Greetings......It has been Seven (7) years since my surgery.
I have talked on the phone and have had email correspondence with many who have read this blog. I pray that you all are doing well.
My sleep is good...not perfect....but much much better than before surgery.
I have had no pain and very very little numbness.
I will still say "go for it" if your doctor recommends mma surgery.......but make sure you get the best doc.
I would love to hear from you if you followed my blog and had the surgery or are serious about having the surgery......I don't check this blog often so email me at thrasheraz@cox.net.......
Friday, January 20, 2017
Friday, January 7, 2011
One Year Later
Well I am still living, breathing and sleeping one year after my surgery which took place on January 5, 2010. That date will always be ingrained into my memory. And I do not have a good memory when it comes to names and dates.
My sleep is good...very good. Have good energy levels and my overall health is much better. My upper gum area is still 30%. I apologize for not posting more, but I have been enjoying life to much and actually forgot about my blog for a while.....that is good news.
Please feel free to email me if you have any questions or concerns. If you have been reading this blog and are deciding on having the surgery or had the surgery send me an email.
John
Wednesday, June 30, 2010
Six Months Since Surgery
Sorry about the delay in getting back to you all in reporting my progress. It has been just about six months since my MMA surgery. My post-op sleep study was accomplished in April and I received the report (see section below). I just got off the phone with Dr. Li, my surgeon. I received a stern and needed lecture from him.
Let me back up a little first. I sent Dr. Li an email this morning in which I exhibited some concern about my post-op sleep study results. The report from the Stanford Sleep Clinic states, “This study shows obstructive sleep apnea.” “Recommend follow-up in clinic for further assessment and treatment options.” My questions to Dr. Li were pretty much asking, “Did we have success?” Now that I reread my email, that was a pretty dumb question. The point I guess I am trying to get at is: No matter what the numbers say in my sleep studies, the bottom line is how do I feel and how am I sleeping?
How Do I Feel You Ask?
Let me back up a little first. I sent Dr. Li an email this morning in which I exhibited some concern about my post-op sleep study results. The report from the Stanford Sleep Clinic states, “This study shows obstructive sleep apnea.” “Recommend follow-up in clinic for further assessment and treatment options.” My questions to Dr. Li were pretty much asking, “Did we have success?” Now that I reread my email, that was a pretty dumb question. The point I guess I am trying to get at is: No matter what the numbers say in my sleep studies, the bottom line is how do I feel and how am I sleeping?
How Do I Feel You Ask?
There is no better time than right now to say I am doing remarkably well post MMA surgery and all of the credit goes to Dr. Li. First and foremost, I am sleeping very well. Over the past three weeks, my sleep has improved markedly. I have had many days (I mean nights) in a row where I have slept up to six hours straight without waking up. Even if I wake up two or three times, I still fall right back to sleep. Since surgery, I have not had one incident where I woke up and felt like I needed air or had stopped breathing. I have been waking up in the morning and feeling like I had a good night’s sleep. That had not happened for the past 20 plus years.
Now to an unexpected blessing: Throughout this past year in preparing and planning for this surgery my whole focus was on stopping the sleep apneas and getting a good night sleep. I never really thought about improvements that would occur during exercise, sports and other daily activities. When I used to swim or play basketball, I would always be exhausted after only two minutes of activity. I would stop and as we would say, “I would be sucking air.” I could swim one or maybe two short laps in a pool and even though I would be breathing while I was swimming, I would still need to stop, stand up and take in some air. Basketball was the same thing.
I experienced a short time ago on my first attempt to swim after surgery, that I could go 6, 8 & 10 laps without being tired or needing to stop and gasp for air. My x-rays, shows that my airway before surgery was about the width of a match stick and post surgery about the width of my large finger. I can’t wait for the first opportunity to play full court basketball again. When I exercise now, whether it is walking or lifting weights, I seem to be more willing to do the exercise and to be able to do so for extended periods of time.
I am back to eating about anything I want, however it takes me about twice as long to accomplish this. So I am usually the last one finishing eating, but that’s ok because they say it is healthier to eat slowly and also you eat less when you eat slower. I have been able to keep off most of the 22 lbs. I lost, even though I probably am taking in the same amount of calories. They say sleep apnea causes weight gain and I believe it.
My upper gum area is still about 50% numb. But this numbness is gradually decreasing and I expect this may take another 6 months before it is close to being back to normal. I have not had any pain in at least four months or more….. check my previous blog postings.
