She was heading downhill at high velocity when it happened. It was nothing she hadn’t dealt with before – hitting a pothole – as her bike was a hybrid with strong tires. But when it landed back on the pavement, she saw in disbelief the front tire suddenly fly out from the spokes. The quick release had been open. “I don’t actually remember falling,” says Annabel. “But I recall the impact for sure.” There was no time to tuck-and-roll or to break her fall in any way. She landed with full force on her jaw.
After being helped to the side of the road, Annabel checked her wounds. She was bleeding from her wrists, knees, elbows, and feet. Most of all, she was aware of a deep gash in her chin that was pumping blood, dripping down her neck. She knew she’d taken a bad spill, but she was in one piece. She could stand up, and when did, she thought, “Holy Cow. I’m OK. I think I’m OK.”
But she was far from OK. In the days to follow, Annabel gradually came to realize her injury was potentially very serious. She was in a great deal of pain and could not eat anything solid. In the ensuing weeks, a much bleaker picture was laid out for her: without radical surgery she would never be able to chew normally again.
Annabel grew up immersed in art, nature, and natural healing. “My mother is a very knowledgeable, grounded, gentle woman. She’s an artist, a gardener who very much embraced the outdoors,” she explains, adding that her mother also passed on to her a healthy attitude around the body. “I’m not somebody who is fearful of disease or injuries. It’s expected of a human being who lives their life fully and takes risks.”
In addition to her strong character and healthy upbringing, Annabel’s medical training as a midwife put her in a unique situation when dealing with her injury. “I’m all about home care,” she says. “I don’t like hospitals… sitting in waiting rooms where I can possibly get sick [in addition to the primary injury].”
This is an understandable concern, given the disturbing facts regarding superbugs in hospitals: as reported April 2012 in The Globe and Mail, “Minor ailments such as strep throat and infected cuts could once again become fatal. And operations such as organ transplants and hip replacements could become impossible to perform [due to antibiotic resistant bacteria rampant in hospitals].(1) Hence, following the accident, she went home to attend to her wounds.
In time, the situation became clear, she couldn’t eat and had to hold her chin to project her voice.
The first thing Annabel did was to clean up her wounds so she wouldn’t get an infection. Next, she used a suture bandage for her chin. She then assessed herself and concluded she had no dizziness or confusion. She did call Telehealth Ontario and explain she had no signs of concussion but wondered what they thought about her jaw. They suggested she look in the mirror to determine if her face was symmetrical. She saw that there was damage but essentially it appeared to be aligned. Really believing all she needed was rest and to be in the outdoors around loving supportive friends, she decided to go on the much anticipated camping trip. “I’ll just let everyone know I’m injured,” she thought, “and heal there.”
For the first 48 hours, she chalked the pain up to inflammation, and used homeopathic Arnica gel with cold compresses. As time passed, the reality of the situation became clear. Her mouth just wasn’t functioning normally; she couldn’t eat and had to hold on to her chin to project her voice. Also her body was very sore now and sand was getting in her wounds. That’s when she decided being at the campsite was perhaps not the best place for her – and that possibly her jaw was broken. When she got home and looked in the mirror again, this time she saw that her lower jaw was actually pushed up over her upper jaw. “I looked like a werewolf!” Annabel says, laughing. But that was a year and a half ago.
Since the accident happened on the first day of her holidays, Annabel had a month to set a plan in motion. Her journey towards healing began with consulting both allopathic and alternative practitioners. Five days after the traumatic event, Annabel saw her family doctor, then a dentist who confirmed a dislocated jaw. It took three tries to get it more or less back in place – without sedatives. “I probably would have declined [sedatives] anyway,” she says. “I’d rather feel it and give feedback. That’s the way I am.” She did request a shot of whiskey though, which elicited much laughter. Her jaw dislocated again a week later and she had another adjustment; she belted it in place at night for added security.
In the weeks ahead, Annabel faced numerous challenges. She was in constant pain; she could barely open her mouth and was unable to eat solid foods or talk much. In addition, emotional and psychological trauma after such severe injury is to be expected. She eventually had little choice but to take time off work and focus more fully on her recovery.
Soon after the injury, Annabel also turned to her existing alternative therapists for support. Toby Neal, a Toronto-based homeopath, helped alleviate both her physical and psychological symptoms and kick-started the healing process with several remedies.
