Pinski's Excellent MMA Adventure

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

2009-08-12T14:16:00.000-07:00

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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

2009-06-03T12:14:00.000-07:00

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

2009-04-03T21:41:00.001-07:00

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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

2009-02-05T20:37:00.000-08:00

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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!

2009-01-03T17:31:00.000-08:00

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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

6 Month Update

2008-12-06T07:23:00.000-08:00

Hey Mom;

It's hard to believe how quickly time goes by. 6 whole months since my MMA surgery, which actually seems forever ago.

Last Friday, I went to Stanford to see a pal (k8e) who had MMA surgery last Wednesday. She had a bit of a tough time the first couple of nights, but she's doing much better now.

I originally met her at the MMA get-together in Sunnyvale a few months ago. She was one of the people who hadn't had the surgery and was still trying to decide if she was going to go through with it. Anyway, she made her decision and vwala! There she was, all fixed up and recovering comfortably in Ward C2!
I also happened to see a few familiar peeps (nurses) at the hospital.....and Dr KL also happened to be there which really didn't surprise me at all.

He's a great guy, and it's always good to see him.

I also met another MMA recepient ("D")from out of state. She was walking down the hallway

with her husband ("R") and I recognized the little 1-sucher incisions on each cheek. It looked like she was doing really well. It's good to know that 2 more people out there will probably sleep much better at night now!

On the Pinski-front, recovery is going as good as can be expected. Feeling in my mouth is gradually coming back. The lower regions are the most significant as far as improvement goes, but the top is also following suite. My hard pallet is slowly getting feeling back from the back, forward and I feel frequent sensatioins in random front teeth., which feels kind of strange, (especially when my teeth feel like they are vibrating when I talk or blow my nose) but that's still progress.

As I mentioned in the last entry (I think), Dr KL did a terminate reduction in his office, but a followup appointment revealed that a second round is in my future, so I will be going back next Monday to have that done. I want to do as much as I can before the end of the callendar year since I've already fully paid my out-of-network insurance (and then some) deductable.

Speaking of insurance, still no word on weather my fight to get back the 5 figure sum I had to pay the doc up-front will be re-imbursed. I think it very well might be, but it's still in the hands of my company's benefits adminitistrator and her supervisor. Turns out the insurance company low-balled the payout and I'm not too keen on them getting away with that since they led me to believe they would pay all of what was deemed as "reasonable and customary" after I paid the out-of-network deductable.

Also, I have another MMA-related appointment with an orthadontist on the 19th. Unfortunately, I have been having a bit of trouble with my jaw and my bite. In other words, my TMJ seems to have returned. I don't think my teeth are quite lined-up as they were (close but not quite), so I am going to consult with the otrho to see if a third (sigh) round of braces are in my future. I had much worse TMJ back in my 20's and it pretty much went away after my second round of braces, so I'm hoping that a re-alignment of my bite (or some sort of treatment) will help clear it up once and for all. Fingers crossed that something can be done because the jaw (especially on the left side) is pretty achy most of the day, but especially in the mornings.

Lastly, I have to think about diet and exercise which I've done neither of recently. I did lose 20 pounds after the MMA surgery, but I've unfortunately gained all that back, plus 7 or 8 pounds. I'm feeling a little "thick" and out of shape, so I'm visualising (!) doing something about it soon!

So that's about all the news worth reporting. Here's a pic taken today. As you can see I'm back to my old bearded self with a slightly updated haircut.

Hope everything is going well in your neck of the woods. Paul and the cats are doing really well, and send their love. We're looking forward to getting the tacky aluminum rainbow Christmas tree put up, so let the X-mas decoration excitement begin!...next weekend!

much love:

Pinski

3 Month(ish) Update + First annual SuMM(A)it!

2008-09-14T07:42:00.000-07:00

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Hi Mama!

Whassup?? How are you and dad? Paulie and I are doing just fine and continue to be happy, healthy and slightly boring. I haven't written much lately because there wasn't a whole lot to report, but suddenly there is!

First off, there's the basic 3 month(ish) post-MMA update: My recovery is coming along really, really well. I'm still "over-the-moon" with my follow-up sleep study results which really gave me a mental boost. I've still been sticking to mostly soft foods because I had been told by Dr KL that the bone in my upper jaw is thinner than most, and it's taking longer for the bone to stabelize than in most people, so I would get a little "down" around meal time becuase of my limited food choices. However, I have discovered that I really like sushi! Who'd-a thunk? So, my upper jaw seems to be getting stronger each day. I can tell because my top teeth are getting more solid and less wobbly. The numbness in my mouth also seems to be slowly improving, and I'm getting a lot more feeling in my bottom teeth and in my chin area as well. When I shave, I can actually feel my chin now, so it doesn't feel like I'm shaving somebody elses' chin. I am also starting to get some subtle warm sensations and an occasional sort-of painless "throbbing" in my front teeth. Not exactly feeling, mind you, but I can tell that something is starting to happen, which makes me hopeful the feeling in that area will eventually return. That's progress, eh'?

