I'm late! I'm late! ...for a very important update!

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Hi Mom!

Sorry about that! I know it's been over 2 months since my last update, but I've been a busy guy!

First off, let me say that P.Smitty and I had the BEST TIME EVER visiting y'all last month, and the 30th class reunion was also so much fun. It was *especially* great getting to re-connect with my long-lost friend Mary, who lived across the street from us. Turns out she doesn't live all that far away, so hopefully she and her husband will pay us a visit to S.F. in the near future! (hint-hint!)

P.Smitty and I are doing well except for the little problem with P.Smitty breaking his foot a week or so ago. Guess those cowboy boots he bought on vacation will have to wait to be broken in.
I have to say that after all the great caregiving he gave me after my MMA (and MMA Part Deux) surgeries, it's nice to return the favor in any way I can.

Anyway, the day after we got back, I rolled on down to Palo Alto to have my braces put on (third time's a charm!) by "Dr. I". ....and here they are!

I decided to spend a little more for the 6 clear bands on the top. After what they cost, I figured what's another 400 bucks?
...but let me back-track a little to get you up-to-speed.

It turns out that the X-Rays and MRI's showed that my (allegedly) "perfect teeth and bite" weren't actually all that perfect to begin with.
For starters, the way my teeth were fixed the *second* time with braces wasn't exactly the best way it could have been done. Truth be told, I should have at least had my lower jaw moved forward back then, which makes perfect sense since I always had a significant chin deficit. This was way before my OSA diagnosis, but I can't help but think that had that been done back then, I might have been able to avoid the MMA surgery.....or maybe not. Who really knows?
Regardless, "Dr I." says that the angle of both my top and bottom teeth are off quite a bit. Note: this was after the 2nd round of braces and way before the MMA surgery. The top ended up at a questionable angle (more inward) and my lower teeth are pitched out signifigantly. Now, after the result of the MMA surgery, when I bite down, the top and bottom teeth meet together instead over-lapping like they are supposed to. In addition, my molars don't meet in the back at all and that is making my jaw joint hurt. To bring temporary relief, Dr. I previously crafted a plastic appliance that I could wear at night, (on the top and bottom), but because of the braces being in the way now, he altered the lower one to still fit, and I wear it with rubber bands at night. It's not quite as enjoyable, but it's better than nuthin'!

So to me, I honestly think that my MMA surgery was done perfectly, and my jaw is exactly where it needs to be. It's just that the teeth aren't. Luckily, the angle of the teeth can be fixed pretty easily. Dr I. is going to create (i.e. grind) a little extra space between my front lower teeth to allow them to be angled/pitched (not moved) back. He will do the opposite with the top teeth and that should pretty much fix the "lack of an overlap" problem.

The bigger problem is going to be the molars. Dr I. is going to have me wear rubber-bands from the top to bottom in the back (oh goody!) to create tension and pull the the molars closer to each other. This will take time, but we hope it will work. If not, the 2 lower "fixed bridges" I have on either side will need to be replaced with ones that are "built up" higher.
We are hoping to avoid that because those bridges were not cheap and they cannot be "altered". Only replaced.

How long will all of this take? Who knows, but I'm "visualizing" 1 - 1.5 years max. ...but if it takes longer, it takes longer.

Another challenge I have ahead of me is how this is all going to be paid for! I have submitted the claim (with a medical CPT code) to my health insurance company because I feel the need for braces is a result of a previous medical procedure (the MMA surgery) and I would not have needed them otherwise. Makes sense, right? Unfortunately, the insurance company thinks it's a dental issue, so we do not agree. The difference of what I will ultimately have to pay if it's not covered by medical will be about $3,700 so I'm going to be patient, but keep fighting until I exhaust my last resource. Luckily, I have a good benefits administrator here at work, and I think that will help me.

I know all of this sounds like a huge pain in the drain, but it's really not that bad. The MMA surgery was successful, and now it feels like forever ago, and I'm sure that in another couple of years, this whole orthodontic thing will feel like a thing of the past as well.
So, I'll keep you posted on my progress.

Oh! I almost forgot to add that on Sept 12th, we'll be having our 2nd annual MMA Summit, so I'll get to see all my fellow MMA friends, hopefully meet some new MMA friends as well, and we'll all get to tell our "war stories"!

