I met with Dr. Viozzi on August 20th and it was a great visit. I had been fully expecting that I would have the arch bars removed at this appointment, but I forgot that we would be deciding that at this appointment and it was possible they would be staying on. This was Dr. Viozzi's first week back after a two-week vacation, so he was very busy. My wife and 2 1/2 year old daughter were with me and we arrived at the Mayo Clinic about 50 minutes early. While we were showing our daughter the view from the 12th floor, Dr. Viozzi walked around the corner. After some happy hello's, Dr. Viozzi asked us to come right in because it would actually work out better for him if we did. I had no problem with that because I was planning on getting the hardware removed. Dr. Viozzi's nurse came in within a couple of minutes and she told me that she had read my blog and has also forwarded it on to Dr. Viozzi. He hadn't had a chance to read it yet, but I suspect that the main reason they removed the arch bars that day is because the nurse read my blog and the expectation that I had for their removal. They usually remove the arch bars in a procedure room in another building, but they decided it would work out fine in the room we were in. I don't think it was planned that way, but it worked out just fine (at least for me).
A spray was used on my gums to reduce any pain I might feel and it was supposed to taste like Pina Colada or something like that. It didn't really taste like that to me, but I can't begin to describe what it did taste like. But the taste was more pleasant than arch bars, so I won't complain. I think it took less than 10 minutes for them to take out the arch bars and there was very little pain. A couple of the wires hurt when they were removed, but it wasn't too bad. It felt great to finally have those things out. It also meant the Dr. Viozzi agreed with my assumption that I was doing well enough to have them out. He ordered a panoramic x-ray to make sure all the bits of wires were gone and to make sure there weren't any surprises in there. When he came back, he had some good news I wasn't expecting to hear that day. If you remember from my earlier posts about the unplanned fractures I had on my right side, we were taking a 'wait-and-see' approach to see how the bone fragments would heal on their own. I was expecting to go back in November or so to see how that area was doing. Dr. Viozzi came back in and said that he could see bone forming in the fractures and the pieces were healing together just fine. I figured I'd have to wait 6 months to hear anything definitive on this, but I got the good word in just over 2 months. Based on that and the fact that I didn't have any real bite issues, Dr. Viozzi basically took off any eating restrictions for me. I could start working my way up to foods that were harder to chew at whatever pace was comfortable for me.
All that good news coupled with the progress I have made with sleep made me pretty happy. Prior to my latest visit, I had stopped taking any medication to help me sleep and had started setting an alarm again. I had tried Ambien CR, but I always had a hangover from that. I even stopped the trusty temazapam. I still had been wearing ear plugs as I would wake up at the slightest noise for some reason. I figure it's just because I had to wear ear plugs for the past 1.5 years while on CPAP and dealing with other problems. This seems strange to me because I used to snore so loud. We also started locking our cats in the basement at night. They weren't too bad to have in there, but it seemed like any slight movement would wake me up. It doesn't help that one of them is a bed hog. We may try letting them out at night after a while, but we should probably wait until things stabilize a little more.
Today, about a week after arch bar removal, sleep is still getting better. I slept without ear plugs for the first time last night. I only remember waking up once and was able to fall asleep fairly quickly. I woke up before the alarm, but decided to lay there for a while. I dozed a little until the alarm went off and then got up. I still feel tired during the day, but not like I did while on CPAP. If things didn't improve at all from where they are now as far as sleep goes, I'd have to consider the operation a success. I finally took the CPAP back yesterday and haven't had to use it since that little episode a few weeks back. I have more feeling coming back in all areas that were affected. It took about 6 weeks before I started getting any feeling in my chin, but now I even have some feeling in my lower lip. I still have numbness in my gums, mostly on top. There is still some residual swelling on the front of my face below my eyes and under my nose. I'm told that this will take 6-12 more months to go down, but it's not enough to bother me at this point. Basically, wherever there is any screw or plate, there is a little swelling. The only other place is on my right side where those fractures occurred. Some of these things tend to make my face look slightly lopsided, but I don't think anyone other than I can tell. I'm not that picky about my appearance, so I'm not bothered by it. It will go away in due time.
