9 Year Update

Well, I guess it's been quite some time since I posted an update.  A lot has happened since my last update.  I graduated with that degree I was working on last time, got a good job, a couple promotions and now have a second daughter.  The girls are now 5 and 11.

I was still having those lingering issues with sleep...maybe not quite the same, but close.  That changed this summer after a couple of things happened.  The first was that my mother had a stroke, most likely do to being overweight and mismanaging her diabetes.  Hers is a case where she progressed from type 2 to type 1 diabetes and it most likely could have been prevented by being more careful with food choices and getting exercise.  She is mostly back to the way she was before the stroke, but is now confined to a nursing home because she can't perform all of the ADLs (activities of daily living) without help.  She's probably going to live a long time, but unless she can lose a lot of weight and get more mobile, she may never go home again.

Not long after that, I finally went in for a general physical.  It had been quite a while, so I figured it was time.  I had been starting to have apneas again, but I knew it was weight related like before (post surgery).  I had cycled up and down with weight over the past 5 years or so and I just couldn't stick with the usual diet and exercise plan.  I had been back up to close to 260 and down to 240 or so and up and down and up and down...you get the picture.  Well, this skinny doctor told me I should lose some weight, especially around my belly, which is where I carried most of my extra weight.  I agreed because I knew that was the only way to get my sleep back in order.  He also did a routine blood screening and would contact me with the results.

Well, If I wasn't committed before the blood test, I certainly was after I got the results.  My blood glucose level was in the 'pre-diabetes' range.  Quite frankly, that scared the hell out of me!  My cholesterol was a little high, but not as alarming.  The doctor reiterated his suggestion that I go on a diet and lose weight.

I started with more of a Paleo diet approach, but with the other typical diet characteristics.  Calorie restriction and lots of exercise.  I wasn't looking forward to 3-5 days at the gym and being hungry all the time, but with the recent events and the test results, I was going to do whatever I had to (for a while anyway).  I lost about 5-10 lbs over the first 3 weeks, but the more important thing that happened during that time was that I did a ton of research.  It started out with trying to see if I was doomed to turn into a type 2 diabetic with type 1 in the more distant future.  At first, it didn't look good until I searched for something like "is pre-diabetes reversible" or something to that effect.  What I started finding gave me hope that I could not only stop the progression of diabetes, but quite possibly reverse the entire process.  (This is where I start sounding like someone who drank the kool-aid and recorded an infomercial).  This miracle diet promised amazing results if I would just take it seriously and give it a fair chance.  As it turns out, after reading more about this diet, it really isn't a miracle at all, but rather it simply takes advantage of your normal body processes to burn fat.  You may be thinking, "He's talking about Atkins! Phooey!".  Well, not quite.  It's actually the Ketogenic lifestyle.  I say lifestyle for a reason, but more on that later.  In my opinion, Atkins doesn't go far enough with carb restriction to be truly effective and tries too hard to keep feeding you sweets.

Before you disregard keto as another fad diet, I would encourage you to do a lot of research.  I was very skeptical myself at first, but I decided to give it a shot.  Besides, what's wrong with a diet that lets you have bacon and eggs every day for breakfast!  Part of the problem with the Standard American Diet (SAD) is that it's completely wrong and was developed by a doctor who ignored any data that ran counter to what he wanted the results to be.  It was rushed through and the food pyramid was born.  The problem with that is the pyramid is about the worst way to possibly eat and along with processed and sugary foods is responsible for the obesity and diabetes epidemic we are facing today.

I'm going to encourage you do to some research using the links that are at the bottom of this post.  Once I started living keto, I noticed a lot of positive changes within just a month or two.  I continued to lose weight at the rate of about 10 lbs per month, but I wasn't hungry while doing it.  I was only going to the gym about once per week (and skipping weeks when it was busy).  I noticed my back and neck weren't as stiff and sore.  One odd thing was how my hands felt thinner and more limber.  There are a lot of other things that changed more subtly, but I have not had one bad side effect other than taking too much MCT oil on occasion.  I know I was joking about calling this a miracle diet earlier, but in some ways it does feel like a miracle.  Once my wife and I got used to eating and living this way, it was so easy and kinda fun to experiment with new foods and seeing how changing things up affected weight loss.

