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

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.

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.

Free at Last! Free at Last! Thank God......

There are no better words to describe my feelings than the words spoken by Martin Luther King in his "I Have a Dream" speech. Yesterday Dr. Kasey Li removed my arch bars. I feel like I have to learn again how to eat and speak.

After four to six shots (I stopped counting....I hate going to the Dentist), my face felt like it was the size of an exercise ball. He yanked.... excuse me extracted out the six to eight (I also stopped counting) wires holding the arch bars in place. These wires anchor in the arch bars around my teeth. Now that I think about it, it felt like he was pulling an iron anchor out of my mouth. It may sound like I am complaining, I am not, but I think I feared the arch bar removal more than the surgery itself. Let me say right here and now that Dr. Li did an excellent job and even though I am a "baby" (this is not the place to mention I am an ex-Marine) when it comes to repairs to my teeth after it was all done it was not a big deal..... no real pain.

Now that I am free of the arch bars and bands that held my teeth and jaws closed for 34 days, 8 hours and 23 minutes (but who's counting) I have to pace myself very carefully. I understand from other MMA surgery patients and from my own inadvertently bite of something that it can be quite painful if you get too aggressive on eating or talking too much. The pain that occurs with a too hard of a bite or too much talking is hard to describe. I am not sure whether it is jaw bone or jaw muscle pain, but it originates at the back lower jaw area (where it the lower jaw was cut/broke apart and screwed back together).

I have decided that I will have to work slowly back into the chewing and talking routines. I can tell you right now, if one has to be drastically reduced it will be the talking, because this 6' frame is almost down to 180 lbs. and I have seen too many food commercial (especially the Superbowl ones) to hold back much longer.

Enough of the downside. I really needed to lose some weight. My goal........ to start eating only the good things. I am actually craving a salad, but that is probably 3 weeks away.

Now that my flu, cold or bronchial infection is losing its hold on me I plan on:

1.) resting allot; 2.) eating/drinking well; 3.) exercising; and 4.) thanking the Lord and all of you for your prayers.

Ohhhhhh My Sleep, I almost forgot about that, (that sounds good, just forgetting about it) my sleep is back on track. It was difficult sleeping or attempting to sleep when I had a fever, cough and sinus congestion. Now that that has diminished, I expect a long gradual improvement. Last night I slept for four hours straight and then on an off till seven in the morning. But the most important thing is I woke up and did not feel bad. I actually felt somewhat rested. Just give me a few more days (maybe weeks) like this and my wife will have to keep me from mountain biking in the hills behind our house!

When we arrived home from Palo Alto last night our fantastic and loving daughters and families had a bouquet of roses (and a beautiful note) waiting for us when we opened the door. I am not a flower person, but I am a father that loves his family and this meant allot to both of us. My wife deserves these flowers and much more for all she has endured before, during and after the surgery.

The Good, The Bad and The Ugly….Part II

It has been a full month since my surgery. Many MMA surgery bloggers report that the time flies by. Unfortunately I cannot say that. This past week has been pretty tough. It has been a week since my last blog entry. You will see why in a minute.

The Good

My recovery from surgery has been going well but I believe it has likely been hampered to some degree by my illnesses. I have very little pain and numbness due to the surgery. I am able to sleep on my back without any breathing problems. My sleep is gradually improving.

My arch bars come off in three days….Haaarahhhh. We are both flying over to San Jose on Monday for just the day. It is just a 10 minute procedure done in Dr. Li’s office. Mary is taking very good care of me.

The Bad

Tuesday and Wednesday nights were the worst nights I have had since surgery. For that matter, I think they were the worst nights I have ever experienced, including CPAP usage and non-usage. The longest period of sleep I obtained was no more than 10-15 minutes and you are not going to get even close to deep restorative sleep in that short span of time. I was coughing every 2-3 minutes all night long.

The Ugly

I apparently caught the flu or a severe cold this past Sunday or Monday. I had a fever up to 101 and have been constantly chilled 24/7. My sinuses are clogged and I have the worst cough I have ever had in my entire life. My stomach feels bloated and very upset and this has not gone away even for just an hour or two.