As far as eating goes...I ate pizza last night and was actually able to take fairly normal bites off the slice instead of using a fork. My biggest limitation is that I can't open nearly as wide as I had before, but that is getting better, too. It will be a little while before I can eat a burger or brat, but I can deal with it.
I have also been able to shoot trap again since week 6, and that has gone well. My scores picked up right where I left off, so I was really happy with that. I did notice that if I shot more than one round, I would have a little soreness, usually on the opposite side I held the gun. I think it was just that my jaw wasn't used to being in that position. We had our end-of-season shoot-offs last weekend and I shot a total of 7 rounds (175 shots) and I only had a little jaw soreness on the opposite side. It was all gone the next morning, so no problems there.
About the only lingering issue I have is one I forgot to ask Dr. Viozzi about. I have some add feelings in my left ear that seem to be persisting. It's rather hard to describe, but it's like my inner ear feels hot from time to time. Kind of like the feeling you get in a finger if the circulation was cut off and then returned. It's not getting worse, so I'll probably wait to see if it gets better.
Tuesday, August 26, 2008
Friday, August 15, 2008
6. Weeks 3 - 8
Well, I haven't been very diligent in posting new information up here, but if you've read other blogs as well as the Recovery Timeline, you will have a good idea as to the more general progression of events. I'm going to be a little less detailed than the day-to-day types of blogs you may have already read. That is mostly due to the mental setbacks that I experienced starting at about week 3.
My physical recovery had been going pretty much as expected with very minimal pain, decreasing discomfort and improved eating. I was still taking medication to help sleep, but I was also having to sleep fairly upright until about week 5. During week 3, I had one night where I slept very soundly and woke up the next morning feeling great! I was sure I was cured! Well, that was a premature assessment. When you read in other places that there are ups and downs, believe it. I went to one day of feeling great, to a couple of weeks of more hell. What caused this hell? My apnea came back...or so I thought. I started having episodes where I felt I was choking awake, feeling that someone had been beating me on the chest for about an hour and sweating like I had been running for an hour. Just like the good ol' days. Well, I started trying to find different positions to sleep in and sleeping in bed was now out of the question. CPAP wasn't an option because I could keep the thing from blowing air out of my mouth and I couldn't get a full face mask to work at all. So, I started in on a good solid case of mild depression. I didn't want to work on this blog, I didn't want to try to work, although I probably could have put a few hours in. I didn't even want to do the fun things at home that I was able to do. I just wanted to sit around and wait until I was physically healed so I could try the next surgery to make things better. So here I am, wired shut, moderately uncomfortable, months away from being ready for any kind of additional surgery, but seeing that as my "only hope", I felt trapped.
I followed this pattern for about 4-5 days until I finally was able to dig myself out with my wife's help. She helped to remind me that we figured the most probable outcome of the MMA was that I'd still have to have something else done to get a complete or mostly complete cure. So, my mood improved and I started getting back to living a little again. Finally, it was week 6 and time to get my wires cut. Dr. Viozzi's nurse (whom I haven't asked for permission to name yet) called me early that week and all I could think as my wife handed me the phone was that they were going to make me wait longer. Well, Dr. Viozzi had her call me to move me up a day as Dr. Viozzi was going on vacation. Well, being the pessimist that I sometimes am, I figured he was cleaning up his schedule so that he could get started on his vacation early. Well, I was wrong there, too. Dr. Viozzi wanted to cut the wires a day early so that if I were having any difficulty, he would be there the next day to help instead in some far away place.
I want to take a moment here to talk a little bit more about Dr. Viozzi and his nurse. I started down this road being very distrustful of surgeons due to my experience with the UPPP. After meeting with Dr. Viozzi the first time, I started thinking maybe he was alright, but I still needed to be careful. I have come to believe that Dr. Viozzi must be the pinnacle of what doctors and surgeons are supposed to be. Very intelligent, kind, thoughtful and caring. I figured that a doctor working at the world renowned Mayo Clinic would be always in a rush to leave and grow tired of questions. I have never had cause to believe any of that with Dr. Viozzi. Even when I thought the surgery had failed, I didn't blame Dr. Viozzi or doubt his ability. By that time I knew he only had my best interest in mind and that he had fully prepared me for what was going on. I was certainly disappointed when I thought the apnea was still going strong, but not in him. I would recommend him to anyone who is looking for an opinion on what to do with an OSA problem.
