Pre-Op Testing Complete & Insurance Preauthorized

My MMA Surgery is T-Minus 15 Days and Counting

Preauthorization Received - It's a Go

In just under eight (8) days my insurance company GEHA precertified my MMA surgery. I am amazed and proud of GEHA. Our prayers have been answered. My surgery is still set at Stanford University Hospital, Ambulatory Surgical Center on January 5th at 7:30 am. Check in is at 5:30 am which is great, since I am sure I will be finished sleeping by 3:00 or 4:00 am anyway. We will be staying in Palo Alto Jan. 3rd through Jan. 14th. We are driving our car both ways. It is 11 hours and 735 miles from Phoenix.

The only thing left to do, is enjoy Christimas and New Years with the family, pack and say my prayers for the doctors, nurses, hospital staff and a successful surgery. Amen

Pre-Op Testing Complete and Passed

I have completed the Pre-Operative Testing, CBC blood workup, EKG & Treadmill stress test and all is well.

Swallowing Concerns

I recently had some concerns about my upcoming MMA surgery and how it would affect some swallowing issues/choking issues I have had since my first soft tissue sleep apnea surgery. I sent Dr. Li several medical swallow test results which took place 1-2 years ago. I was afraid the new surgery might aggravate these issues. He informed me the surgery would not impact them. So no more worries. I am good to go. I would go tomorrow if I could.

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.

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.

Immune System Compromised

My MMA Surgery is T-Minus 31 Days and Counting

Immune System Compromised

On December 4, 2009 I received a call from my Allergy Doctor who provided me with the results of several blood tests which were taken recently. I have been having chronic allergy infections for the past five years. I have had eight sinus infections where I needed antibiotic treatment in the past two years. These immune system “immunoglobulins” blood test (see web site below) revealed my IgA antibodies are very low and practically non-existent. They further revealed my IgG antibodies are abundant (mid-range) but are not functioning as they should.

According to WebMD:
“IgA antibodies are found in areas of the body such the nose, breathing passages, digestive tract, ears, eyes, and vagina. IgA antibodies protect body surfaces that are exposed to outside foreign substances. This type of antibody is also found in saliva, tears, and blood. About 10% to 15% of the antibodies present in the body are IgA antibodies. A small number of people do not make IgA antibodies.”

“IgG antibodies are found in all body fluids. They are the smallest but most common antibody (75% to 80%) of all the antibodies in the body. IgG antibodies are very important in fighting bacterial and viral infections.”

http://www.webmd.com/a-to-z-guides/immunoglobulins

The question I have: Is my compromised immune system caused by sleep apnea and not obtaining enough deep restorative sleep?

And, with successful MMA surgery, will my immune system recover?

I would be very interested to hear from anyone who may have had this same situation and what were the results after surgery.

Few Notes of Interest

My MMA Surgery is T-Minus 36 Days and Counting

Pre-surgery Consultation

In six days I go to Stanford (Dec. 7th - this day will live in infamy). I will have a short consult with Dr. Guilleminault. I will then go see Dr. Li for my pre-surgery evaluation and consultation. I believe he will review my sleep study; conduct a physical exam; take xrays of my airway; take fiber optic imaging of my airway; discuss treatment options; and yes, discuss the costs.

Hopefully Dr. Li's findings will be that I am a good candidate for the surgery (remember I just turned 60) and that there is a very good chance of success. Based upon other blogs that I have read and the bloggers comments, I think I will be having Dr. Li leaning towards treating the apnea's by moving the jaws forward as much as possible even if it dramatically changes my looks. I told my wife, I can always grow a beard. Priest and Deacons in the Greek Orthodox Church are suppose to have beards anyways.

For those that are interested, the cost of the pre-surgery exam, consultation, and test is about $1,500. That will be a good test of my GEHA insurance coverage. I will likely pay something in the range of 25-50%.

I will write again upon my return from Stanford on September 8th.

No More Good Nights

Those few good nights have vanished as fast as they arrived (see my earlier blog). The only thing different in my sleeping routine has been the addition of a cool mist (with wick) humidifier set at 50% humidity. The brand name is Bionaire. If any one has comments about using a humidifier at night along with using a CPAP with humidifier, please let me know. I will try one more night with the room humidifier and then I will go a few nights with out it to see If a few good nights return.