When I saw the doctor, I was back up to about 256 when I weighed in on April 5th 2017.  Today, I weighed in at 210.6 lbs.  That may not seem like a lot to some, but I figure I have at most 10 lbs to go before my wife starts getting concerned about me being 'too skinny'.  If you are wondering how this is all going to affect my blood test...well, so am I!  I go in for a follow up (after a quick bout with Lyme disease) on Wednesday and will ask for a blood test again.  I have checked my blood sugar quite a few times with a home meter and I am usually well under 100 at any time during the day; after fasting overnight or even after eating.  If you do keto right, there isn't anything to turn into glucose.  And your liver will make all the glucose your body needs.  For those of you who will click on the links and learn about keto, I am fully fat adapted and can go for whole days without eating and I don't feel any real drop in energy levels while doing it.  It's a great way to live!

So, while this info is great for the people who need to lose weight to reduce or cure their sleep apnea, it does nothing for those who were like me and had to have the MMA surgery to correct a bone structure issue that was really the cause of  sleep apnea.  For you folks, I still can't stress how much the MMA surgery helped me.  I'm not like some who got such a complete reversal that they have no issues.  Even now, after losing about 45 lbs I still can't sleep flat on my back without some moderate  apneas from time to time.  But, with that weight gone, those issues are so scattered and minor that I feel normal.

There are so many other benefits to living keto that I have no plans to go back to eating carbs after I hit my weight loss goal.  I will definitely cheat a little (I miss chocolate ice cream!), but I am sold on the keto way of life.  I would encourage you to talk to your doctor before starting any of this, but make sure they back up any concerns with real science...not just the crap they read in a text book 20 years ago in med school.  I am still amazed at how so many doctors offer such bad advice to their patients on so many things.  Do your own research and take control of your health.

I will try to remember to post my blood test results as (hopefully) proof that this way of life has had the desired affect on more than just my weight.

As promised, here are some links with what I thought of as good information.

There are quite a few good articles on this site

https://authoritynutrition.com/search/?q=keto

Some other sites I thought were pretty good.

https://wellnessmama.com/1440/reverse-diabetes-naturally/

https://ketodietapp.com/Blog/post/2014/01/29/Complete-Guide-to-Fats-Oils-on-Low-Carb-Ketogenic-Diet

https://ketodietapp.com/Blog/page/KetoDiet-Buddy

https://www.rodalewellness.com/health/why-the-food-pyramid-got-it-all-wrong

http://www.thealternativedaily.com/the-food-pyramid-is-dead-wrong/

A couple of podcast sites

http://2ketodudes.com/

http://ketotalk.com/archive/

If you want to read a medical study….

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

A Keto-friendly pizza recipe

https://www.dietdoctor.com/recipes/fat-head-pizza

(Recent addition) Intermittent Fasting

https://www.ruled.me/keto-guide-intermittent-fasting/

https://www.ruled.me/intermittent-fasting-on-keto-diet/

11 - 3+ Year Update

Well, it's been quite some time since I've posted an update.  In reality, there really isn't much to report that is significantly different than it was last time.  I still have that lingering numbness in my chin and a little in my gums.  It doesn't bother me much other than when my face gets cold.  It just enhances the stiff feeling that a cold face normally gets.  I am still sleeping fairly well.  I have found that my weight does have a certain threshold that I can't cross.  I have bumped up against that threshold a couple of times and if I lose 5 or more pounds, my sleep improves dramatically.  That's interesting to me because my weight was never considered to be a root cause of my OSA.  I'm a fairly broad-shouldered 6'-3", so I am overweight by the chart in the Dr's office, but I would only be able to achieve the chart weight if I lost all possible fat and removed one leg.  So, I can stand to lose some weight, but not near what that silly chart says.  