I met with Dr. Viozzi that Thursday, which ended up being a few days short of the requisite 6 weeks for being wired shut, but I was (happily) willing to take the risk of being opened up 3 days early. My jaws felt very strange after being released. It was a little difficult getting my teeth to bite and move my jaw around. I was able to open just wide enough to get a toothbrush around to get the worst of the gunk off my teeth, but it was a little painful. The arch bars had to stay in to help me get my bite movement on track and also to band up at night before bed to keep from jarring the right side where all the problems were. While I was there, I told Dr. Viozzi of my fears that the apnea had returned, but he still said it was too early to tell. There could still be some residual swelling and that was the reason that follow-up sleep studies didn't happen for 6 months after surgery. I had begun to think at this point that he was just trying to offer me a little hope to get me through but didn't really believe what he was telling me. I'm sure that was my pessimism coming through, too. He had never offered false hope or minced words before this, so there really wasn't any reason to believe it now. He ordered the panoramic x-ray to take a look at things, but didn't order the "side view" that would show my airway. When I was in the room with his nurse, he popped his head in to order the "side view". If I had to guess, I would say that he would not have ordered that view unless he was trying to show me something. I think he thought it was premature to take that picture that early. I may be wrong, but I still think he was looking to give me some proof that things may not be as bad as I thought. Maybe someday he'll tell me. Well, after a brief wait, Dr. Viozzi came into the room and said he had some great news. My airway was much larger than it was before. He showed us the picture, and it was even more open than I expected it to ever be. Dr. Viozzi didn't come right out and say it, but from the answers to some of my questions, I think he was having doubts about the accuracy of my apnea claims. I don't think he thought I was lying or anything like that. I just think he felt that either most of those "symptoms" would go away, or there was some other problem. It did make me feel much better, so if that was the goal, it worked. I now had a real dilemma. If I now had an airway you could drive a truck through, what was waking me up at night?
During the first days, eating was not very easy and I found myself eating less than I had when I was eating through a syringe. I kept to very soft foods and even those made my teeth and jaws hurt. It was all very strange. The entire top of my mouth felt like it was very loosely attached even though it was very solid. Over the next week, things improve and eating became much easier. I also started to sleep in bed with the help of a new medication, Ambien CR. Insurance didn't cover a penny of that prescription, so $145 later, I had a new drug. I kept feeling like I had some pretty nasty apnea, but I started to think of it differently. I had to leap to the conclusion that I no longer had apnea and that some other thing was making me think otherwise. Again, it was too early to make that leap, but that is how my mind works sometimes. So, now "knowing" that I didn't have apnea, I was free to explore other explanations. To make a days-long process short, I determined that the majority (if not all) of my symptoms were due to swallowing difficulty. Something that I hadn't really thought about was the fact that I had to bow my head slightly in order to swallow when my teeth were held tightly together. I didn't really think too much of it, but now that I was looking at all other possibilities to explain my problem, things start to squeeze into place. Granted, I was the one squeezing them, so I'm sure my judgement was clouded a little in an effort to make this theory work for me. If I then thought about the position my head was in when I had these episodes, it seemed that most occurred when my neck was either fairly straight, or even slightly tilted to the rear. This made swallowing while sleeping very difficult and I think it was that struggle (which does involve the tongue) that cause me to wake and had a feel similar to a tongue-based apnea. I now had a working theory that let me have my apnea cured and explained why I was waking up.
