Guess What....MMA Surgery on January 5th

My MMA Surgery is T-Minus 26 Days and Counting

Guess What?.................... I am having Surgery on January 5th, 2010.

I am flying high right now. The excitement is so great; I have almost forgotten my sleep apnea associated problems. I will elaborate below.

First Appointment: Stanford Sleep Medicine Center – Dr. Guilleminault

On December 7th we flew to San Jose and arrive at my first appointment of the day at Stanford Sleep Medicine Center (which is now located in Redwood City rather than at Stanford Medical Center in Stanford) for my appointment with Dr. Christian Guilleminault. We reviewed my sleep apnea history; he did a quick “look-see” of my throat and nose; we discussed my recent attempts to get my BiPAP to provide relief (air pressure setting of 18 cm); and I explained that nothing has changed. My symptoms today are the same as they have been since I was first diagnosed in March of 2006.

I looked over my list of 48 questions which I had been diligently preparing over the past 4 weeks, and fired away. I did have compassion on him; actually this list was for Dr. Li my surgeon; therefore I had the letter “G” placed beside only 19 questions. and I only asked Dr. G those questions. I don’t believe I have prepared so much for one interview, since my government days where I would prepare like this for a debriefing of a cooperating money laundering defendant who was about to turn on all of his co-defendants and tell all.

I will get to some of those specific questions later, but I would like to summarize Dr. G’s conclusions first. He restated (as he did back in January) that I was born with a small airway and a small jaw structure. The new news was: as I have gotten older the muscles and soft palate inside my mouth and airway has gotten relaxed and does not work as well as they use to. I have likely been snoring most of my life and snoring has a tendency to destroy nerve endings and the cells on the surface of your airway. This is something new I have never heard or read about. He elaborated further by stating that proper and correct breathing is dictated not just by an open and proper sized airway, but also by the communication between the brain stem and the airway muscles and nerves. This coordination and communication is very important for our breathing and inhalation/exhalation of oxygen.

He further stated, the soft palate surgeries I had, without a doubt, destroyed some of these nerve tissues and inhibited the required conductivity/communications. The bottom line is my disrupted and fragmented sleep is caused by both obstructed sleep apneas and the miscommunication or reduced communication of my breathing component of the autonomic nervous system.

Another factor bearing on this communication between my brain stem and muscles, etc. is the fact that I am 60 years old. We did not discuss that the age alone creates miscommunication but rather, any cells that were destroyed or damaged by snoring and/or the soft palate surgeries would not be restored as easily as if I were in my 20’s or 30’s. He went on to say that this is why many MMA surgeries are not 100% corrective.

Another factor that he believes may be affecting my airway is the two disc fusion surgeries I had had 10 and 15 years ago. If you do the math that is about the time I started having the depression symptoms (which are similar to OSA symptoms). There are two types of disc fusion surgeries. They are posterior and anterior. Anterior disc fusion surgeries (which I had) bring the surgeons work much closer to the airway. My neck surgeon was a great surgeon; however, there are always rewards and consequences when you chose to have surgeries.

Dr. G nor his “fellow” doctor who was assisting him would give me a recommendation to have the MMA surgery. They also would not say “don’t have the surgery.” Their recommendations were: Get a 35 degree bed cushion pillow which will elevate my head up above my body to offset gravity pulling on my soft tissue and closing my airway; losing some weight around my middle; and take two types of medication (Singulair and Flonaze) to help keep my airway open and possibly help with my chronic sinus infections.

Dr. G also pointed out the right side of my nose collapses when inhaling. That is something I never noticed and likely would never notice. This situation obviously affects my air intake especially at night while sleeping on my back. I will need to address that with my surgeon. My recollection from reading other blogs is that after MMA surgery, the nose tends to look wider (larger). I wonder how moving the jaws forward will affect the collapsibility of my nose.

