Dear Mom: (The Intro)

Hey, Mom;

Remember that sleep-study I had a couple of years ago that said I still had "moderate sleep apnea" --- even after that (UPPP) surgery I had back in 94 (where they took out my tonsils, soft pallet and uvula) ? Well, I went to my ear-nose-and throat specialist recently and he told me that it looked like my apnea had returned (that is, if it indeed ever left:-), and since I never did anything more after that, I really should see someone who specializes in sleeping disorders.
So, it was off to "Dr K" at UCSF, who checked me out, stuck a scope down my nose (good times!) and told me that even though I have a deviated septum, I also have a very narrow airway in which to breathe. He then referred me to yet ANOTHER oral surgeon....someone who does surgeries that are more extensive. I'm thinking to myself: "Ummm, this can't be good".
He explained that in the more severe cases of sleep apnea, there's a surgical procedure called "maxillomandibular advancement" (a.k.a. MMA)" and I might very well be a candidate for it. Then, he explained exactly what that was. Literally, *moving* my jaw? Holy Crap!!

I immediately went home to "Google" this afformentioned procedure, and started reading blogs. The first one I read was "Rogers MMA Sleep Apnea Surgery at Stanford" blog. He's my age, great writer, and a helluva nice guy. Very detail-oriented too. I knew after reading all of his blog, how "heavy-duty" MMA surgery really is, but even after all he'd been through, he had no regrets about having the surgery done. I e-mailed him and his reply was really encouraging. He also told me about the sleepnet.com forum site where peeps such as myself discuss (in great detail!:-) everything one could imagine discussing, around MMA and more!

Fast-forward to a couple of weeks later: I went to the appointment with the other oral surgeon, "Dr C" at UCSF, who took X-Rays, lots of front and side-profile pictures, and made molds of my teeth. Since UCSF is a teaching school, they all have to collectively decide what their plan of action will be. This took another month (yawn!) to finally find out what they wanted to do.
As I suspected, it was recommended I have MMA surgery. I was given a release form for jaw reconstruction surgery and all that. In asking a few questions, I discovered that although this doctor had done "3 or 4 hundred" jaw surgeries, they had actually only done about 10 MMA ops. B-z-z-z-z-T!! Not *nearly* enough experience for my comfort level thankyouverymuch.

So, I remembered how highly Roger spoke of his surgeon, "Dr. P" (who is a pioneer in MMA surgeries), so I went home, and called up Dr P's office to make an appointment. Turns out, he's not in my insurance network, but I didn't care because I decided I needed the best.
It took several weeks before I could get in to see him. Since the sleep study I had brought with me was a little over 2 years old, he ordered another one for me that night. He also took x-rays and a lot of front and profile of pictures.
That night I went to the sleep study in Menlo Park (just north of Palo Alto). They are never that much fun, and I'm surprised I got such a good nights sleep with 436 wires and sensors (okay, I'm exaggerating a bit) hooked up to me from head to toe.
The next week I was back at Dr P's office. Turns out, in the last 2 years, my RDI (Respiratory Disturbance Index) rose from 19.6 to 24.5, and my oxygen saturation had gone from bad to worse. Then, (this sounds *so* hard to believe, that now I'm not sure if I heard him correctly, but) I *think* he said each of the 24.5 episodes (when I'm not breathing) lasted an average of 49 seconds. If that is true, I'm not breathing for about 1/3 of the time I am sleeping.
Holy Crap again!! No wonder I'm always tired!! Maybe that's why I get headaches so easily too.
So, he tells me I'm not only in for an Upper and Lower Bi-Max (MMA) surgery, but also a Genioglossus Advancement (GA) as well. The MMA would be done to move the jaw forward, and the GA will help move my big-fat-stupid-tongue forward. It's the primary offender - because it falls back and cuts off my air when I'm sleeping. Also the reason why I haven't been allowed to sleep on my back for several years.

The office staff At Dr P's was really nice. The lady who handles the insurance informed me what to expect regarding matters of my insurance. Turns out my insurance company pays 80% of out-of network stuff, and 100% after I pay the $1,600 max (of the 20% part). Easy enough. Or so I thought!! There's this little thing called "reasonable and customary", which basically means if the doctor charges more than what the insurance deems as "resonable and customary", guess who gets to pay the difference?? Yeppers! That would be yours truly! (moi')
In this case (hold on to your chair) around 20K. ...and that's not including the anesthesiologist (sp) and some other random stuff.
Remember that advice you always gave me? "You'd better shop-around, uh-huh....you'd better shop around". Well, that's what I figured I'd better do.