While Annabel was remarkably composed and functioning, she was nevertheless in shock and extreme pain that was pulsating. For these symptoms, homeopathic Aconite (Monkshood) was prescribed, which further helps with inflammation. Neal also used homeopathic Hypericum, good for mental anxiety, as well as for the particular type of shooting pain associated with nerve irritation. Last but not least, Neal relied upon the powerful properties of Arnica to reduce swelling and bleeding and to heal bruises. (Annabel had used Arnica immediately after the accident, aware of its extraordinary ability to heal tissue trauma.)
“Not everyone has the ability to follow through [with alternative therapies and self care] in the way Annabel has,” says Neal, who strongly emphasizes education in her practice and helping clients help themselves. “It just goes to show if you support your body and treat it properly, it has an amazing ability to heal on its own.”
Two months after the accident, Annabel was scheduled for a Magnetic Resonance Imaging (MRI) scan. She was still on a liquid diet consisting of superfoods such as Greens+ and other nutrients, such as hemp protein and flax oil for immune system support, to promote healing and to sustain her; as well, she was taking various supplements including glucosamine to repair cartilage, and aloe vera juice (a great healing accelerator, pain inhibitor, immune booster, and natural detoxifier).
Thanks to nutritional medicine, homeopathy, and self-care she was able to move past the initial trauma, but she was still experiencing significant pain and taking ibuprofen as needed for pain. In addition, her jaw came dislocated in the middle of the night on two occasions; she had to learn how to put it in place herself.
“It was a horrible time,” says Annabel. “It felt dire to not be able to eat [normally].” But it wasn’t just the functional aspect of eating – getting nutrition into her body. She also realized she could no longer enjoy the foods she loves: “I grew up with a great connection to food,” she says. “Give me a good crusty bread and strong cheese, or a salad with toasted pumpkin seeds.” Suddenly, it was all gone; she could not chew a thing. To make matters worse, she had tremendous difficulty in another critical area – speech. For the first two months especially, she would struggle with articulating her words. “I would sometimes drool [due to] excess saliva from the trauma. I’d be tripping over my tongue and then a nerve would get pinched and I’d have to hold my face.”
Needless to say, Annabel was in a place of acute worry – not only about her injury and what it would mean long term; she was deeply concerned about how she could sustain herself and her children financially, after needing to go on disability with limited medical coverage. Then there was the upcoming MRI, which she was feeling particularly stressed about.
One of the tools Annabel used to help her through the experience was hypnosis. Shawn Gallagher, a Toronto Board Certified Hypnotist, was indispensable to her at various stages of her healing. Specifically, Gallagher used visualization techniques and guided meditation to reduce Annabel’s anxiety and pain surrounding her injuries, and to visualize positive healing – which also supported Annabel in preparing for the MRI. “It’s not uncommon for people to feel concerned over tests like MRIs,” says Gallagher. Visualization techniques through hypnosis, she explains, can really help build confidence in our ability to overcome our fears and to self-heal. “The subconscious mind is incredibly powerful. The ability to tap into something safe and natural that is your own strength – whether for confidence or [something physical] – is so awesome. Most people go through life thinking they don’t have that power.”
Tapping into that power proved to be one of Annabel’s most vital resources – especially after receiving her MRI results from the Oral and Maxillofacial [OMF] surgeon, which stunned her. “The OMF surgeon told me that it was a terrible injury, that they rarely see them this bad.” He went on to explain that usually the cartilage is salvageable. “Yours,” he said, “is blown apart.” The hardest part, she admits, was getting past that image of seeing her cartilage shattered. Without hypnotherapy, she says, “I’d have been really stuck in that place where I saw that cartilage and thought ‘there’s no way in hell it’s going to heal.’”
Craniosacral therapy has proven effective for a range of health issues.
After she moved past the initial shock, however, Annabel was keen to get all the information available to her. She explained to the OMF surgeon that she was considering Craniosacral Therapy (CST) and wanted his opinion on what her risks were if she opted out of surgery. Bone erosion was the big issue. Since the cartilage was destroyed, even the normal activity of eating and talking would wear the bones until eventually they too were useless. She inquired how long that might it take. He couldn’t say for sure – possibly years. As for cartilage replacement, no such options were available.