So last Monday, I went to Dr KL's for a quick procedure called a turbinate reduction. I had previously had some trouble with having a stuffy nose (mostly in the evenings), even after the good doc straightened the slighty defiated septum I had on that side. Turns out, a quick look up my schnoz revealed I had unusally large turbinates. So, after numbing everything up, he stuck a probe-like thingie up there and zapped both turbinates with radio waves, which is supposed to shrink those pesky, over-sized turbinates. It didn't hurt at all and the procedure only took about 10 minutes. In some cases it has to be done a second time, but right now it's too early to tell if I'm a candidate for another go-around. He also checked my upper jaw and said it's coming along well, and is starting to strengthen-up. So, I'm heading down to Dr KL's office tomorrow (Monday), and I'll have him take a gander at my turbinates to see how they are doing.

However, I'm actually going there to meet someone from Southern California who will be having MMA surgery on Tuesday. His name is Wayne and I was introduced to him through Nurse Daisy at Dr. KL's office. I have elected myself as his sort-of "MMA advocate" because after learning he would be coming up here alone and would not have anybody there with him after getting out of the hospital, I asked him if he would accept my help (by keeping tabs on him while he's in the Bay Area - just to make sure he'll be okay), which he happily accepted. We've only spoken on the phone so far, and he sounds like a very nice guy...but still really scared since he's coming up here "solo" and was originally going to go through it all alone. We just can't let THAT happen!! So, I'll keep you posted on how he's doing.

..and speaking of other MMA patients.........

This weekend was a lot of fun. As you know, when I started this whole journey I didn't know "Jack-S**t" about any of this MMA/GA stuff, and through the internet I gained a lot of knowledge and made a lot of friends who have been through the same thing. Well, to make a long story short, (and thanks to my good MMA buddy and neighbor Learian who spear-headed it all) there was an "MMA" get-together down in Sunnyvale this weekend. 19 people showed up. A couple of them were pre-op, and a few were "caregivers" and the rest were post-op MMA alumni -- One of which just had his MMA surgery just 9 days ago and one who had his MMA back in the early 90's. You're the man, Dominic!!
....and let me just say: There were some strong, great-looking chins there!!
It was a great mix of people and a good time was had by all. I don't think anyone who hasn't had MMA surgery or sleep apnea (or has acted as a caregiver) would have found it very interesting, but I think everyone who showed up could really relate to why we were all there.

It was great putting faces to all of the names I had seen on the sleepnet.com posting and various blogs. Fellow bloggers "Dreamette", "Western Joe", "Cupertino Joe" and new blogger "Dawn" were there, as well as many sleepnet.com posters. I hope we will be able to make a yearly event out of it. Here's a pic of almost the whole bunch of us!

Top Row: (L to R) Brad, "Alamo Joe", "Western Joe", Dominic, "Kettlebell", Michael, "BlueLite", and Adam

Bottom Row: (L to R) "k8e", "Sleepy Head", "Pinski", Courtland, "Dreamette", "Learian", "Seattle Bill", and "PJgirl".

Not pictured: "Cupertino Joe" and "zzzzz"....who didn't arrive until after this pic was taken...and Dawn (below-who actually took this picture)

Dominic savors his chocolate milk through a Zip-and-Squeeze while Dawn (his lovely wife, and caregiver) watches on.

Everyone enjoying plenty of food and drink (well, except for Dominic, that is)

"Western Joe", Michael, "Kettlebell" and Brad review their sleep studies.

In all, I think everyone had a great time and I hope we can do it again next year.
Anyway, that's about it for now. Hugs and kisses to everyone!

with love:
Pinski

P.S. I love Stevie Nicks. (I just thought I'd throw that out there)
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My Sleep Study: Before and After Specifics

2008-08-29T07:42:00.000-07:00

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Hi Mom;

As previously reported, I got the results from my post-surgical sleep study and I am still very happy, excited, and grateful for these amazing results.
However, since then a couple of people have asked me about the specific differences between my pre-surgical sleep study and the post-surgical sleep study, so I thought I'd break it down and show you how "worth it" this whole "Excellent Adventure" was!