I have received emails from several people either asking me a question or just commenting.  I actually just now responded to someone considering getting surgery with Dr. Viozzi.  I'm happy to answer anything I can about my experience and am sorry that it takes a little while for me to respond.  If it's been a while and I haven't answered, please feel free to follow up and remind me.  I know how important every little bit of information can be when struggling with OSA.  I don't think I'll ever forget some of those nights of terror I had and how hungry I was for information.

Overall, things are going very well.  I doubt I will ever forget the whole experience dealing with OSA.  I will try to keep this blog updated at least once a year or so.  I don't think any more often would really be beneficial for anyone as things are pretty stable.  I think it could be reassuring to some to hear whether or not MMA may be a permanent solution.  I know there are some who have had such success with their surgery that they basically fall off the face of the Earth.  GOOD!  That means that they've moved on with their lives and have a new focus.  I know that when I was looking for information prior to surgery, the one thing I couldn't find was someone still posting after 5 or 10 years.  It would have been very reassuring to me to see a ten year success story.  I'll do my best.  Good luck and I hope you all have a great 2011 Holiday Season and a great 2012!

10 - 1 1/2 year (+) update

Hello all!

Well, it's been a little over a year and a half since the surgery and things are going very well. I am back in school and getting A's so far. I am working part/full time depending on my class schedule. The great thing is that I have the energy to do it. If I were still struggling with CPAP, I don't think I would be enjoying my new chosen career path as much as I do. I can stay up late working on homework or other tech related things that could be labeled homework in a sense. What's great is that I can get 5-6 hours of sleep and still function pretty well. Prior to the surgery, 12 hours wasn't enough. I am still tired with only 6 hours, but I am only tired. No headaches, chest pains, night sweats and just general fear of sleeping.

I still have some significant numbness in my chin and lower lip area, but it's something I have learned to ignore for the most part. I have at least a little feeling in close to 100% of the effected areas. Dr. Viozzi thought I'd get it all back, but he also said that stretching is the hardest thing for a nerve to heal from. I am ok with what I have knowing that it is probably permanent. He informed me plenty that this was a risk. It's not something that I dwell on because it really doesn't cause my any real issues. About the worst thing is being out in the cold. My mouth-chin-lip area got kinda stiff in the cold before the surgery, but now it's a little worse with the addition of the numbness. Still, not a big deal.

I still do have some sleep issues from time-to-time. But these issues pale in comparison to what life used to be like. Things tend to get a little worse in the winter due to a stuffy nose, but I still sleep pretty good. I did have a second septoplasty, but that didn't seem to really help. I don't have any plans for any additional work, either. I have kept up with some excercising, but not religiously. I have gained back some of the weight I lost after the surgery, but some of that weight is muscle. (But some of it isn't ;)

About the only other issue I have is a slight misalignment...and that's probably not the best way to describe it. More like a floating bite. Because of that unplanned break on my left side during the surgery, the jaw muscles and whatever else don't act the same on the left vs. right sides. Also, I do get a little TMJ pain from time to time. But some of it may be due to the uneveness of the break as well as favoring one side when chewing. I think it was WesternJoe who had a similar issue and fixed it by chewing more evenly. I tried it and it definitely seemed to help.

I do get an occasional email from someone checking this out from the link on the sleepnet forums, and I want to encourage anyone reading this to go ahead and send me an email if you want to ask anything. It may take me a bit to get back to you, but I try to respond as quickly as I can. Well, that's about it. I still think the surgery was well worth it...even with a couple of lingering 'issues'. Take care everyone and have a great 2010!

9. 1-Year (+) Update

Hello,

It really is true that after sleep apnea stops being the focus of your life, you just kind of fade away on the posts and blogs. I am now a little over a year post-MMA. I've had a lot of things happen since my last update, so I'll try to summarize as best I can.