In arriving at a decision, Annabel weighed two critical things: the risk of bone erosion against the risks of surgery – specifically, the potential for eye and/or ear damage. However small that risk may be, Annabel was not willing to take it. She decided to buy some time and go ahead with CST. The OMF specialist was respectful of her choice and asked to be kept in the loop. “He knew the therapists at the Cranial Therapy Centre and commented that they were an excellent team. He was genuinely interested,” says Annabel. “If I get better, he said, he wanted to know, because ‘it’ll be a miracle’.”
After the MRI, Annabel relied predominantly upon CST to carry her through the next few months. During that time, she says, “accessing that physical feeling of healing was done purely through [CST with Mary Margaret Heron].”
CST was developed almost a century ago, and has its roots in osteopathy. Essentially, CST helps restore cranial mobility by releasing abnormal restrictions and tensions in the body; it also aids in realigning bones to their proper position. CST is based on understanding the continuous subtle movements of the cranial bones, which respond to fluid pressure changes around the central nervous system. These fluctuations in turn create a rhythm in the body – and it is this rhythm that the therapist attempts to restore to a more balanced state by gently working with the spine and skull, using his or her hands as the only tool to manipulate the deeper layers of fluid and membranes beneath the bones of the sacrum and cranium.
CST has proven effective for a wide and diverse range of health-related issues including insomnia, learning disabilities, birth traumas, and, among other problems and injuries, TMJ syndrome.
Annabel’s treatments, conducted at the Cranial Therapy Centre in Toronto, consisted of one-hour sessions once a week for the first month, then once a month for several months, after which there were follow-ups every six months.
Annabel recollects the first treatment as a cathartic experience: “Mary Margaret gloved up and put her fingers into the back of my mouth. She could feel the trauma and inflammation.” Suddenly, Annabel’s head began jerking about involuntarily and she started crying uncontrollably. In effect, she was reliving the memory of her accident; as Heron told her at the time, “It will take a lot of tears.” Annabel understood well how tears are critical to the healing process: “I know… that if you cry and have that discharge it helps relieve tension longer term, so crying actually made it hurt less.”
Says Heron (who is an Osteopath and a Registered Massage Therapist, with additional training in CST): “My primary goal, in Annabel’s case, was to balance the parts of her jaw that were restricting her and make sure the fluid and membranes were moving as they should.” As alternative therapists, she explains, supporting the natural process [of self-healing] is what we do. It is also one of the core beliefs of osteopathy. “Until there is no longer any fluid flowing between cells, our body has the ability to heal itself.”
And indeed, Annabel did begin to heal. CST also helped gradually to diminish her pain and prepare her for yet another course of treatment – one that was essential if she was to avoid surgery.
The next critical stage in Annabel’s journey was working with Dr. Dennis Marangos – a general dentist with a practice that focuses on Temporomandibular Joint disorders (TMJ) among other problems; he also builds splints for jaw-related injuries and conditions, as well as for preventive purposes (i.e., for athletes, to minimize injury). “Dr. Marangos had a lot of attention for my story,” she says.
For Marangos, listening carefully to his patients has always been a core part of his practice. “Over the years, my patients have taught me that there’s more to our body and health than what conventional medicine and dentistry sometimes have to offer.” He ran tests to determine overall neurological health and was impressed that her injury didn’t appear to be affecting the rest of her body. When he did internal images, however, it was the reverse, confirming the MRI results.
Nevertheless, she was determined to avoid surgery and Marangos supported her choice to instead try alternatives. “If I can make you 50% better with splints and encourage some other healing with physio- and craniosacral therapies and so on,” he challenges, “why would you want to go for surgery?”
The jaw joint is possibly the least predicable of all the joints of the body, in terms of surgery success, explains Marangos. Therefore, it is only logical to take the more conservative, reversible route first (i.e., splints) before jumping into surgery. “If [dental] orthotics doesn’t work,” he says, “then surgery is still an option.”