I initially started with an antibiotic thinking this was a sinus infection. After two days, I got worse. Dr. Li informed me that I very likely did not have a sinus infection since I had a fever and was coughing. I immediately went to my primary care doctor. Can you believe I called my doctor’s office at 8:00 a.m. on Thursday and I was in his office at 9:30 a.m.? He believes I have some sort of a bronchial infection. He ordered chest x-rays just to be sure pneumonia was not setting in.

He placed me on a new antibiotic (it is a smaller pill and easier to take); gave me two shots in the cheeks (not the ones that Dr. Li worked on). One was a strong antibiotic and the other was an anti-inflammatory injection. Another record……These two shots hurt the worst than I have ever experienced. And remember, I had a ton of shots when I was in the Marines and throughout my life. I was willing to take whatever they had to make me feel better. It has been a day and a half and my cheeks still hurt.

However, the most significant thing I was given, which I believe will lead to my recovery is an oral prescription medicine called “Promethazine with Codeine”. This is a cough suppressant which also causes drowsiness. I do not mind that side effect at all. It actual helped me sleep last night. I am doing better today. I really needed that sleep last night. But I still feel pretty lousy. I have not been able to eat much. My stomach feels bloated and upset all the time. Hopefully in one or two more days, I will feel better. Every time I need to take a pill Mary removes my front bands, I take the pill and then she puts the bands back on.

I feel like my body is an open petri dish. With my immune system in shambles and my body recovering from the surgery it seems like I catch whatever ailment is near me. Well, give me a couple more days and I should be doing better. Just having the arch bars removed will be a giant step forward.

Ahhhhhhhh Sllllleeeeeeeeeeep

Last night I slept from 10:30 pm - 3:00 am and then again from 3:00 am - 7:00 am. I slept like a baby. Very peaceful undisturbed sleep. I still did not feel that great when I woke up and got out of bed. But about 2:00 pm in the afternoon, I thought I was in heaven. I felt great, energetic, happy and many other wonderful feelings. This was the best I have felt in 15-20 years. I guess I gained a little on my huge sleep deprivation debt. Thank God.

3 Weeks plus ....... "Steady As She Goes"

Well this is a milestone. I am counting by weeks now rather than days. My sleeping is slllllloooowwwwwllllllyyyyyyy improving. I am falling asleep quicker now, 15-30 minutes. I awake 2-3 times and usually fall back to sleep fairly soon. Heck, that is probably better than a lot of 60 year olds. I have had only one incident of waking up gaging for air in the past two weeks. I am still recovering from surgery; still have some anxiety and stress; and my body is still learning how to sleep. So no problem as far as I am concerned.


I have been reading some older blogs from other MMA patients and comparing where I am today compared to where they were at three weeks. Thank God, I am doing as well if not better. With my bands on my archbars still keeping my teeth completely closed, I find myself clenching my jaws and putting undo tension in my jaws. So I have to remind myself often to relax the jaws and mouth, especially at night when I go to bed.


Thanks Katherine (my daughter) for reminding me to update this blog. I love you.


My energy level is fairly good. I do not get sleepy very often in the afternoon or evening. Only one nap in the past week. I am doing my taxes now, so I try to stay pretty focused. My focus is still a problem. I hope it will improve as my sleep improves. Once I start getting more deep sleep; this will reduce the very deep deficit I have built up over the past 15-20 years.


I haven't mentioned pain or numbness because there is very little and it has been that way since day 6 or 7. I have been having long dreams almost every night. I forgot what dreams were. I have started to develop some pressure buildup in my ears with some slight popping. But what the heck my head has been through a lot over the past month.


My wife has not only been helping me tremendously with my food prep and care, but yesterday went out with me on a new investigation. I wrote down questions feverishly as she asked questions of her own. It went well and the new client understood my situation completely. He was just assaulted and had a bandaged face.