Who loves you, mama! xoxo:

Pinski

1 Year Update

Hey there, Mama!

Good lordy! I can hardly believe that one year ago today, I had my MMA surgery! Since then, there have been so many ups and downs and challenges, but in retrospect I'd do it all again in a heartbeat.

There are so many people to thank along the way, starting with Dr. R, my ear, nose, and throat specialist. He was the one who suggested I see a specialist since I had never had a follow-up (which was not smart) after my sleep study 2 years previous to that.
He referred me to UCSF, which didn't turn out to be my ultimate destination, but quite a learning experience. They suggested MMA surgery, but as soon as I heard the words "precautionary tracheotomy" I was out of there!

....which led me to the World Wide Web where I started to educate myself about this mysterious "MMA surgery" stuff. The first stop on the WWW? Rogers MMA page, which was *super* interesting, very well-written, and had so much good information in it. I contacted him to compliment him on his site and told him about my upcoming surgery. He wished me luck, and suggested I check out the Sleepnet discussion forum. There, I really got an education about all the things that have happened to others and that may or may not happen to me if I went through with the surgery. Scarey!!

The next stop after that was Dr's R&P in Palo Alto. Then, due to some circumstanses (mostly financial), I decided to check out yet another doctor, Dr. KL. After seeing him, I knew I had found the right man for the job. So, I scheduled the surgery and started doing a LOT more homework.

I contacted a couple of people privately from the Sleepnet forum ("Dreamette" and "Learian", who had both had MMA surgery) who lived in the area, not far from me. After many, many questions and answers, I was ready for the big day.
Of course, I not only had to get mentally prepared, but physically prepared which meant getting a good blender, humidifier, and all the "accessories" I'd need. Oh, and did I mention the food part? Lots of protein shake material, yogurts and many cans of soup!

When the big day came, I was as ready as I'd ever be and the surgery turned out to be pretty intense, but not as hugely intense as I thought it would be. I was finally on "the other side"!!
The hospital stay was good. The staff in the ICU and Ward C were great, but after 3 days, it was good to go home.
Paul was key in my recovery because if I needed anything, he was there to lend a hand or do it for me. The unfortunate "ICU Part Deux" a week later was unique to me, and just a little setback. No biggie! ;-) I wish Paul wouldn't have had to go through that part, but he did survive. A little traumatized, but he's okay now!

From there, my recovery was slow but the progress was good. I started feeling more rested and had a lot more energy by the time I returned to work 7 weeks later. Those 7 weeks were for recovery, but to me it felt like a long vacation!

The one to thank the most though is Dr KL. His level of skill and care are unmatched by any doctor I have ever had and many others would agree with me. His staff are also the greatest and they made my MMA experience a really good one.

Fast-forward to today. I'm still recovering, and my progress is pretty good. Unfortunately, because of my weak upper jaw-bone, it moved a little bit after the surgery and now my bite is out of line. So, I am scheduled to get braces for yet a third time in mid-July. No biggie! This will help me get my bite back in line, and hopefully take care of the TMJ issues that have recurred from 15+ years ago, before having braces the second time.

Then there's the numbness. The feeling in my lower jaw is good. There is still a little bit of numbness but if I didn't get any more feeling back down there, it would still be okay.
The upper jaw is another story. I think the "re-cauterizing" of my upper jaw during "Part Deux" was quite a setback. The front half of my hard pallet and teeth are still pretty much numb, however I do get some infrequent "sensations" in the front which makes me think I still have potential to get more feeling back. I have noticed lately that my top molars (especially on the left) have more feeling in them than before.

I also have really changed my eating habits. Since it took a while longer for my top jaw to
stabelize, I wound up eating a lot of pasta. That in turn made me gain back all the weight I had lost after the surgery and then some. I was up to over 200 lbs, which was just entirely too much. So, I started changing my eating habits, and have lost 26 pounds since the first of this year. Now, along with the great nights sleep I get, I have more energy than I know what to do with. I know I'm 48, but seriously, I feel HALF that age. (Alas, all that hasn't made my eyesight any better;-)

Over the past year, I have also been contacted by some people who have read my blog and reached out to find out more about my MMA experience. It has been great talking with them, letting them know how my experience went and assuring them that it's not going to be as bad as they think it will be. Shout-out's to Wayne, Terrie, Neil, Bobby and Sara!