Long story short (too late!!) : I went to see Dr KL, another highly-recommended doctor (also in Palo Alto) who has a LOT of experience with MMA surgeries. I immediately knew he was the doc for me. Also, he was willing to negotiate his fees down a little bit, but it's still going to be a hefty 5-figure cost. That's okay. This is my health we're talking about and I want the best. I mean, I bought the Kenmore Elite washer/dryer, the temprapedic bed, and the Samsung flat-panel boob-tube, so why not get the best in my health care as well, right?

By the way, would you care to float me a little loan?? ;-)

So, the big day is June 4th. I'm scheduled for the MMA and the GA, and it should take about 5 hours. It'll be done at Stanford and I'll be in the ICU the first night, and in a regular room for 1 or 2 more nights, depending on how I'm feeling.
I should be back to work the following Monday! ONLY KIDDING!!!!! Apparently, it's a long recovery. I'm so glad I have a decent employer! They have no problemo with me taking 6 weeks off, and I'll still collect a full paycheck since I will be on medical leave.

Don't worry about a thing. Even though he's a little freaked out about all of this, I'm sure Paul will step up and be a fantanstic care-giver as usual. I told him he should run-for-the-hills, but I'm sure he's going to be there for whatever I need. He's a great boyf and I am so lucky to have him. HOWEVER, he (jokingly) said I should call *you* to come out and take care of me, while he goes to Los Angeles to see his family for a few weeks. Big chicken!

I've been in touch with a couple of people from the sleepnet.com forum and was even fortunate enough to meet (in person) this super-nice lady who goes by the name "learian". Dr KL also did her MMA surgery, and it turns out we live in the same town!! It's a small world, idn't-it? She offered to meet me for coffee and show me her before and after pix, so we had coffee at Starbucks and she and her S.O. offered-up a lot of really good information to me and Paulie. Actually, I'm hoping my recovery and attitude is half as "model" as hers was/is. I consider her my MMA inspiration! Thanks, "L"!

I'm a little concerned about the pain-management part, though. As you probably recall, I'm allregic to codene so I have to take vicadin instead. ...and lets just say, from previous surgeries (abdominal and my elbow scopings), I like the vicadin a leeeetle too much. That in itself is going to be a challenge because I'd imagine there's going to be a certain amount of pain involved. When I take more vicadin than is prescribed, I tend to get really itchy and kind of queezy, I don't poo for days at a time, and it really messes up my sleep. (i.e. I sleep lightly and wake up even more frequently than I already do) In fact, remember the morning shortly after my UPPP surgery, when I hurled up that banana yogurt? Well, lets just say, it actually *wasn't* the yogurt that made me gak. Nuff said! Paul knows all about this, so he's going to be in charge of the pain management department this time.

BTW, have I ever told you how much I love jicama? Sweet, crunchy, weird jicama! Gawd! Which, brings me to the food part: You remember how I told you about my intolerance to all sorts of foods these days, right? Marinara, citrus, coffee, and (my life-long favorite) fried foods? Well, I read that there's a possibility that MMA surgery can help...sometimes even cure this. I'm not expecting it, because I can't imagine how one has to do with the other, but we'll see. Oh, to be re-united with one of the true loves of my life, onion rings!!
So, in the next several weeks before the surgery, I'm on a mission to eat as much chewy and crunchy food as I can, because after that, it's liquids and puree'd food for a long-*ss time!
I can only imagine how creative I will become. Anybody for a steak-shake? ;-)

I bet your wondering: Why such a long-winded letter, sonny?? Well, it's because I've decided to kill 2 birds with one stone (figuratively, of course) and combine a blog and letters to you.
There are so many great and informative blogs out there, but I decided I'd take a different approach, and write in a style that more reflects my personality. Of course, I'm sure some people will find it unbearable to read, so they can skip it. After all, that's what blogs are all about. I hope by documenting my personal experience that others facing a similar surgery might benefit in one way or another.
....and since you KNOW what a "talker" I am, (and there'll not be much of that for a good bit of time after my surgery) what a better way to "talk about" my MMA experience, eh'?

So, bookmark this page and hopefully I'll update it every week or so with my progress....and if after the surgery, you get a phone call, and the person on the other end says "Ayyye moorrsh mauya owya ooin' shaya?" You'll know it's me!!

Well, enough about me. Hope you and dad are doing well, and I *really* hope it's stopped snowing there by now. You know, you really *should* move to where it's warmer!! ;-)

I'll write more later:
love;
Pinski

P.S. You should see my new office at work! As soon as I get the disco ball put back up, it should feel like home!