Armed with this new information, I decided it was time to get my sleeping habits back on track. I decided that the quickest way to get myself back to a normal sleep cycle was to force myself back into one. It would be a little painful and deprive me of a little sleep, but I felt that with my apnea now cured, I should shake the rest of the bad stuff out, too. I quit taking any sleep assisting medications and started setting my alarm. As of the date of this post (8/15/08) I am finishing up the first week of this new plan. Just as expected, I have lost a few hours of sleep, but I feel that things are improving. I am waking up a few times during the night, I almost never sweat during sleep anymore, and the bags under my eyes are slowly lightening up. I also figured out that the reason it felt like someone had beat me in the chest before was most likely caused by anxiety. Since I convinced myself that the apnea was gone, the anxiety when having one of the waking episodes went away rather quickly, too. I get to go get the arch bars off next week, so I am hoping that having free roaming jaws will help reduce the number of wakings due to swallowing....assuming that my theory holds true. My wife and I will also be gradually setting the alarm earlier and earlier to get us to our goal of getting back a couple of hours of our days. I still don't know what the future holds for the right side of my mandible, but other than some funny noises and some residual swelling, that side isn't giving me any problems. My teeth sometimes feel like they make earlier and firmer contact on that side, but things seem to be ok there. We'll see.
My physical recovery had been going pretty much as expected with very minimal pain, decreasing discomfort and improved eating. I was still taking medication to help sleep, but I was also having to sleep fairly upright until about week 5. During week 3, I had one night where I slept very soundly and woke up the next morning feeling great! I was sure I was cured! Well, that was a premature assessment. When you read in other places that there are ups and downs, believe it. I went to one day of feeling great, to a couple of weeks of more hell. What caused this hell? My apnea came back...or so I thought. I started having episodes where I felt I was choking awake, feeling that someone had been beating me on the chest for about an hour and sweating like I had been running for an hour. Just like the good ol' days. Well, I started trying to find different positions to sleep in and sleeping in bed was now out of the question. CPAP wasn't an option because I could keep the thing from blowing air out of my mouth and I couldn't get a full face mask to work at all. So, I started in on a good solid case of mild depression. I didn't want to work on this blog, I didn't want to try to work, although I probably could have put a few hours in. I didn't even want to do the fun things at home that I was able to do. I just wanted to sit around and wait until I was physically healed so I could try the next surgery to make things better. So here I am, wired shut, moderately uncomfortable, months away from being ready for any kind of additional surgery, but seeing that as my "only hope", I felt trapped.
I followed this pattern for about 4-5 days until I finally was able to dig myself out with my wife's help. She helped to remind me that we figured the most probable outcome of the MMA was that I'd still have to have something else done to get a complete or mostly complete cure. So, my mood improved and I started getting back to living a little again. Finally, it was week 6 and time to get my wires cut. Dr. Viozzi's nurse (whom I haven't asked for permission to name yet) called me early that week and all I could think as my wife handed me the phone was that they were going to make me wait longer. Well, Dr. Viozzi had her call me to move me up a day as Dr. Viozzi was going on vacation. Well, being the pessimist that I sometimes am, I figured he was cleaning up his schedule so that he could get started on his vacation early. Well, I was wrong there, too. Dr. Viozzi wanted to cut the wires a day early so that if I were having any difficulty, he would be there the next day to help instead in some far away place.
I want to take a moment here to talk a little bit more about Dr. Viozzi and his nurse. I started down this road being very distrustful of surgeons due to my experience with the UPPP. After meeting with Dr. Viozzi the first time, I started thinking maybe he was alright, but I still needed to be careful. I have come to believe that Dr. Viozzi must be the pinnacle of what doctors and surgeons are supposed to be. Very intelligent, kind, thoughtful and caring. I figured that a doctor working at the world renowned Mayo Clinic would be always in a rush to leave and grow tired of questions. I have never had cause to believe any of that with Dr. Viozzi. Even when I thought the surgery had failed, I didn't blame Dr. Viozzi or doubt his ability. By that time I knew he only had my best interest in mind and that he had fully prepared me for what was going on. I was certainly disappointed when I thought the apnea was still going strong, but not in him. I would recommend him to anyone who is looking for an opinion on what to do with an OSA problem.