As my previous posts suggest, I had some problems after my MMA. I still felt I had significant apnea disturbing my sleep, but I had one sleep study about 6 months after the MMA and at my insistence, there was another at about 9 months. Both sleep studies had the same result...And AHI of about 1. So, for all practical purposes, I was and am cured. I wasn't sleeping well at night and I even spent most of December and a good part of January sleeping on the couch. I had been in a car accident in October and had a neck injury that wasn't helped by my time on the couch. The accident wasn't related in any way by my sleeping issues as I was rear-ended by someone on a cell phone.

So, after my second post-op sleep study, I finally had to admit that my sleep issues at that point were most likely mental in nature. I think one of the biggest problems I had was the temazapam. I think it took much longer for my body to purge those chemicals than I first suspected. Also, I think sleeping badly was a learned behavior that had to be unlearned. A bad habit is hard to break.

Well, it's July now and I don't think I had really good sleep until about March 2009. So, even though I was cured, it took me a long time to really get over the issues I was having. I still have some apnea episodes that wake me up, but they don't seem to be too severe. My wife recently witnessed one of my episodes and she said I had just started snoring a little louder on my back and gave louder snore and stopped breathing for just a second and woke up right away. I still do snore, but she is able to sleep though it mostly. Also, if my nose was a little more clear, there were some nights that I didn't snore at all. Well, that leads me to the next event.

Because most of my lingering sleep problems seemed to be related to poor breathing through my nose and my mouth falling open, I decided to address the problem. I visited with the ENT that had done my UPPP, septoplasty and turbinate reduction. He did see that my turbinates had enlarged noticeably and that my septum had displaced a little. This is most likely an effect of the swelling and tubes that were such a fun part of my UPPP. So, about a month ago, I went in and had another turbinate reduction. Things have improved somewhat and my snoring seems to have lessened. My mouth still tends to fall open when I lay on my back, but I'm hoping that my body will fix that on it's own now that I can breath through my nose.

Through this entire ordeal I have been layed-off from one job, closed my business that I started after that and spent about 4 months unemployed with no unemployment benefits because I was self employed. If I had still been dealing with OSA and all of the other sleep issues, I don't think I'd have dealt with all of those things as well as I have. I have now changed gears and enrolled in classes to get a different degree and have started a new temp job that may turn to permanent. During my time off (I was telling people that I was using up my unpaid vacation) I redid my bathroom and self-studied for a new certification for my new career path and did a lot of other things that I had the energy to do now that I can sleep.

One thing I have to clarify for those contemplating surgery or any other OSA treatment...for me, there wasn't a magical change in my sleep. My life is much better than after the UPPP that made things worse. It's also better than on CPAP. CPAP did make things better, but I am much happier now. I may still feel tired on some days and still need more sleep, but figure that I probably feel like most people without apnea.

As far as healing, I still have partial numbness in my chin, mostly on the left side and some on my gums and palate on the maxilla. I have some minor TMJ issues, but they aren't any more than an annoyance at this point and are only intermittent. The only other side effect I have, and I don't know if this is just a natural change or if something caused it...My eyes tend to dry out with my contacts in. I haven't done any research on the matter, so I can't point to any cause or possible cause other than being another year older.

Well, that's pretty much the last 9 months. I will try to pop up here every so often to update, but it gets more difficult as time goes by. I know it will be of interest to people who are curious about the long-term success of MMA surgeries. If you are contemplating surgery for OSA, the single best thing you can do is research and ask questions. Get second opinions and ask more questions. Don't buy in to the first good thing you hear. There are no guarantees and beware any doctor offering anything sounding like one. Visit sleepnet.com for a long time and see what issues other folks are dealing with. This is not the time to jump in with both feet. Good luck and God Bless!

8. 4 1/2 month update

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.

7. Weeks 9 - 10. Lots of good news

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.

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.