Post Op Sleep Study Results
I received my overnight Diagnostic Sleep Study report and just today I talked with one of the sleep clinic doctor regarding the report. Briefly, the doctor stated I still have what they classify as moderate sleep apnea. My numbers are as follows:
Study Areas_____Post Op___Pre Op
Sleep Efficiency____91.4%___75.4%
RDI_____________23_____27
Apnea Index_______1.5_____8.9
Total Apneas_______10_____54
Total Hyponeas_____139____109
REM Periods_______ 6______2
Stage Shifts________93_____208
No. of Awakenings___29______54
It is important to understand that the pre op numbers are not from a diagnostic sleep study. It was a split study with a CPAP. CPAP machines did not work well with me and caused central apneas. So comparing numbers is not a very good analysis of success.
Conclusions
In the words of Dr. Li, “It is not what the numbers say, but in how you feel.” My MMA Surgery was an overwhelming success. I do not need to sleep with a CPAP machine. My overall health has improved greatly. I sleep much better. I “live” much better. I thank God for my health, family, doctors and friends.
Monday, April 26, 2010
A Win is a Win……..
Insurance Issues
A win is a win even on a technicality. My insurance company has paid everything I believed they should have paid. However, they only paid this “just” amount because of a technicality according to their letter. As I have previously written, I was blindsided by two insurance company policies that I was unaware of and which resulted in my insurance company underpaying my surgeon’s medical billing by $12,000.
These two insurance company coverage policies are:
“Multiple and bilateral surgical procedures" which means if they perform more than one procedure or surgery at the same time then one will be billed as the primary and will be covered at 100%. All other procedures will be billed as secondary and will be covered at 50%. In my MMA surgery that means that the upper jaw surgery was covered at 100%; the lower jaw surgery was covered at 50%; the Septoplasty was covered at 50%; and the arch bar placement was covered at 50%.
"Primary billed procedure and secondary (minor) billed procedure" which means the insurance company can determine that certain procedures performed during surgery that are billed separately, such as the Septoplasty and arch bar placement can be placed into the primary billed procedure such as one of the jaw surgeries. Once they do this they then only pay for the primary procedure and in effect disallow all of the secondary charges.
My approach to these two issues: I recommend fighting these coverage policies separately. I was successful on getting my insurance company to keep each of the four billed procedures as separate procedures and pay on them accordingly; thus abandoning this "Primary billed procedure and secondary (minor) billed procedure" policy. This is when they brought up the “multiple and bilateral surgical procedures" policy to only pay 50% for the second, third and fourth procedures. To make a long story short, I then wrote a letter directly to the President of my insurance company in which I argued against this “Multiple and bilateral surgical procedures."
I only won this battle and got them to ignore this policy because they failed to advise me of this policy in my pre-surgery authorization letter. Therefore they covered each of the four procedures as separate procedures. Their letter specifically said that this policy still exists and the only reason they were covering everything at 100% was because in my preauthorization letter they failed to advise me of this procedure.
Sleep Issues
Now on to my sleep….. My sleep is improving. Just last night I sleep all night from 10:30 pm to 5:00 am with just one awakening (and just for a few minutes). Prior to that I had been waking up about one to three times per night (after 2:00 am), but I then would fall back to sleep. I am certainly more refreshed when I wake up and have much more energy during the day. I still get pretty tired by 6-7 pm, but I still think and act like I am only a 30 years old during the day so I should expect to be tired at age 60. Everyone states that your body systems will take up to a year to learn normal sleep patterns. After all, I was not sleeping normally for over 30 years.
More Good News
Some further good news, I had some general blood tests taken two weeks ago and the results were very impressive. My cholesterol and testosterone levels have greatly improved and that is without any medications. For 20 plus years my testosterone levels have been very low and have not responded to various medications. Now they are in the normal range without any medications. My cholesterol levels are in the high normal range and again without medications. Prior to surgery I was able to keep them in the normal range only by medications. My antibodies still need major improvement. Let’s see how they look after 9-12 months of deep sleep. I will keep you posted.
Post Op Sleep Study
I go for a post operation diagnostic sleep study at Stanford on April 29. It will be exciting to see how my obstructive apneas have decreased and what the other numbers show. I will let you all know. Thanks for being interested in my progress.
A win is a win even on a technicality. My insurance company has paid everything I believed they should have paid. However, they only paid this “just” amount because of a technicality according to their letter. As I have previously written, I was blindsided by two insurance company policies that I was unaware of and which resulted in my insurance company underpaying my surgeon’s medical billing by $12,000.
These two insurance company coverage policies are:
“Multiple and bilateral surgical procedures" which means if they perform more than one procedure or surgery at the same time then one will be billed as the primary and will be covered at 100%. All other procedures will be billed as secondary and will be covered at 50%. In my MMA surgery that means that the upper jaw surgery was covered at 100%; the lower jaw surgery was covered at 50%; the Septoplasty was covered at 50%; and the arch bar placement was covered at 50%.
