking to some colleagues who had had similar procedures — in highschool — a lot of my initial anxiety began to dissipate. The feelings toward braces at 30 were still very much prevalent.

Surgery #1

At 10 AM on the morning of November 7th, 2018, I received the first cuts of this story.

Surgery went smoothly and I spent the night at UBC Hospital where the nurses took incredible care of me. The pain was surprisingly manageable, no doubt thanks to the cocktail of meds pumping through my system. In fact, the worst thing of the entire experience was the “nasotracheal intubation” — a.k.a nose tube. Considering what my surgeon had just done to me, I’d say it went swimingly if my biggest complaint is a nose tube.

Me after jaw surgery New face, who dis?

Now to survive a month of liquids…

I’ll be honest, prior to surgery I was not at all phased by the notion of a month-long liquid diet. Maybe it was my previous experimentation with things like Soylent or my love for smoothies, but the reality is I grossly underestimated what lay ahead.

The first couple of weeks were alright. I was using MyFitnessPal to track my caloric intake each day, ensuring I was getting enough nutrition, and I got creative with soups and smoothies. Week 3 and 4 (especially) were a bit of a struggle though.

At week 3 I was over the whole potato soup and smoothie routine. Out of no where I found myself craving spicy-sour Tom Yum Noodle soup. Begrudgingly, my girlfriend agreed to pick some up from our favourite thai spot and make it more accessible to me, i.e., blend it. Huge mistake. I’m sure you can imagine what blended shrimp, mushroom and rice-noodle in a spicy-sour sauce looks and tastes like.

Did you think vomit?

That’s what it was: vomit.

I’d say in hindsight this was a terrible idea but I think anyone could have guessed how this was gonna turn out. Clearly I was experiencing mirrage-type delusion. After that I decided to stick with what I knew and muscle through the remainder of my sentence. Oat smoothies became my ride-or-die.

Aside from the new eating habit, this also kicked off my social-distancing before social-distancing was cool. I spent some time (a LOT) reading Asimov, playing Fortnite (losing) and watching a bunch of TV and movies.

Between my sedentary lifestyle and restricted diet, I lost about 10 lbs. In fairly lackluster-fashion, my first meal after getting my elastics removed was scrambled eggs and rice. As much as I was allowed to chew, I wasn’t exactly ready for a steak.

As far as my mouth was concerned, the heavy lifting was done and now it was a matter of braces for what I had thought at the time was only going to be 12 months — little did I know that my ortho and COVID had other plans…

By Christmas 2019 I was eating more regularly and started prepping for shoulder surgery #1. At this point I was just waiting for a date from my shoulder surgeon.

Balls and Sockets

X-rays of my shoulders after surgery.

My shoulder issues were the result of years of recurring dislocations and neglect on my part following a snowboarding accident (left) and a weird fall while playing hockey (right). It was one of those things where I didn’t realize the damage I was doing because the pain, although excruciating in the moment, was surprisingly fleeting.

Stupidly, I would frequently dislocate an arm, relocate it myself, and continue doing whatever I was doing in the moment. The worst example of this was when I was tree planting in Northern Ontario one summer and in a single day I dislocated my left shoulder 4 separate times — all by myself in the middle of the bush with nothing else to do and no access to medical attention, I decided to work through it. The reality is that even if I was next to a hospital at the time I probably wouldn’t have done anything about it. Younger Cole wasn’t a long-term thinker. Pair that with a reasonably high pain tolerance and you have a perfect explanation as to how I ended up where I did.

Now you may be asking, how the hell do you dislocate a shoulder 4 times in one day?

It’s a great question. After you’ve dislocated once, it becomes easier and easier to do it again. The technical term for what my shoulders did is actually called a “subluxation” — this is when the ball rolls out of the socket, gets stuck for a bit and then rolls back in after very awkward body manipulations (picture Elaine Benis dancing).

In my case, a dislocation could be triggered by something as simple as putting on a jacket, reaching for a car door, or pointing at something on a whiteboard (all real life examples). On the 4x day, The trigger was reaching down to plant a tree in the ground a few thousand times over the course of 10 hours. It’s the full extension of a reach where my shoulders were most vulnerable. For someone with bad shoulders, tree planting was a less than ideal match.

I didn’t plant again after that season.

Over the years, I’ve had multiple X-rays and the results always came back with comments like, “only minor damage, which should be easily fixed with a labaral repair and physiotherapy.”

Admittedly I sucked at doing my physio exercises, but It wasn’t until I got CT-scans done when the reality of the damage I had been doing sank in. Seeing the fully rendered 3D model of my shoulders on my surgeon’s screen made it clear that full pieces of my shoulder were missing. I had eroded about a 1/4 of my left shoulder socket and about a 1/3 of my right. Put simply, a labaral repair wasn’t going to do shit. This was going to require some bigger cuts and some new hardware.