Anyway, I just wanted to touch base with you and acknowledge this landmark date.
I hope you and dad are doing great, and we are looking forward to our trip home in July.
See you soon!!

love:
Pinski
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10 Month Update

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Dear Mom;

I've been slacking on the updates a bit, so I figured it was time to post another one.
10 months! Seems like "forever ago" now...

On the TMJ-front, I'm beginning to realize that it's going to take a bit of time to solve this dilemma. Probably another year (and that's if I'm lucky!) So, in my last bloggie, I mentioned the "guard" that my orthodontist Dr I. crafted for me. It covers my lower teeth and is "built up" in the back to keep me from being able to bite down too far-- which used to create a lot of pressure on my jaw joint.
Unfortunately, this didn't exactly solve the problem because when I sleep on my side, my lower jaw drops down to the side, and over time causes the jaw joint to hurt, pop and snap. So, at my followup appointment, I mentioned this to Dr I. and he had a solution. ...or a "contraption", depending on how you look at it.

He crafted a guard for my upper teeth as well, which is also built up in the back, and has a hook-like metal thing in the front.
Then, he attached a thin wire from side to side on my existing lower guard. The wire from the lower guard hooks on to the top and keeps my lower jaw from dropping down to far when I'm sleeping. Actually, it's brilliant and I really like it. This is what it looks like:









Unfortunately, it's kind of hard to cough, sneeze or yawn, but the lower guard can come off fairly easily by just using the tip of my tongue to push it up from the back of my lower front teeth.
One small drawback is that I still clench my teeth a little bit, but for the most part, I really like this solution.
The whole purpose of this exercise is to wear this "contraption" (only at night) for 3 months in order to stabelize the jaw joints before he puts me in braces. As you recall, this will be the 3rd time for braces for me, but I'm told it will only be for about a year this time. Fingers crossed.
He will need to shift my top teeth forward and my lower teeth back, and pull my molars closer together (using the tension of rubber bands), so that the back teeth meet comfortably.
Right now, only my front teeth meet when I bite down.
Since this mis-alignmentt is the result of a surgical procedure, (and by NO FAULT of Dr KL - My weak-boned upper jaw moving back after the surgery was to blame) we are going to try to get it covered with my medical insurance instead of dental. Dr I said it has been done, but it still might be challenging to get the insurance company "on board", so I might be headed for "Insurance Challenge, Part Deux"! That's okay, I'm up for it (with the help of Super Suzanne, my benefits administrator).

Well, enough about that. Lets talk about Diet Bacon!
So, our "[my company's name]'s Biggest Loser" program started at the beginning of February and my team (I'm the captain) "Diet Bacon", is doing famously well. In fact, at the last weigh-in, we were still in the lead for weight loss, followed closley by my bosses' team, the "Beauty School Dropouts".
However, the team with the best name, the "Deep Fried Cheesy Puffs" aren't doing so well. ahhhh.
Anyway, I have lost 15 pounds in the last 2 months and I reclaimed a belt notch! The program lasts for 1 more month, so if I keep it up I will reach (or come very close to reaching) my goal of 178lbs. Not bad since I started at nearly 200 lbs. I don't even miss the Onion Rings that much any more.

Lastly, I went to see my friend "T" the other day. She had MMA surgery at the beginning of March and she is doing really well. Before that, she had an RDI of 80 (yikes!) and her O2 saturation was in the 70's, (dangerously low) so it's good she finally got taken care of. Dr KL did the surgery and she also thinks he's the best. She's even reported that she's not sleeping upwright in a recliner anymore, but instead sleeping on a regular bed ...for 7 hours straight!Nice!!

Anyway, that's about all the news worth reporting, so I'll close for now.
P.Smitty and I are really looking forward to seeing y'all in July when we come home for my 30th (geez!) class reunion. THAT otta be a hoot!

Who loves you, Mama??

xoxo:
Pinski
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8 Month Update

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Yo, Mama!

Wow! 8 Months. Some days it feels like only weeks ago, and other days it seems like years.
Actually, all things considered I think my recovery is going pretty well. On the sleepnight site, I have read so many postings of people with different problems and challenges after their surgeries, and although I have some of my own, they still seem to be quite manageable. With the exception of the TMJ/bite problem, (and ICU part deux), I feel really fortunate that my recovery has been so smooth.

