body talk

An oral surgeon recently told me my jaw pain likely stems in part from arthritis.

“Aren’t I a little young for that?” I asked her, a laugh in my voice. “Arthritis? At my age?”

The oral surgeon smiled under her mask. A smile that said, “Oh, this poor idiot.” No, she told me, it was not early for arthritis. I was right on time as a woman in middle age, a woman in her 30s or 40s…

This was when I realized that I am, by many standards, a woman in middle age. It only took a $400 consult with an out-of-network surgeon to break the news.

In four weeks, that oral surgeon will walk into an operating room where I will be waiting after an anesthesiologist puts me under. She will insert a needle somewhere into my left jaw. She will flush out the joint with some kind of fluid, then manipulate my jaw while I’m still sleeping. I will go home sore and—hopefully, eventually—able to chew without pain. Maybe for a couple of years, if I’m lucky. It’s possible I’ll even be able to yawn without pain, but I haven’t dared to dream so big.

My insurance (and most insurance) doesn’t cover treatment for TMJ disorders. I will pay handsomely out of pocket for this procedure, because women in middle age get desperate. I will feel sick to my stomach about the money—I already do. I’m uneasy about my own privilege in being able to hand over so much cash without extreme financial acrobatics, but also sickened by the injustice that I have to do it at all.

Then, the guilt for spending all this money on a procedure meant to merely return my body to its baseline functionality. There’s no value add.

Still, the economics likely make sense for a woman in middle age: Hopefully, I have many decades ahead of me. Decades during which I’d like to be able to chew both soft and hard foods and yell in joy and yawn from exhaustion and gasp in awe.

The acute temporomandibular disorder symptoms started after my son was born nearly two years ago. I am a lifelong tooth grinder and jaw clencher; I’ve had a mouthguard since childhood, before they became popular among aging millennials. But these symptoms were new. Sharp pain made it impossible to chew. Sometimes, I could barely talk.

Since then, my treatment has included: Extensive physical therapy with two different PTs, NSAIDs, prescription painkillers, prescription muscle relaxers, steroids, trigger point injections, dry needling, masseter Botox, warm compress, cold compress, custom TMD splint, MRI imaging, meditation, relaxation, yoga, massage, magnesium supplements, nerve flossing, stretching, strengthening, YouTube experts, tea, Tiger Balm, lacrosse balls, foam rollers, a double peanut ball, therapy.

None of it got to the root of the pain, and then my face caved in.

The indents appeared overnight. I looked in the mirror one morning and met them for the first time. Maybe I was rubbing a tinted moisturizer in when I felt a curious dip, or maybe I caught a side view from the mirrored inside of the medicine cabinet—I don’t remember.

The two craters in the hollows of my jaw are completely symmetrical. It’s like someone took their index fingers to the dough of my face and made two imprints on either side, just below the ear, in the spot where my jaw bone clicks whenever I open my mouth.

Maybe the skin atrophied slowly, so I didn’t notice it. Or maybe it happened suddenly, like a building collapsing after years of teetering atop a flimsy foundation.

For most of my life, I’ve felt like a brain stuck in a body. Like I am not of my body. That my body is a tool I can control and manipulate through intense exercise or special diets, a thing that on good days is a marker of my worth, and on other days is a potato sack—pure function.

Of course, the truth lies somewhere in the middle. And part of the truth is that youthful, physical beauty becomes less inherently compelling to me every year, because youth and beauty are pretty much synonymous. Duh. I am getting older, and that’s that.

But vanity still strikes. It’s not that I want to look younger than my age, but I do yearn to maintain the features that I feel, delusionally, are my birthright. I want my old face back, without the symmetrical craters. I want my body to obey.

The face craters are insult to injury. They pile on top of a condition that already makes me feel insane: TMD is not well understood, primarily affects women, languishes in a gray area between dental and medical care, causes significant pain, but it isn’t terminal, and most insurance plans won’t cover treatment, so… best of luck.

My past and current TMD treatment team includes:

1. Dr. K****, DDS. TMD specialist. Ordered custom orthotic after evaluation of symptoms, review of previous treatments and MRI imaging that identified displaced discs on both sides of the jaw and “early degenerative changes” to the left side.

2. Dr. P****, DDS. Dentist certified to administer masseter Botox for TMD symptoms.

3. Dr. K****, DDS. Faculty at university dental school; TMD specialist. Administered trigger point injections in clinic.

4. R*****, PT. Certified in dry needling. Administered ~16 weeks of biweekly physical therapy.

5. M*****, PT. Certified in dry needling. Administered ~8 weeks of weekly physical therapy.

6. Dr. P*****, MD. Facial cosmetic and reconstructive surgeon. Evaluated face indentations; suggested fat transfer as a solution.

7. Dr. B******, MD, DMD. Oral surgeon. Recommended arthrocentesis of the jaw based on MRI imaging and previous failed treatments.