The procedure they had pegged for me is called a “Latarjet” — named after the French doctor who first performed it in 1954 — and it involves cutting a piece of bone that your bicep attaches to and repositioning it to the front of your shoulder socket with two screws. This creates what they call a “boney block”, preventing the head of your arm to slip out — as it was doing so frequently before. If you’re curious, here’s a 3D animation of what they do.

It took me some time to wrap my head around the mechanics of it and to also accept the fact that there was no better alternatives for my situation. We have come a long way as a species but unfortunately for me 3d printing new humeral heads (ball) and glenoid cavities (socket) are not a thing — yet.

Supposedly the procedure is quite common amongst New Zealand All Blacks players which, for someone who spends 8 hours a day at a desk, is either really cool or very concerning. But hey, If it works, it works. Right?

Desk or not, our posture is the same… (Photo via @1NewsSportNZ)

If timing isn’t everything, within days of me giving notice to my job of 5+ years, I received a call from my surgeon — they had an operating room booked for me in 3 weeks time. As my health benefits were set to expire and I was planning to contract for the foreseeable future, I rushed to get my own health and disability insurance set up.

As my risk-averse, accountant father always says, “it’s better to have it and not need it, then to need it and not have it.”

Surgery #2

On the morning of February 20th, 2019, I had surgery number 2. I remember entering the OR, talking to the medical team about my tattoos, counting down from 10, 9, 8 — fade to black.

I woke up post-op and once again was feeling surprisingly good. The nerve block they had put in pre-surgery was still very much in effect and my pain was almost non-existent. If you’ve never had a nerve block before it’s like when your foot, hand, arm, etc. fall asleep — just more permanent. You have no feeling, no control, and basically the target appendage is dead weight, entirely subject to gravity’s will.

Getting home, I setup camp on the couch, and waited for the nerve block to wear off with meds at the ready.

I wasn’t allowed to lie on my back as I needed to keep my shoulder/arm elevated to reduce swelling so it took a few nights of trial-and-error to get the pillow-pyramid just right. A cocktail of Tramadol and Hydromorphone every 4-6 hours were a red-carpet welcome for sleep and dreams.

By day 5 I was completely pill-free, having the odd Tylenol to take the edge off. Living in Vancouver, I was especially fearful of opiods so I wanted to get off them as soon as I reasonably could — that, and they absolutely ruin your stomach.

CBD oil was a welcome companion that I can’t recommend enough.

At this point in my journey I was required to to wear a beast of a sling (pictured below) 24 hours a day. In addition to this, my face was still slightly swollen from the previous surgery; I had braces that were regularly well-stocked with food from a recent meal (one handed flossing with braces is hard); and I wasn’t allowed to do any physical activity aside from walking.

Slingshot His smile tells me he didn’t have to wear that thing for very long…

The body dysmorphia was real. Not only did I not feel like myself, but I also didn’t recognize the person staring back at me in the mirror. Needless to say, I wasn’t in the best place mentally. Once again I became socially-distant — had I only known what was coming in 2020 I probably would have done otherwise.

After 2 months in the sling I was given the ok to start light-physiotherapy. It took a few months but eventually I got back to biking, running, and weight training to strenghten my new shoulder.

It wasn’t until almost a year after surgery (December 2019) where I began to feel more confident in my new abilities. I was aware how all consuming my fear of dislocation was before surgery but only after I had recovered did I recognize how many little things I worried about — and didn’t have to anymore!

Experiencing the success and relief of the first procedure, I began to feel excited about what having 2 good shoulders would be like. Also, as my physical health improved, so too did my mental health. I got to enjoy most of the summer with my friends and even got to go skiing in the winter with my girlfriend and her family.

I started disccussing shoulder surgery #2 with my surgeon in October of that year and wanted to time it for early 2020 to allow for a relaxing Christmas and also provide enough time to recover before a trip to Bali my partner and I had planned in March.

Early December I got the call and was booked in. The date was set for January 11th, 2020. I was equally excited and nervous — excited for it to be done, but nervous to go through it all again. Thankfully, this time around I knew what to expect and there was comfort in the fact that it was going to be my non-dominant arm.

Surgery #3

For the most part, shoulder surgery/recovery round 2 was fairly straightforward. I dealt with the same pain, limitations and struggles I had in round 1, only everything was a little more mild. Instead of doing everything with my left hand, I now used my right. Instead of reading a ton of Asimov, I read the Gentleman Bastard series and watched all four seasons of The Expanse. 10/10 would recommend.

One thing I was conscious to change this time around was making a solid effort to go the gym and get on the stationary bike a few times a week. I’m acutely aware of how physical activity impacts my mental health so I wanted to nip that in the butt from the outset this time. It certainly helped.

Everything was looking good. I was 6 weeks post-surgery when I had my second follow-up with my surgeon and was given the ok to stop wearing my sling after another week — thank God. I had received a date from my orthodontist to get my braces removed — thank God 2x. My girlfriend and I had two weeks in Bali coming up to celebrate being done with all of my “upgrades” — thank MasterCard points.