Needless to say, I left Stanford and Dr. G feeling deflated. No pun intended. I have promised not to say this again, but I have to. I am an ex-marine. By the way we also say, “Once a Marine, always a Marine.” So we marched off to Dr. Li, who I was hoping and praying would see things in a better light.

Second Appointment: Sleep Apnea Surgery Center – Dr. Li

I grabbed my list of 48 questions. Dr. Li was going to get all 48 asked of him. We arrived at Dr. Li's office and his staff was very pleasant and welcoming. I turned over my two packets of exhibits containing sleep studies, lab reports, my sleep apnea history sheet (eighteen pages long), medical history including prior surgeries, current medicines, etc. Now that I look back on this appointment and the way I felt just before going in was like a felt before the big game (high school sports) or the start of a criminal trial where I would be presenting evidence or testifying against drug dealer, tax evader or money launderer.

I thought I had prepared the best I could. I had all my ducks in order. And now it was up to the jury. Dr. Li’s staff took ex-rays and prepared the video scope. Dr. Li came in….finally I am here… I can get the answer to my number one concern. Can I get a chance at fixing my problem or am I going to live the rest of my living life in hell? To my fellow believers forgive me, I do hope and pray on reaching Heaven and the Kingdom of God.

Well I can’t beat around the bush any longer. After all, this is not suppose to be a novel. Dr. Li’s words are still ringing in my ears. They were “John, I believe we can improve your sleep apnea 80-85% with this MMA surgery.” Other good words were: your age is not a factor; you are a robust 60 year old; as far as performing the surgery your age is not a factor (medical safety). My age really only decreases the percentage of success. At a younger age my improvement could be 90% plus.

From this point forward, I was flying high. I cannot describe how a felt then and how I feel now. I can imagine it is how prisoners of war feel when they see their captors hold their hands up in the air and their rescuers are coming through the front doors/gates. I know the surgery recovery will be tough. I know there are no promises. But with the results that others have achieved (thanks for your blogs & emails); the prayers of all of you; my trust in the Lord; and being in the hands of one of the best if not the best; I am confident that a good night’s sleep is in my future.

Dr. Li also stated that I may have some numbness that never goes away… for the rest of my life. My thoughts were because of my age. Things don’t repair as easily.

On our way out the door, I ran into two patients which had just undergone the MMA surgery. Ms. S. could not get her notebook and pen out fast enough after I told her of my good news and upcoming surgery. It is amazing how this difficult situation brings us so close to each other. The compassion, love, desire to help and encourage our brothers and sisters with OSA; and many other attributes seem to percolate from within us. It is not much different than how we were all drawn together after 9/11. I told Ms. S. I was 60 years old and a little concerned. Her notes to me read: Surgery 5 days ago; I’m 50; best thing I ever did; Dr. Li is the best; and here is my email address. Thanks Ms. S. By the way we have already exchange emails twice each.

Onward and Let’s Go

Needless to say, I have been going non-stop since returning from Stanford. This is the main reason why this posting is being made several days after my doctor’s appointments. My list of things to do:

Set Surgery Date…………………………....…...done
Pre-Operative Test – CBC blood test……...done
Pre-Operative Test – EKG…………………….done
Donuts and coffee………………………….......done
Pre-Operative Test – Stress Test.….appt. made
Arrange Stanford hotel & make reservations........done
Verify Insurance coverage & cost- surgeon.……....done
Verify Insurance coverage & cost - anesthesiologis......done
Verify Insurance coverage & cost -hospital.................done
Cinnamon roll and coffee…………………....done
Determine Insurance catastrophic protection (out of pocket costs)..done

Make appointment with for teeth cleaning..................done
Buy Magic Bullet Deluxe ($35 after$10 off at Costco......done
Make copies of medical directive,living will, etc.................pending
Share the good news with family & friends.....................done
Update blog…………………………………......done

I have decided to get this update posted now. I will follow up shortly with the Specific Questions and Answers from Dr. Guilleminault and Dr. Li. I also will include a topic regarding Diagnostic vs. Titration Sleep Studies and a section Costs and Insurance Issues.