1) Feelings. Nothing more than feelings.
The returning of the feeling in my lower jaw, lip and teeth seems to be pretty typical. Still some numbness, but actually if no more feeling returned, I would be okay with it. As for the top region, I still have a ways to go. The feeling in my palate is slowly coming back, but I estimate I still have 2/3 of the way to go. The front half of my top teeth still have very little feeling, although I seem to be able to chew pretty well with my molars.

2) Sweet Dreams are made of this. Who am I to disagree??
My sleep study proved to be a big success, and i don't think much has changed since then. I always get a good nights sleep, wake rested, and my energy level is good. However I never did start sleeping with my mouth closed (as Dr. KL suspected I would), so when I sleep on my side, (especially on my left side), my jaw drops open and shifts to the left and pressure is put on my jaw joint. Over the course of time, it starts causing the joint to "snap"(and hurt).

3) Chew-chew!
Eating has been an ongoing challenge for a number of different reasons. After the surgery, Dr. KL told me the bone of my top jaw was thin and he even used some of the bone he took from the Geneoglossus Advancement and grafted it up there. In the following weeks it was clear that the jaw was healing slowly, so he advised me to stick with really soft foods, so to me that meant a lot of pasta (because at that time I was SICK of soup) B-z-z-z-z-z-t! That turned out to be a bad idea, because I gained back the 17 pounds I had lost after the MMA surgery and gained an addition 7 more, tipping the scale at an unheard of 200 pounds. Holy frejole'!
Well, my top jaw seems more solid now, and I started eating some firmer foods, but that was about the time when chewing that stuff started to irritate my jaw joint. Grrrr! Since my bite is not aligned now, (my front teeth meet and my molars don't) and I have been wearing that splint the orthodontist made for me, little has changed. In fact, it's possible that the TMJ has gotten a little worse. I still think if I ever want my teeth and bite to be normal again (i.e. how they used to be), I'm going to need braces....for a third time. Oh goody. AND, if I'm ever going to not be 200 pounds, I'm going to have to go on a diet. ...which leads me to the next subject.

4) Diet Bacon!!
Ahhh, wouldn't THAT be nice. Actually, there's a little story to that. As you know, we have a corporate gym at work and they organize random fitness events. So, now thay are doing a "Biggest Loser"-style program where teams of people compete collectively to lose weight via diet and exercise. I formed a team of 6 gals and 4 guys for this challenge and our team name is "Diet Bacon". Luckily, there's a lady on our team who knows a bit about nurtition, so she will be sending out weekly newsletters with different kinds of advice and cooking tips. My goal is to lose somewhere around 20 to 25 lbs., and we have 3 months to do it. Goodbye donuts!! Goodbye Onion Rings! Goodbye startchy foods! I will miss y'all, but maybe someday we'll meet again (in moderation)

5) Orthodontist Follow-up:
I had an orthodontist appointment scheduled for this week, but after I arrived they told me the doc couldn't make it (for some reason), so I had to re-schedule for the 25th. I was bummed because I wanted to tell him that I didn't think this guard is doing much good and that in fact I think my jaw is actually starting to get a little worse.
Basically, I still think that if I ever want to have my bite back to where it used to be, I'm going to need braces. Guess I'll have to hold off on any further speculatioin

6) ....and last but not least. The Insurance Company Update.
I wanted to finish this note with a really happy ending, and it is. After many months of calling, waiting, calling and waiting some more, my insurance drama is finally over! Well, at least the MMA chapter that is.
As you recall, (and you probably do, since y'all floated me the loan), I had to pay a hefty 5-figure up-front deposit to the good doc. That's because it was uncertain if my insurance company would cough-up enough to cover the surgeons fee.
Long story short: After 5 months, they didn't. They low-balled the payout and it looked like I might not ever get my deposit back. So, with the help of the (AWESOME!) benefits administrator where I work, (and a couple more months of waiting) the insurance company finally coughed up what they should have in the first place!! This was music to my ears!

A side note: I met a nice lady here where I work who has a much worse case of Obstructive Sleep Apnea than mine, and it looks like she is headed for MMA surgery herself, and I know Dr. KL will take excellent care of her, as he did with me and hundreds of other people. We talk quite a bit, and I keep her posted about my recovery and insurance whoas, in hopes of her being more prepared and educated about what is in store for her.