Summary of the Best MMA Surgery Blogs

I have just started a summary of all the blogs on MMA Surgeries. I hope to post this like my Stages of Sleep document sometime between now and my surgery. Some of the sections of the summary will include: List of Blogs including location, date and surgeon; What to do before surgery; week by week expectations during recovery; what to eat and not to eat; etc.

Again any feedback you might have regarding this summary and what to include will be welcome.

So long for now. God Bless.

A Few Good Nights

My MMA Surgery is T-Minus 45 Days and Counting

I have just experienced 2-3 days or should I say nights over the past week with relatively sound sleep. I classify sound sleep as: not waking up more than 3 times; and falling back to sleep within 15 minutes; and not having to remove my CPAP mask because of too much air; and waking up for the last time after 6:00 am. I can't say what caused this. No new pressures on my CPAP. No real change in other habits.

I did not feel any better during the day, but then I am realistic enough to know it takes more than a few intermittent good night sleeps to make me feel better during the day. But, thank God, I still appreciate any improvement or change for the better.

My sleep doctor has order a new mask for me which will also cover my mouth. His theory is I may be doing some mouth breathing and thus I may be losing pressure out through my mouth instead of down the airway - keeping my airway open. I will let you all know after I give it a go for a week or so.

Stages of Sleep Chart

My MMA Surgery is T-Minus 53 days and Counting

Stages of Sleep Chart

I have created a chart showing the Stages of Sleep. The information on this chart was gathered from many websites and a few books. I found this chart useful in reviewing my symptoms and reviewing my sleep studies. I am not a sleep doctor or specialist, so beware. As with all things found on the web, always check other sources. If you find any errors or have comments please leave a comment on this blog and I will try to address it on my chart or in my blog.

The site to visit to see this chart is: https://docs.google.com/fileview?id=0B7aw9Z_GdcW2MDgxMzQ3MTktMGVhOS00YjkxLWI1NDMtY2YxYTgxNDkzZWJm&hl=en

One Last Try to Fix

My MMA Surgery is T-Minus 57 days and Counting

 Last Try - A Pressure of 18 Centimeters:

I have tried and tried and tried at this new recommended presure. Every day, I mean every night and all night (6-8 hours) for 10 months. I promise not to mention again that I am an Ex-Marine. No results. My symptoms from day one (3 & 1/2 years ago) are the same. I go to bed around 10:00/10:30pm. My Symptoms are:

• I usually fall asleep within 5 to 15 minutes.

• I sleep straight for approximately 4 hours.

• Then I battle getting back to sleep and stay asleep for the rest of the night.

• I usually am able to sleep for 15 to 45 minutes segments.

• I get up out of bed about 6:00 / 6:30am (8 hours sack time).

• I get up un-refreshed, tired, low energy, depressed, poor concentration, etc.

Let me repeat myself. These symptoms have not changed since I was first diagnosed with sleep apnea and was put on a CPAP/BiPAP machine.

I should let you know, that I do not have a surgery date yet. I don’t even know if Dr. Li will give me the go ahead after seeing me on December 7th. Say your prayers for me and don’t forget to include my insurance company for an “OK – Approval.” So the 57 days includes a 30 day waiting period for scheduling and my insurance approval. I will let you all know as soon as I hear anything.

Diagnosis and Initial Treatment

My MMA Surgery is T-Minus 58 days and Counting


Diagnosis & Initial Treatment:

On March 15, 2006 I had my first of six sleep studies.  Per my sleep doctor the Split Polysomnography Sleep study disclosed that I had severe sleep apnea and did not respond to NCPAP.  I will try and recall the best I can what happened next. As we all know while suffering from sleep deprivation your memory, concentration and focus are severely diminished.  I will give you the short version of what happened over the next three and a half years: On May 8, 2006 I initially started using a CPAP. I then tried a BiPAP, BiPAP autoSV, VPAP, VPAP-ST and H4i humidifier. I have been on pressures of 4 to 18 centimeters and everything in between. I have used nasal masks and nasal pillows. I have used chin straps, eyes masks, ear plugs, and nose breathing strips.