The promised land of strong shoulders and a straight bite was starting to come into focus. Unfortunately this was also the end of February 2019. History will forever record what happened next.

COVID

For the most part I get my news from Twitter and Reddit so my curated feeds of mostly technology and design were keeping me sheltered from a lot of the developments at the time — this was still before tech Twitter began “teaching” us all with their “expert” viral growth insights.

Each time I went to the gym for my semi-regular bike rides I began noticing the TVs there were becoming more and more focussed on the developments of a novel coronavirus that originated in China. As the days past, the promised-land I had in my sights began to fall back behind the horizon as more and more things were either postponed or cancelled.

I did manage to get in to see my surgeon before serious restrictions were put in place but our Bali trip was cancelled and my “braces-off” date of May 11th was postponed indefinitely. Luckily though, we were part of the first cohort of travelers that received full refunds for all of our bookings.

I’m not going to go into detail of my Covid experience because I think it’s the last thing anyone needs right now but needless to say, after a year and half of self prescribed social-distancing, more distance was the last thing I needed.

We struggled a bit with our vacation being cancelled and I tried to come to terms with the fact that I had no idea when my teeth would be free from their shackles. There was so much out of our control, it took some getting used to. We developed coping mechanisms. Our first was to tackle the Marvel Cinematic Universe. While this provided temporary solace from our current reality, once Thanos was “snapped back” and Tony Stark was laid to rest, so too were we returned to 2020.

Running

In addition to our celebratory vacation, we also booked a half-marathon as something to train for and help me get “back to healthy again”. It was no surprise though when it, too, was cancelled.

Although at first I felt relief I wouldn’t have to put myself through the grueling training, or the run itself, I knew it was something that would have been really good for me. That, and it was something my partner Rebecca was really looking forward to doing together. Acknowledging that it was in my best interest to get healthy again and that having an event to work towards would be good, we committed to running the race anyways.

This was a key turning point for me, my recovery, and my general mental health for the year.

Running has always been something Rebecca craves and I tolerate. After almost 2 years of mostly couch-sitting, I was not exactly in peak running condition. Slowly though, my 5km runs became easier and easier. 5km became 7km, and 7km became 10km. I began to feel better and better and even started to look forward to our long Sunday morning runs together. Each week we would increase our distance by 2 or 3 km so that we were ready to tackle the full 21.1 km come race day.

As each week passed and our running distances grew, so too did my outlook and postive feelings of self-worth. Sure, my teeth were still trapped and I couldn’t see my family or friends, but my shoulders were mostly recovered, I had a great partner to quarantine with, and overall, my health was on the up and up.

Race day came and I managed to keep a pace of 5:17/km. My goal was to keep it sub 5:30 so I was stoked with the results.

Catharsis

Aside from avoiding doing more damage, the main reason I decided to take on shoulder surgeries was that I wanted to be able to get back to the active lifestyle of my younger years. I stopped playing all of the sports I loved because overtime the risk-reward of injury to fun just wasn’t worth it anymore.

As I continued to work through physio and more physical activity, the idea that I could play basketball, volleyballl, or even hockey again started to become more and more realistic. I began to feel like everything I had gone through was going to be worth it. That’s not to say I didn’t think it would be during recovery, it’s just that when you have trapped-in-your-own-body type feelings the way I did, you tend to forget the reasons why you put yourself through everything in the first place.

I wanted to write this piece now because I finally got my braces off last week.

Although it ulimately has very little impact on my life day-to-day, it was the last thing I’d been waiting on to be able to wrap up my experience these last 2 years.

There’s no denying it was a struggle but I fully recognize struggles are inevitible. While reading some philosophy this past year I came across this passage from Seneca who spoke of struggles as if they were taxes,

“Nothing will ever befall me that I will receive with gloom or a bad disposition. I will pay my taxes gladly. Now, all the things which cause complaint or dread are like the taxes of life — things from which, my dear Lucilius, you should never hope for the exemption or escape.”

Seneca, Moral Letters, 96.2

Pretty accurately, my jaw and shoulder issues were really the taxes I had to pay for years of neglect. I deferred payment for so long that interest continued to accrue until it was no longer managable.

Noone escapes struggle. We can avoid them and put them off but eventually we have to face them. The best thing we can do is count our blessings and remember the highs when we’re going through the lows — and that’s my biggest learning through all of this.

These last couple of years have not been all bad.

Aside from consuming a ton of books and movies, I’ve also built stronger relationships with my partner (and best friend), my friends, family and even myself. I’ve taken some time to learn new skills and work on different projects. I’ve checked off some major health to dos and am continuing to work at improving my health overall. Probably most exciting of all, I got engaged!

It goes without saying that 2020 has been a struggle but the reality is that the sharedness of it is going to ultimately bring us much closer overall. If you’re like me and were having trouble processing it all, try writing about it — even just for your self.


Nov 27 2020

Sourdough

Aug 24, 2020

Uses