I met with Dr. Viozzi that Thursday, which ended up being a few days short of the requisite 6 weeks for being wired shut, but I was (happily) willing to take the risk of being opened up 3 days early. My jaws felt very strange after being released. It was a little difficult getting my teeth to bite and move my jaw around. I was able to open just wide enough to get a toothbrush around to get the worst of the gunk off my teeth, but it was a little painful. The arch bars had to stay in to help me get my bite movement on track and also to band up at night before bed to keep from jarring the right side where all the problems were. While I was there, I told Dr. Viozzi of my fears that the apnea had returned, but he still said it was too early to tell. There could still be some residual swelling and that was the reason that follow-up sleep studies didn't happen for 6 months after surgery. I had begun to think at this point that he was just trying to offer me a little hope to get me through but didn't really believe what he was telling me. I'm sure that was my pessimism coming through, too. He had never offered false hope or minced words before this, so there really wasn't any reason to believe it now. He ordered the panoramic x-ray to take a look at things, but didn't order the "side view" that would show my airway. When I was in the room with his nurse, he popped his head in to order the "side view". If I had to guess, I would say that he would not have ordered that view unless he was trying to show me something. I think he thought it was premature to take that picture that early. I may be wrong, but I still think he was looking to give me some proof that things may not be as bad as I thought. Maybe someday he'll tell me. Well, after a brief wait, Dr. Viozzi came into the room and said he had some great news. My airway was much larger than it was before. He showed us the picture, and it was even more open than I expected it to ever be. Dr. Viozzi didn't come right out and say it, but from the answers to some of my questions, I think he was having doubts about the accuracy of my apnea claims. I don't think he thought I was lying or anything like that. I just think he felt that either most of those "symptoms" would go away, or there was some other problem. It did make me feel much better, so if that was the goal, it worked. I now had a real dilemma. If I now had an airway you could drive a truck through, what was waking me up at night?
During the first days, eating was not very easy and I found myself eating less than I had when I was eating through a syringe. I kept to very soft foods and even those made my teeth and jaws hurt. It was all very strange. The entire top of my mouth felt like it was very loosely attached even though it was very solid. Over the next week, things improve and eating became much easier. I also started to sleep in bed with the help of a new medication, Ambien CR. Insurance didn't cover a penny of that prescription, so $145 later, I had a new drug. I kept feeling like I had some pretty nasty apnea, but I started to think of it differently. I had to leap to the conclusion that I no longer had apnea and that some other thing was making me think otherwise. Again, it was too early to make that leap, but that is how my mind works sometimes. So, now "knowing" that I didn't have apnea, I was free to explore other explanations. To make a days-long process short, I determined that the majority (if not all) of my symptoms were due to swallowing difficulty. Something that I hadn't really thought about was the fact that I had to bow my head slightly in order to swallow when my teeth were held tightly together. I didn't really think too much of it, but now that I was looking at all other possibilities to explain my problem, things start to squeeze into place. Granted, I was the one squeezing them, so I'm sure my judgement was clouded a little in an effort to make this theory work for me. If I then thought about the position my head was in when I had these episodes, it seemed that most occurred when my neck was either fairly straight, or even slightly tilted to the rear. This made swallowing while sleeping very difficult and I think it was that struggle (which does involve the tongue) that cause me to wake and had a feel similar to a tongue-based apnea. I now had a working theory that let me have my apnea cured and explained why I was waking up.
Armed with this new information, I decided it was time to get my sleeping habits back on track. I decided that the quickest way to get myself back to a normal sleep cycle was to force myself back into one. It would be a little painful and deprive me of a little sleep, but I felt that with my apnea now cured, I should shake the rest of the bad stuff out, too. I quit taking any sleep assisting medications and started setting my alarm. As of the date of this post (8/15/08) I am finishing up the first week of this new plan. Just as expected, I have lost a few hours of sleep, but I feel that things are improving. I am waking up a few times during the night, I almost never sweat during sleep anymore, and the bags under my eyes are slowly lightening up. I also figured out that the reason it felt like someone had beat me in the chest before was most likely caused by anxiety. Since I convinced myself that the apnea was gone, the anxiety when having one of the waking episodes went away rather quickly, too. I get to go get the arch bars off next week, so I am hoping that having free roaming jaws will help reduce the number of wakings due to swallowing....assuming that my theory holds true. My wife and I will also be gradually setting the alarm earlier and earlier to get us to our goal of getting back a couple of hours of our days. I still don't know what the future holds for the right side of my mandible, but other than some funny noises and some residual swelling, that side isn't giving me any problems. My teeth sometimes feel like they make earlier and firmer contact on that side, but things seem to be ok there. We'll see.
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