8. L*****. Somatic therapist.

If I plot out the specialists’ locations on a map, I mostly travel to them going west then east, west then east. I derive no meaning here other than imagining the Cheshire Cat’s smile, creeping wide, the balls of his jaw moving nimbly in and out of their sockets.

The face craters have thrown all of these specialists for a loop. Nobody can explain what caused them. Everyone has a different theory based on flimsy evidence. When I reach back out down the line to all the people I’ve worked with, their reactions range from mild curiosity to a surprisingly aggressive shutdown of my inquiry—they must worry I’ll be litigious, that I’ll blame them for the cosmetic fallout.

I picture, for some reason, the cover of “Chicka Chicka Boom Boom.”

1 is spooked. 2 is stumped.

3 responds with a “harumph.”

4 opts out; 5 shoots his shot.

6 wants fat transfer to the spot.

7 palpates with fascination.

8 prods chakras from stagnation.

Chicka chicka boom boom, could my face implode soon?

It’s taken me until middle age to understand that I am not just bringing my body along for the ride with my mind. It’s usually the other way around. And it hasn’t been a joyride lately.

Before I undergo my jaw procedure, I will meet with an OB to determine what needs to happen regarding a polyp in my uterus, and, less urgently, a cyst.

Unlike my jaw, my uterus is closer to my gut, an area that I’m already practiced in monitoring and scrutinizing.

My gut, before motherhood: A place for unruly extra weight to congregate; the worst-case scenario. A belly. A paunch. A constant source of shame.

I used to do Mari Winsor’s Pilates VHS tapes in my childhood basement. I sucked my belly button to my spine, so far back my belly might have disappeared completely. I hoped it would.

The password to my old secret LiveJournal from high school and college (“insanity,” one word, lower case) still lives in my hands. Each day for years, my fingers would glide across the keyboard to log in and document another attempt at calorie restriction. I’d upload photos of my beer-bloated body in a bikini with the head cropped off, imploring strangers to guess my weight. I grew desensitized to the stench of the chemical off-gassing from all the slimming clothes I bought on clearance at Express and Forever 21—black bodycon, black spandex.

Today, I check to make sure my belly is still there. I hold my hand to it constantly, comforted by the rhythmic expansion and contraction as I breathe. My body has softened, and I’ve softened a bit towards it.

It’s not so much that I love my tiger stripes! or I’ve embraced body positivity. I’ve merely sat back, gobsmacked, as a dormant ferocity from my midsection awakened and started demanding respect. My gut is an animal. I’ve stopped pretending to be the master of it.

I never felt a fire in my belly—something like intuition or conviction—until I became a mother. I never felt connected to my core until pregnancy and birth tore it apart and forced me to find it again.

Creating new life reorganized my gut. Obliterated it, actually. Rebuilding my core became a personal project instead of an aesthetic one. I started doing Pilates again for the first time in years, following along with the videos on my phone to connect with the power bubbling up from the bottom of the well. To witness how a strategic contraction from my middle can move a femur in its socket or pull a pointed toe up from tapping the floor. To remember who I am from dead center.

I keep seeing pictures of myself from five or six years ago, before I was pregnant or trying to be pregnant, and I admit I sometimes get a little wistful for a body that I thought was not-so-great at the time.

Right now, I feel like a cubist portrait of my former self: All my parts are roughly the same, but shifted slightly from where I left them pre-pregnancy. This is what happens to a body that is capable of expanding and contracting over and over, as it is meant to.

There is more strength in my body today than there was in my 30- or 20-year-old body. There are also are polyps and cysts and jaw joints wiggled out of place.

My personal theory behind the TMJ issue is this: The relaxin pumping through my system during pregnancy to loosen my hips also loosened ligaments in my face, around my jaw. The stretching required of my body for the baby to grow and exit was not isolated to my uterus or hips or cervix or breasts. I shifted—and fell out of alignment—in unexpected places. I also found alignment for the first time in other places.

How upset can I be, when I would not go back to the body I had if it meant giving up any part of what I have now—including the strength at my center?

I’m not sure yet if I’ll bother getting a fat transfer to fill in the holes in my face. I’m not sure yet if the jaw procedure will help me go back to chewing pain-free for six months or six years or any amount of time. I’m not sure if I’ll need a hysteroscopy to remove the polyp or what it will mean if the uterine cyst does not dissolve.

I am certain of the way a lightning bolt of pain strikes when I chew through raw kale, and the way my gut sinks into a murky green pond when I look over the procedure estimate from the oral surgeon’s office.

I am certain of the way the murkiness dissipates when my daughter ascends from naptime with perfect rat’s-nest bedhead. I am certain of the warm gold rising up to my heart when my one-year-old son shouts “mommyMOMMYmommy!” and leans in for a kiss. I am certain of the strength of my convictions that start from somewhere deep inside my physical being—somewhere lower and more rooted than my head. There is so much grief and so much revelry in having a body.