Did I forget to mention, on April 7, 2006 only 3 weeks after my initial diagnosis, I had four sleep apnea surgeries performed at one time. They were: Septoplasty (straightened septum); Palatoplasty (removal of uvula); Partial Tongue Base Resection (posterior tongue base); and Turbinate Reduction.  The next morning I was eating Dunkin Donuts and coffee in my hospital bed. Thanks Mary (that’s my wife). I also had lasagna for dinner (at the hospital).  Thank God, I recover well from surgery.  

An important note here: I was lead to believe these surgeries would likely correct my sleep apnea and free me from my CPAP. I do not recall the exact words of my sleep doctor and surgeon before surgery as to the prognosis. But I believed the surgery would fix my sleep apnea. This may be due to my positive and optimistic attitude.  I do recall the words of my sleep doctor after another sleep study (4 months post surgery) and not much improvement in my symptoms.  He said sorry John, I don’t know what to say, you just fall in the 3-5% of sleep apnea patients that treatments don’t work. He also threw up his hands and srugged his shoulders and said maybe you could lose some weight. (I am 6’ and weigh 195 lbs).

By the way, I have only missed three days of CPAP/BiPAP usage (and that was just to test myself on what would happen without it) in the past 3 & ½ years. Did I tell you I am an Ex-Marine….. I know I did, just kidding. The apnea surgeries mentioned above did decrease my apneas; however my symptoms did not immprove. The ENT surgeon was very good and a great doctor.

Determination (both figuratively and literally)

Moving forward: as I did with my “psych” doctors, I have seen several sleep doctors. They all tried different sleep medicines, different pressures etc.  After doing tons of research, I changed insurance companies (from a HMO to a PPO) so that I could go to what I think (and many others also) to the best sleep doctors and clinic in the country – Stanford Medical Center – Sleep Disorders Clinic http://stanfordhospital.org/clinicsmedServices/clinics/sleep/sleepDisorders.html

On January 14, 2009 a “bi-level nocturnal polysomnogram” sleep study was performed at Stanford. During the scheduling and preadmission period, I made sure that I would be seeing the “top dog” (with all due respect) which was no other than Dr. Christian Guilleminault. http://stanfordhospital.org/profiles/stanfordhospital/physician/Christian_Guilleminault

The next day Dr. Guilleminault and his array of medical interns stood around me and said: Your genetics and possibly your prior sleep apnea surgeries are not allowing the CPAP/BiPAP machines to work properly.  Your airway is very small.  A pressure of 18 centimeters may work to keep your airway open; unfortunately it also causes central apneas.

My understanding is that when I use a CPAP at pressures above 10 cm., my system gets too much oxygen, thus my mind sees to little carbon monoxide in my system therefore it shuts down my breathing. Dr. Guilleminault stated that after a few months on the pressure of 18 centimeters, if I do not see any improvements, then I should consider MMA.  I met with Dr. Guilleminault and Dr. Li the next day for a preliminary surgery consultation and a “look see.” They repeated the same prognosis.

What is MMA Surgery?
http://www.sleepapneasurgery.com/maxillomandibular_advancement.html

Introduction & Background

My MMA Surgery is T-Minus 60 Days and Counting

Introduction:

Greetings from John in Phoenix Arizona. I am approximately 60 days away from Maxillomandibular Advancement surgery (MMA surgery). I was so impressed by Roger’s blog (http://www.rogerarrick.com/mma) on his MMA surgery (May 2005 – Sept. 2008) that I could not resist the temptation to follow in his excellent footsteps and write my own blog. Please excuse my in-experience. I have never even read a blog before Roger’s, let alone write one.

On December 7th, 2009, I am headed to Palo Alto, California to the offices of Dr. Kasey Li for my MAA surgical consultation. I am so excited. That may sound strange to some of you. Here is a guy 60 years old, headed into major surgery on his upper & lower jaws and breathing airway and he is excited! I will try to explain as we go.

Background:

I should start with some background. I have lived in Phoenix, Arizona for the past 28 years. I am a retired U.S. Treasury Special Agent. I am currently self-employed as a forensic financial investigator. I am married (for 35 years) and we have four grown adult married daughters (and six grand children). “That’s right,” I have lived with 5 women for over 25 years.