"Primary billed procedure and secondary (minor) billed procedure" which means the insurance company can determine that certain procedures performed during surgery that are billed separately, such as the Septoplasty and arch bar placement can be placed into the primary billed procedure such as one of the jaw surgeries. Once they do this they then only pay for the primary procedure and in effect disallow all of the secondary charges.
My approach to these two issues: I recommend fighting these coverage policies separately. I was successful on getting my insurance company to keep each of the four billed procedures as separate procedures and pay on them accordingly; thus abandoning this "Primary billed procedure and secondary (minor) billed procedure" policy. This is when they brought up the “multiple and bilateral surgical procedures" policy to only pay 50% for the second, third and fourth procedures. To make a long story short, I then wrote a letter directly to the President of my insurance company in which I argued against this “Multiple and bilateral surgical procedures."
I only won this battle and got them to ignore this policy because they failed to advise me of this policy in my pre-surgery authorization letter. Therefore they covered each of the four procedures as separate procedures. Their letter specifically said that this policy still exists and the only reason they were covering everything at 100% was because in my preauthorization letter they failed to advise me of this procedure.
Sleep Issues
Now on to my sleep….. My sleep is improving. Just last night I sleep all night from 10:30 pm to 5:00 am with just one awakening (and just for a few minutes). Prior to that I had been waking up about one to three times per night (after 2:00 am), but I then would fall back to sleep. I am certainly more refreshed when I wake up and have much more energy during the day. I still get pretty tired by 6-7 pm, but I still think and act like I am only a 30 years old during the day so I should expect to be tired at age 60. Everyone states that your body systems will take up to a year to learn normal sleep patterns. After all, I was not sleeping normally for over 30 years.
More Good News
Some further good news, I had some general blood tests taken two weeks ago and the results were very impressive. My cholesterol and testosterone levels have greatly improved and that is without any medications. For 20 plus years my testosterone levels have been very low and have not responded to various medications. Now they are in the normal range without any medications. My cholesterol levels are in the high normal range and again without medications. Prior to surgery I was able to keep them in the normal range only by medications. My antibodies still need major improvement. Let’s see how they look after 9-12 months of deep sleep. I will keep you posted.
Post Op Sleep Study
I go for a post operation diagnostic sleep study at Stanford on April 29. It will be exciting to see how my obstructive apneas have decreased and what the other numbers show. I will let you all know. Thanks for being interested in my progress.
Friday, March 26, 2010
Sleep is Great...Insurance not so Great
Sleep is Great
I am going to bed, falling asleep and sleeping for seven hours with only one or two awakenings. I am a light sleeper and I attribute these awakenings to that and I am not experiencing any breathing problems. I am waking up somewhat refreshed and have plenty of energize throughout the day. In the evening I am tired, but I am 60+ and I have to say I am making up for lost time so I have a lot going during the day.
I still have some swelling and numbness in my upper gum area, but no pain anywhere. I am still down 22 lbs which is great and eating is still a chore. So be it.
Dr. Li's office advises that most patients get a post op sleep study at three months, so I need to get going on setting that up at Stanford.
Insurance not so Great
I thought it has been only two weeks since my last entry, but it has been one month. Sorry about that. I have been totally involved in corresponding with my insurance company. They have thrown out two policies at me which have reduced my reimbursements by as much as $15,000. You should all be aware of these two policies if you are considering MMA Surgery.
They are:
"Multiple and bilateral surgical procedures"
"Primary billed procedure and secondary (minor) billed procedure"
With both of these insurance policies and reimbursement procedures the insurance company saves many dollars. I was not advised of either of these policies when I was talking with the customer service representatives prior to surgery. I was advised in the pre-authorization letter that the two minor procedures, the septoplasty and arch bars would be considered incidental and part of the primary procedure which is the Maxillary Osteotomy and Mandibular Osteotomy.
The bottom line was my insurance company wanted to pay for the upper jaw advancement at full benefits and the lower jaw advancement at half benefits because they were performed at the same time, even though the work and time was equal for both and each required separate incisions.
I am still battling these issues, but I am fighting a multi-billion dollar business. So look into these two issues and contact me with any questions.
I will keep you posted
Friday, February 26, 2010
I can't think of a title......
Sorry for the delay in this update. It has been seven plus weeks since my MMA Surgery. No news is good news. Anyways I am still sleeping well. I have no breathing interruptions. Nothing has really changed as far as my sleeping. It has been “clear sailing”…..I mean sleeping. I am still waking up early, but I have done that for forty years or more.
I am able to open my mouth wider now (about 27 mm), but not wide enough to accommodate a Big Mac or other medium to large food sources. No complaints. My upper gums are still somewhat numb, but my upper jaws are pretty normal. I am able to chew soft foods, but salads are difficult. There has not been any pain in the past week or two. In ten days I go to my dentist and get my teeth cleaned and my tooth put back in. My gums still seem to get more swollen after each meal.
