I met with Dr. Viozzi and found him to be a very open, honest and caring doctor. He took the time to answer all of my questions, even though his pager kept going off. So, if you were seeing Dr. Viozzi after me that day, you have me to blame for him being at least a half hour behind. He took a couple of x-rays and then came back and went through them with me. As it turns out, my apnea could possibly be linked to my skull. He explained that as we develop in the womb, our skulls grow first and that once that is formed, our faces grow out and down from there. If the angle from the base of our skull to a point above our eyes is "flatter", all of your facial structures will grow more down than out. This is a very simplistic explanation and I hope it is correct, but you need to talk with the doctor for your individual case.
I had an airway of about 8-9mm and Dr. Viozzi thought that the MMA procedure would have a good chance of 'curing' my apnea. This is where I'll say what every other MMA blogger has said... get a definition of 'cure'. Each surgeon has a different definition. Dr. Viozzi explained his definition before I could even ask as an AHI of less than 20 with a goal of being in the single digits.
One very specific question I asked him was if he were doing a study of "carefully selected patients", would he select me for this procedure. He was pretty confident that he would. The reason that I asked this is that for all of the published results out there for the MMA, almost all them start out by saying "a pool of x number of carefully selected patients". He also told me that if I were his brother, he'd recommend staying on CPAP because there is little risk and it is the best "cure".
Dr. Viozzi also suggested that I go to their sleep lab for a sleep study to make sure that nothing had been missed. I then met with Dr. O who talked to me for a long time about everything including what he thought about the MMA option. He didn't recommend I get the surgery, but he also said he wasn't going to just outright steer me away from it either. I went in for the sleep study later that night and found this sleep lab to be a pretty good step up from the one that I had been in twice before. The results were pretty uneventful and showed that CPAP was curing my apnea, but I had to be drugged to sleep at all with it and didn't sleep long enough with it while drugged.
I met with Dr. Viozzi a couple of weeks later at what I like to call the "You can't sue me after this" appointment. This is where we discussed the MMA in a little more detail, but really focused on the risks. I went into that appointment ready to get on the surgical schedule, but Dr. Viozzi shook me up enough (and pretty easily) that I had considerable doubt creeping in. He could easily sense that and told me he would refuse to even schedule the surgery that day. I didn't try either.
I struggled with the CPAP for a couple more weeks. I knew I wasn't going to be able to stay on the drugs for much longer, either. I tried going off the drugs, but, just like before, it was a total disaster. I did a lot of research over those few weeks but with a new twist. I tried to find cases where the MMA had failed. My definition of 'fail' was anyone who was still on CPAP or had such serious complications that they were worse off now than before. I based "worse off" on their interpretations alone. I only found a couple of cases. One was pretty easy to tell that it was just something that didn't work and the other seemed more like someone who still felt awful but had decided to not find out why. Just disgruntled. I kept going up to Sleepnet.com and I went back to some of the very first posts. One thing I noticed there was that the progression of surgery discussions clearly went from UPPP to MMA over the course of a couple of years. People were 'waking up' to the possiblility that the UPPP wasn't effective and the MMA was showing some very positive results. Not everyone had a picture perfect operation with a perfect cure. There are a lot of people with all kinds of lasting issues. The biggest thing about most of them is that they would do the procedure again knowing that they would have those problems. Everybody's risk/reward ratio works differently, so I would suggest you think long and hard about yourself in that position to determine if it would be worth it.
I finally decided that I was going through with the MMA and I called Dr. Viozzi's office to schedule it. I just couldn't see myself living another 50 years like I was. I wanted the alternative.
A couple of weeks later, I went in for bite casting and measurements. That was a different experience. I had never had bite casts done before. Dr. Viozzi introduced me to one of the residents that was working with him at the time during that visit. We discussed the risks again, but I wasn't unsure anymore. I wanted to take the risk, so we kept the June 16th, 2008 surgery date and that was that. I thought it interesting that part of what the bite casts are used for is to do a "practice" surgery. I don't really know what that all entails but I figured any practice that isn't on me is great practice.