Now on to my more serious situation: Three years ago I was diagnosed with severe obstructive sleep apnea (OSA). They advised me that my airway was being obstructed during my sleep and I stopped breathing for at least 10 seconds 47 times an hour. Most of you if not all of your reading this blog know all about sleep apnea, so I won’t bother you with much more of the details.

On more with a bit of background that most of you will find familiar and disturbing: My symptoms of tiredness, daytime sleepiness, mode swings, depression, low energy, lack of concentration, etc. have been present for the past 15 years or more. For the first twelve years I saw psychologists, psychiatrists, family practice physicians and other medical specialists who unanimously declared I was suffering from “chemical depression.” Following their advice and prescriptions, I took antidepressants, uppers ????, testosterone injections, sleeping pills, some pill that wakes you up in the morning (I don’t remember the name of them), vitamins, and minerals. I read self help books on depression. I continuously returned to the doc’s advising them the drugs did not help much. I changed “psych” doctors every 3 years. I changed antidepressant every 6-9 months (or sooner if a new one came out).

Thank God for the last psychiatrist I saw. After a few months on antidepressants and no improvement, he saw me for a follow up and said these wonderful words “John, you don’t fit the profile but I think you should go and have a sleep study conducted.” He further explained individuals who have sleep apnea usually are overweight, may have a double chin and thick neck. None of these apply to me...well, I am 10-15 lbs. over weight. I had never heard of sleep apnea, sleep studies or some of the other terminology he used but he had my interest and I marched on. Oh, by the way I am an Ex-Marine.

I have always been a morning person. I am an early riser, anytime between 5-7 am and I am up, dressed and willing to go and do anything. Now I am wondering if that was not a predisposition but rather my sleep apnea waking me up early and also the fact that my energy was severely limited and therefore I only had enough energy for the first few hours of the day. Over the past several years, I guess my sleep apnea has gotten worse, because now when I get up at 5 or 6 am, I am awake but I have no energy or desire to do anything, except to go for donuts and coffee (after all I am retired law enforcement and just because I am retired doesn’t mean I gave up my morning ritual).

General Comments:

It’s funny how I can look back at my last 15 years and only now recognized what was really going on. I can honestly tell you that for the past 3 plus years every morning I woke up I felt terrible and just wanted the day to be over so maybe I would get a good night sleep and feel better the next day. I have told several people that if I wasn’t a religious person and I did not consider wanting to hurt my family members, I would have probably killed myself and be done with it. I would be willing to bet that there are many suicide cases out there that are a direct result of sleep apnea.

None of us who have sleep apnea and suffer from sleep deprivation are surprised when we hear that sleep deprivation is considered a torture method and is one of the primary tools used by the CIA and other governments to illicit information from terror suspects. And what about water boarding? Bring it on. It would be a welcome change from sleep deprivation.

It has been approximately a year now since this has happened, but there was a time when maybe one morning every 2-3 months that I would wake up and feel great. My words to myself and my wife would be: “Wow, this is what life is suppose to feel like.” I thank God for these few mornings, because they gave me insight to realize what I might be able to achieve one day. By the way I should mention that 10 years ago I was ordained a Permanent Deacon of Lay Profession in the Greek Orthodox Church. I have not been to seminary school (College). My theological training has been hands on and from reading Orthodox teachings.

One another point which bears mentioning is the reason I decided to write this blog was to hopefully help other sufferers of sleep deprivation, both those that know what they have and especially those that don’t know what they have. But as I write this blog I am learning and appreciating an additional reason for writing this. That is, it is making me feel better… and I have not even had the MMA surgery yet! I am now thinking if this writing is successful in helping others, that I may just give up my fairly good paying self employment forensic financial investigations and travel the country speaking at medical conferences (to doctors & medical providers & maybe even insurance providers). These are the people that come in contact with the diagnosed and un-diagnosed sufferers of sleep deprivation. Why should patients go years being miss-diagnosed as I was when they can be treated either by non-evasive CPAP therapy (and have immediate relief) or eventually by surgical means with significant improvement.

I have more to add at the start of this blog and will do so in a few days. I just wanted to get this blog started and see how it looks and feels.