In Annabel’s case, stabilizing the injured joint 24/7 was critical. So Marangos built her day and night splints. The splints are built after first determining a proper therapeutic position for the jaw; they are then custom-fitted into the mouth and secured with suction. The day splints, typically used over a three- to six-month period, allow for essential functioning such as speaking, eating, and socializing, whereas the night splints are worn while sleeping and designed to keep muscles relaxed and the jaw in a comfortable position; they function to reduce clenching and grinding that can occur during sleep and put stress on the joints.
While Annabel was quite comfortable with the night splints, the day ones caused her some difficulty. “I felt really vulnerable,” she says. “It slowed me down… made me feel shy, insecure, like I had a visible disability; I couldn’t get my head around it.” Being able to communicate effectively is vital for everyone and, for Annabel, it is also central to her livelihood. “A big part of midwifery is being with our clients for 45-minute appointments, communicating with them about their choices and supporting them through their pregnancy. The need to be able to talk is huge in my work.”
She spoke candidly with Marangos about her concerns and he offered an alternate solution: that she wear the day splints during times of stress, such as after eating or at the gym. “When you’re exercising,” he says, “you’re clenching your teeth to lift weights or get that extra burst of energy – which sends specific neurological signals through your jaw joint. If your joint is already inflamed it’s sending you negative signals and it actually decreases your strength and endurance.” Wearing the day splints at these times offered Annabel a viable solution to her dilemma while still minimizing stress on the joint during the day.
Eighteen months later and Annabel has just received the results of her second MRI. All things considered, the outcome is optimistic. While the most damaged cartilage (on the right side of the jaw) is still detached, there are no obvious signs of bone decay or other deterioration; and it appears the cartilage on the left side, which sustained less damage, has been restored.
The bottom line: she’d been told she would never be able to chew a bagel again without invasive surgery, yet she can do that and more. “I can eat pretty much anything,” says Annabel. “I just eat smaller bites and chew more slowly.” She can also speak for longer stretches, she’s back to work full time, she’s not taking medication for pain and, whereas a year ago dental work would have been out of the question, she has since undergone normal dental procedures successfully. Whereas at one point – on a scale of one to 10 – her pain and discomfort was a 10, she now rates it as a two. “That,” she says, beaming, “makes me really happy.”
Marangos’ prognosis for Annabel is similarly positive: “She’s young,” he says, “And if she maintains the same level of awareness [about her health] that she has now, she can postpone that joint surgery for a long time.”
In terms of ongoing treatment, Annabel will continue as before, wearing the night splints, using CST, and maintaining her home care. She also wishes to add acupuncture to her healing repertoire. (Acupuncture is recognized as one of the most effective alternative treatments for conditions related to the temporo-madibular joint. In fact, one recent study reported high long-term patient satisfaction and improvement of symptoms 18 to 20 years following acupuncture and/or interocclusal appliance (bite plate or splint) therapy).(3)
As for Annabel’s journey, it has been a long and sometimes harrowing one, with challenges along the way – the least of which was dealing with at times excruciating pain while trying to keep at bay the fears and worries that lurked just beneath the surface. In some ways, Annabel’s life has changed irrevocably. She will no doubt continue to face challenges in the years ahead, but the experience has also precipitated great blessings. “I’ve always been an adrenalin junkie,” she laughs. “The accident changed all that. I’ve become much more mindful – not just about physical activities but in other areas of my life.” She lingers longer now to smell the roses, so to speak, taking time to savour the foods she enjoys, along with many other basics in life we often take for granted.
Perhaps the most valuable change that has emerged out of her ordeal, though, is a newfound awareness and appreciation for life in general and her relationships with others. About the health care team who supported her through the entire experience and worked hard to help restore much of what she had lost, Annabel’s gratitude runs deep: “They’re incredibly special people,” she says, with a big smile. “And they’re really invested in their beliefs of healthcare from many angles – the emotional, the psychological, the physical. All of them have been so great.” She expresses equal appreciation for friends and family. “The people I know really love me has become clearer. My parents, my sisters, my friends… have been amazing and incredibly supportive. They were there from the beginning, expressing their care and concern; they will always be a part of my life.”
There’s no question that Annabel’s healing journey has also helped enrich her spiritually and cultivate within her a deeper wisdom. But then, when you consider her mantra, which belies her young years, it would seem that wisdom comes natural to this remarkable woman: “The norm [of my belief system] is that everything will be well. My body will heal and I can conquer whatever happens.”
ENDNOTES
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