In closing, I'm still glad that I did all of this and I hope more people with the same problem will find the help they need and get some relief. For many, it could even save their lives.

xoxoxo:
Pinski
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TMJ : Here We Go Again!

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Hey, Mom!

Happy New Year! Here's hoping that 2009 is a great year for everyone.
So much happened in 08', that I'm thinking if I can get through that, I can get through just about anything.
Unfortunately, an old problem I used to have, has recently poppped up again.
Not as severely, but it's definately a concern.

So, I'm not sure if you remember back that far, but do you recall back when I lived "up north" and I had such extesive TMJ that my jaw used to lock shut? It had to be around 1986-87....Anyway, one day I was eating a sandwich and BAMMO! Something happened on the left side of my jaw and it locked shut. I freaked, and didn't know what to do. Trying to "unlock" it with pressure was totally un-successful, so I eventually just waited (2 hours the first time) and was able to manuver my lower jaw to the side and it unlocked. Apparently the jaw joint was swollen or aggrivated and it needed to relax or un-swell. Unfortunately, this became a regular occurance after that. I would guess that it happened at least 20 times a day. Fortunately, I didn't have to wait 2 hours each time to successfully do the lower-jaw manuver. Only a couple of minutes.
I eventually went to a dentist who refered me to UCSF in San Francisco. The doctors there informed me that the disk between my upper and lower jaw became "deranged" whenever I would bite down my regular bite.

After a series of MANY tests, several visits and a whole lot of dough, I was fitted with a clear plastic "re-positioning splint" that fit over my lower teeth, which kept me from biting down too far. This took the pressure off of my jaw joint. I wore that stupid thing (even after it broke in half) for many many years. Finally, I had the means to afford braces because of the bad overbite I'd always had. After two years in braces, I wound up with straight teeth, and my jaw no longer locked. In fact it rarely even popped after that unless I ate something REALLY chewy like bagels or steak.

Fast forward to 2008, and MMA surgery in June.
After the surgery, Dr KL decided not to fully (rubber) band me to stablize my jaw because he discovered (during the MMA operation) that upper jaw bone was rather weak and thin, which would later prove to be a problem.

At about the 5 to 6 month recovery mark, I started experiencing some light "snapping" of the joint on the left side and it was getting progressively more annoying/painful -- especially in the morning, after waking up.
So, Dr. KL referred me to an orthodontist Dr. RI, who specializes in TMJ, who is OF COURSE not in my insurance network. (all the good ones never are!) I see dollar $ign$!

It's tough to say exactly what really happened, but first off Dr. RI said it is not that uncommon for MMA patients' bites to not be perfectly lined up after their surgery.
After I told him the part about my weak upper jaw bone, he said it *might* have moved back a little bit after the surgery.
As a result, my back teeth don't really meet in the back at all, only in the front. So when I try to bite down, there is a lot of pressure on the jaw joint disk.

Dr RI suggested the first line of defense to be a plastic guard (not unlike the afformentioned repositioning splint of 20 years ago, but not so large) to take the pressure off the jaw joint. He also ordered a full set of X-Rays.
All tolled, I am about $1,700 dollars poorer than I was before I got there. I've submitted the bills to my insurance company for re-imbursment, but my guess is that it's going to be a while before I get it back. That's how they "roll". ;-)

I realize that it may take some time for it to help. The orthodontist says he wants me to wear this guard for 6 months, and then decide the next step.
My common sense would guess that if I'm ever to see my teeth where they used to be (pre MMA surgery) I'll probably need braces, but I'm no professional.
Patience is mostly what I need to have right now. I would just as soon get banded up with braces and start that, but I've never been one to put off getting what I think I need.

Fast forward....
It's been about 2 weeks since I started wearing this "appliance" and I'm not sure how well it's working. The snapping on the left side persists and when I take it out to eat, there's not only snapping on the left, but also popping on the right side.
Snapping on the left. Popping on the right.
Paul asked "Where's crackle?" (A bad Rice Crispies reference).
Not exactly what I was hoping for, but I guess I still need to give it more time.
I have an appointment with Dr RI in February, so we'll have to see what he thinks about all of this.

It should be a(nother) real adventure.

Much Love;
Pinski