Questions & Answers from the Doctors

My MMA Surgery is T-Minus 23 Days and Counting


Question and Answers from Doctors

We all come up with many questions especially when it concerns our health. I must paraphrase the questions I asked and the answers I received from Dr. Guilleminault and Dr. Li. I did not take many notes and as we all know us OSA patients don’t have the best memory, attention and focus.

Q: Will you be performing the surgery yourself or handing it off to an associate or medical student?

A: I do everything myself. I do have a long time assistant that helps me.

Note: This was an important question for me, because for my second disc surgery, my surgeon who did my first surgery, who I trusted and had complete confidence in, advised me the night before surgery that her associate would be doing the surgery, since she had to be at another hospital the morning of my surgery. I said no way and I wanted her there. Who knows who actually did this surgery, I certainly was not awake for it. Surgeons have to get their training somewhere!

Q: How does my jaw bone structure look (after looking at my x-rays)? Large, thin, strong, small, etc.?

A: Everything looks normal. Bone grafts not likely needed.

Note: I checked with my dentist (of 20 plus years) before leaving Phoenix and he told me the same thing. The last thing I want is for my surgeon to have to start removing bones from one part of my body and gluing them around my jaws.

Q: Are my central apneas (my recent studies show more central apneas than obstructive apneas) caused by my CPAP/BiPAP?

A: My central and obstructive apneas are caused by air not my brain (like true central apneas).

Q: What changes have you made in your surgical procedures over the past 1-2 years?

A: None.

Note: I asked this thinking he may have learned that certain past practices did not achieve the best results and that new avenues (ideas) resulted in better improvements. I suppose that this is good news for everyone that has had the surgery in the past couple of years.

Q: What has been your oldest MMA surgery patient?

A: 68 and also a 60 year old.

Q: How long should we plan on staying in town (since we are from out of town)?

A: 10 days.

Q: Based upon my x-rays do my prior disc fusion surgeries impact on my airway?

A: It does not appear that they have.

Q: Does OSA compromise my immune system?

A: Yes.

Q: Will MMA surgery improve my immune system?

A: I am not sure.

Q: My minimum oxygen saturation shown on my latest sleep study shows 93%. That doesn’t seem so bad. What do you think?

A: The reason it is higher than you think it ought to be is because it is while being treated with a CPAP. This is why I want to see your diagnostic studies.

Q: Can I judge the quality of my deep-restorative sleep by the frequency and length of my dreams?

A: No. You may also be having dreams that you do not remember.

Q: Will you be considering additional surgical procedures such as GA (Genioglossus Advancement) in addition to my MMA?

A: No. I do not perform GA’s unless my patient asks for that particular surgical procedure.

Note: I was concerned that once my surgeon got me on the operating table and opened me up that he might decide additional surgeries would be helpful. If possible, I wanted to know this in advance.

Q: Do you have an idea on how far you might be advancing my jaws?

A: 10-12 mm.

Q: Should I plan on donating blood for the surgery (hopefully in January) during this trip or isn't blood an issue? Or won't it keep?

A: Blood donation is based on the blood test that you will have at a later time and the likelihood is low that donation will be required.


Costs and Insurance

Back to my visit with Dr. Li. Molds were taken of my teeth. And my credit card…..no just kidding. I did receive a letter explaining the costs for the four procedures that will be billed. I don’t know if it is appropriate to say, but what the heck, I have been always been the type to tell it like it is: $45,000 (approximately). These procedures were broken out by procedure code, so it was easy for me to call my insurance company; give them the codes and they could tell me if they were customary and ordinary. This is important because I have a PPO and Dr. Li is an “out of network” provider. This means I am responsible for 25% of what is customary and ordinary and everything above that amount. Let’s just say I am very happy with the amounts that my insurance company set as customary and ordinary.

I asked my insurance company for it in writing and they refused. They did say our telephone conversation was recorded and could be accessed at a later time. I am not sure if I believe them. If I remember correctly, I think former President Nixon told the Justice Department the same thing. I should have recorded my call with the insurance company myself. It is important to note that you need to give the insurance company the zip code of where the procedure is going to be performed. The fee schedules differ according to where you are going to have the procedure performed.

The good news is that Stanford Medical Center Hospital is an “in network” provider for my insurance carrier so I will only have to pay 10% of certain services and a $100 admission co-pay. Are you ready for this? They could not give me the estimated costs for the hospital charges; however they said that hospital costs are typically twice the cost of the surgeon’s charges. That means the likely total charges for my MMA could be close to $150,000. Don’t forget the Anesthesiologist bill is separate from the surgeon’s and hospital bills. His quote for 5 hours was $3,200.


Diagnostic verses Titration Sleep Study

Most of us (considering MMA surgery) who have not received beneficial treatment with the CPAP/BiPAP treatment have had multiple sleep studies performed, hoping to find that ideal pressure setting and/or machine that will work. I learned from Dr. Li that the diagnostic sleep study is the type of study he needs to review prior to surgery. The diagnostic sleep study is the study that records your breathing patterns during sleep without utilizing a CPAP/BiPAP, thus recording your true apneas and hypopneas. This makes sense; unfortunately I never thought about that, otherwise I would have had a diagnostic sleep study performed just before coming to see Dr. Li.

My recommendation to those of you who are considering MMA surgery is to have a full night diagnostic sleep study done within the past year, especially if you have had any sinus or sleep apnea surgery performed since your last diagnostic study. I believe insurance companies hesitate on doing a full night diagnostic study and typically split diagnostic studies are done where the first half of the night is diagnostic and the second half is titration (where they try the different pressure levels).

My personal belief is that an all night diagnostic study should be done. Then based upon what they see, a second study is performed with the titrated pressure settings. I think this is especially important for someone like me who sleeps through the first 4 hours without wakening and then has very fragmented sleep during the later stages of sleep. You, of course, should ask your surgeon and sleep doctor.