Well, I haven't posted for some time now, so I figured I should get caught up. Things have been moving along very slowly as far as recovery goes. I struggled for a month or so trying to get off the Temazapam I had been taking for almost 8 months. If I had known how much trouble that stuff was, I'd have refused to take it. I'm a little disappointed that my doctor (not Dr. Viozzi) didn't tell me how bad that drug is to get off. I was having sleep starts, sweating, insomnia and probably a few other problems while trying to wean off the drug. I finally kicked it with the help of some Ambien CR, which isn't a picnic either, and with melatonin. I'm now taking 5-HTP each night to help get some sleep, and that seems to work fairly well. I haven't noticed any adverse effects from that yet. I haven't been getting much feeling back other than what I had a couple of months ago, but I think there may have been some improvement. I have at least some feeling in 95-100 percent of the affected areas. Some areas are difficult to gauge feeling in. The worst areas right now are my upper gums under my nose and the lower gums. The next worse is my whole bottom lip and chin area. There is feeling there, but it feels stiff and tingly when I touch it. I am still hoping that more feeling will return.
The only ill effects I seem to be 'suffering' from that bad break on my right mandible is that my jaw has the tendency to slide back on that side when chewing or laying down. It makes it feel like my jaw is a little out of alignment, but based on what Dr. Viozzi said on my last visit, it is most likely muscle related and may improve over time.
As far as sleep goes....I'm still having difficulties there. Now that I'm over the Temazapam withdrawal, I'm able to gauge things a little better. My sleep is more consistent than it had been before the MMA, but I am still having apneas. I have a sleep study coming up in a couple of weeks to see where things stand, and I have a feeling that considerable improvement will be recorded. I am sure that I'm not "cured", but based on how I feel and how I'm sleeping, I am guessing that I'm going to come in somewhere on the border of mild to moderate apnea. I had recorded myself sleeping a few times to see what I could see, and what I did notice was that the apneas I was able to see weren't easy to spot. Also, I was able to sleep for some pretty extended periods of time without visibly rousing. That would not have been the case before the MMA. So, without knowing anything definitive at this point, I've made some assumptions and used that to guess at what my options may be at this point.
I am certain that I still have at least 'mild' apnea and some of those apneas are definitely tongue base related as oppose to palate related. The options at this point are probably these; CPAP, GA (tongue advancement), TAP appliance, or tongue base somnoplasty. One other thing that people have had done is hyoid advancement, but Dr. Viozzi is a little leary of that procedure in light of some problems he's heard about. If there are other options, I don't know what they may be at this point.
Of that list of options, I'd really like to start with the tongue base somnoplasty, but there are two problems with that. First, there isn't anything conclusive that says the procedure has a significant effect and has questionable durability. So, it can't be proven to work and if it does seem to work, it doesn't last. So, in light of that, the next problem is that insurance won't pay for it. What I can't seem to wrap my mind around at this point is that if surgical procedures to reduce tongue volume have a positive effect and somnoplasty also can have similar volume reduction, why doesn't it work as well? Maybe the surgical reduction doesn't really work well either? I'll definitely be asking Dr. Viozzi that one.
The next option would be the TAP appliance. I'm not convinced that this device would help me and I'm not sure I'd be happy having my jaw held forward like that anyway. Also, I'm not convinced that it would stay in place after I fell asleep. I'd prefer this over CPAP and GA, but not by much.
The next option is the Genioglossus Advancement (GA) or tongue advancement. While I'm not thrilled about the idea of another surgery and one that may cause additional or permanent numbness, the idea that I could sleep soundly without any drugs or hardware is very attractive. I know Dr. Viozzi was very hopeful that it wouldn't be needed, I think that it may need to be discussed. One good thing about this procedure is that it has a good track record and insurance companies cover it.
The last option is also my least favorite. CPAP. I have returned my machine and hope to never have to use one again. Even after having resigned myself to using it, I was still unable to sleep with it. It definitely "cured" me when I was able to sleep, but I wasn't able to sleep for any length of time while using it. I don't see that changing. I'm sure I could get by with lower pressures now, but the problem was never really the pressure. It was having something attached to me. That is another reason I don't thing the TAP appliance would work well for me. I think it would cause more disturbances than it fixed. I would be willing to try CPAP for an interim period while waiting to have something else done, but I know it isn't a long-term option for me.
So, that is how I see things standing at this point. So, the big question.....Knowing what I know now, would I have still had the MMA? Yes, I would. It would have been a little tougher to say yes if I knew I wasn't going to be cured, but it was still the best option. Also, I'm sleeping a little better now than I did with CPAP. I am very anxious to see the results of the sleep study and be able to quit wondering. I want to move on to the next step and try to get cured. The only other thing I have to add is that it seems that the question about my appearance is that the change was for the better. I didn't have a recessed chin, but with everything in it's new place, my wife seems to think I have a better profile than before. I don't care so much about my appearance, but if my wife can feel like she's standing next to someone who is a little better looking than he was 5 months ago, that's fine by me.