The swelling in my gums seems to affect my speech quite a bit. I am able to speak as much as needed, but I do sound like a nerd or someone that has a speech impediment. Again no complaints.
You have not heard much from me about my looks. That is because I did not really care. My sleep was so much more important to me. Well, I do not notice much difference. I think I look somewhat different (and not for the better) in the face, but to me it is because I lost 22 lbs. and my cheeks and surrounding areas show the lost of weight. The good news is my stomach also reflects the loss of weight also. My Greek mother-in-law is visiting and thinks my nose looks bigger and in her words “better”. I think that’s because Greeks have bigger noses……so I guess I am more Greek to her. “Opa!!!!!
I am having some serious problems with my insurance company. I was planning on only having to pay approximately $6,000 (my yearly catastrophic limit). It now may be closer to $18,000. But leave it up to the insurance companies to have some small print (which I missed) which further reduces my coverage. I will explain further in my next blog…..don’t forget to remind me.
Thanks for your prayers. They were answered. Thank God.
Tuesday, February 16, 2010
Six Weeks Since Surgery ... Things Looking Good
The surgery is behind me and so is the flu and a bronchial infection. Now I can start evaluating my sleep and the results of my surgery. I think I have had only 2-4 days in the last six weeks that I have not been sick. Today is one of them and hopefully many more to come.
I am looking forward to getting back to exercising which I have not done in six weeks. I am sure that half of the 22 lbs I have lost is muscle. I look forward to eating and eating the proper food. I am going to try and stay at my current weight of 185 by eating healthy and exercising.
To my sleep. I can sleep on my side or back. I fall asleep within 10-20 minutes and I wake up 2-4 times during the night. I have no breathing problems. I never remember having such an open breathing passage way through my nose. I learned not to breathe through my mouth while on a CPAP with nose mask. My wife has not heard me snore and I have not woken up hearing myself snore. I wake up in the morning as if someone gave me a cup of coffee about 5 minutes before I woke up. This is the first refreshed feeling I have felt in 20 years. I am still somewhat tired, but who wouldn't be tired after being sick and having major surgery.
On to pain, no pain, swelling and numbness. I have very little pain and it is only on a few occasions. It is mainly in the back of the lower jaw and sometimes radiates to my ears. It only last 2-4 seconds and it happens 3-4 times a day. Actually it seems to only happen 1-2 times a day now. There is some numbness in my upper gum area. I noticed that when I started flossing a few days ago. No real numbness in chin, face or nose. My gum area also feels like it is swollen a bit.
It has been one week since my arch bars were removed. Eating has been slow and tedious, but effective. I am eating eggs, toast, mash potatoes, shredded chicken and beef, cut up spaghetti and my homemade meatballs. When I chew, I have to do it very delicately, since there is some pain when chewing, but it seems to be getting less and less as I chew more and more. I am not even attempting salad, bacon, pizza, nuts, etc.
Dr. Li says I can go see a dentist for a professional cleaning (and have my tooth put back in) in 30 days (from acrh bar removal). Thank you again for your prayers.
I am looking forward to getting back to exercising which I have not done in six weeks. I am sure that half of the 22 lbs I have lost is muscle. I look forward to eating and eating the proper food. I am going to try and stay at my current weight of 185 by eating healthy and exercising.
To my sleep. I can sleep on my side or back. I fall asleep within 10-20 minutes and I wake up 2-4 times during the night. I have no breathing problems. I never remember having such an open breathing passage way through my nose. I learned not to breathe through my mouth while on a CPAP with nose mask. My wife has not heard me snore and I have not woken up hearing myself snore. I wake up in the morning as if someone gave me a cup of coffee about 5 minutes before I woke up. This is the first refreshed feeling I have felt in 20 years. I am still somewhat tired, but who wouldn't be tired after being sick and having major surgery.
On to pain, no pain, swelling and numbness. I have very little pain and it is only on a few occasions. It is mainly in the back of the lower jaw and sometimes radiates to my ears. It only last 2-4 seconds and it happens 3-4 times a day. Actually it seems to only happen 1-2 times a day now. There is some numbness in my upper gum area. I noticed that when I started flossing a few days ago. No real numbness in chin, face or nose. My gum area also feels like it is swollen a bit.
It has been one week since my arch bars were removed. Eating has been slow and tedious, but effective. I am eating eggs, toast, mash potatoes, shredded chicken and beef, cut up spaghetti and my homemade meatballs. When I chew, I have to do it very delicately, since there is some pain when chewing, but it seems to be getting less and less as I chew more and more. I am not even attempting salad, bacon, pizza, nuts, etc.
Dr. Li says I can go see a dentist for a professional cleaning (and have my tooth put back in) in 30 days (from acrh bar removal). Thank you again for your prayers.
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