The figure on the left represents the before (4/28/08) sleep study, and the one on the right in bold represents the after (8/25/08) sleep study:

Sleep Efficiency Index: 74.2% / 93.3%
Minimum 02 Saturation: 85% / 94.%
RDI: 24.5 events per hour / 4.8 events per hour
Impression: Moderately Sever Obstructive Sleep Apnea / Mild Snoring without significgant OSA.

Sleep Architecture:
# of Stage 1 Shifts: 87 / 25
# of Stage shifts: 208 / 107
# of Awakenings: 77 / 19
# of REM periods: 4 / 4
REM Latency: 66.5 min/ 68.5 min.
REM Latency minus Awake: 43.5 min. / 67.5 min.

Sleep Stages:
Stage 1: 32.1% / 7.9%
Stage 2: 38.2% / 56.7%
Stage 3: 3.2% / 3.2%
Stage 4: 0% / 0%
REM: 26.4% / 32.2%

Apnea Events: Obstructive
Number: 59 / 2
Index: 10.9 / .03
Mean Duration (sec): 27.6 / 11.5
Longest Duration (sec): 49.6 / 13.0
Occur in REM: 0 / 2
Occur in Non-REM: 59 / 0
REM Index: 0.0 / 1.0
Non-REM Index: 14.9 / 0.0

Hypopnea Events: Obstructive
Number: 69 / 29
Index: 12.8 / 4.5
Mean Duration (sec): 25.5 / 16.3
Longest Duration (sec): 50.1 /27.4
Occur in REM: 9 /15
Occur in Non-REM: 60 / 14
REM Index: 6.3 / 7.2
Non-REM Index: 15.1 / 3.2

Respritory Events with Arousals:
Total Events: Index 24.5 Total 132 / Index 4.8 Total 31
Non-REM Events: Index 30.5 Total 121 / Index 3.2 Total 14
REM Events: Index 7.7 Total 11 / Index 8.2 Total 17

Actually, I'm not 100% sure what it all means, but at least I can refer people here if they want to see what the results of my MMA/GA experience was.

Love:
Pinski
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Voot-Voot! The post-op Sleep Study results are in!

2008-08-26T18:32:00.000-07:00

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We interrupt this (now-)monthly blog to bring you this important News Flash!!

Hi Mom!

Yes, as I mentioned in my last blog, my recovery has definately slowed down at this point. I didn't really see the need for weekly updates anymore, so I figured monthly updates would suffice.
However, I have good news about my apnea (or lack thereof!), and even though I'm a little over a week shy of an official monthly update, I just couldn't wait to tell you.

Quick back story:
I had scheduled my 3-month post-op followup sleep study at Bay Sleep Clinic in San Francisco for September 5th. As you may recall, my surgery was June 4th :-), however I got a call in the middle of last week from the lady at the sleep clinic, telling me they had a cancellation and asked if I wanted to come in that Friday night. At first I told her no - that I needed to wait the full 3 months, but thanked her for calling. Then, I got to thinking about it, so I called Dr KL who said it would be okay to do it a little early.

So, last Friday night I hopped on the bus and got to the sleep clinic at 9:30 sharp. After waiting much longer than I would have liked, the nice technician Mandy hooked me all up, and exactly 3.7 minutes later, I was fast asleep. I woke up once at 3 a.m. to go to the restroom, and before I knew it, 6 1/2 hours had passed and Mandy was waking me up, telling me I was done. Uh, I guess she was kicking me out....at 6:00a.m.!
She didn't say much about how I slept except for the fact that I snored lightly.
Before I left, she told me the results should be sent to Dr. KL at the beginning of next (this) week.
...and sure enough, they were.
It turns out P.Smitty was almost right. He said he didn't think I had any events anymore, which wasn't too far off.

Dr Li called me at work this afternoon with the good news.

. . . . . . . . . . . . . . drumroll please . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . My RDI is 4.8!!!

How awesome is that?? I feel SO fortunate that my MMA surgery was such a success. He said my O2 level never fell below 94%, and that I only stopped breathing about twice an hour for like 11 seconds. I can live with that!!!
Then, he said "For someone your age, we can consider this a success". Uh, hem? My age???
Well, I knew what he meant and I thanked him for the great news. He is a great surgeon and a great human being in general.

Anyway, I just had to share the good news with you, Mama! I'll save the rest for the monthly update, coming soon to a blogspot near you!!

Love;
Pinski
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2 Month (8 week) update - Back to work for Pinski !

2008-07-31T12:46:00.000-07:00

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Ola', Mama!

Holy Crap! Where did the time go? One day I'm on the couch watching "The Price is Right" with ice bags on my face, and before you know it, I'm back at work!
Man, I enjoyed not working, but truthfully I was getting a little bored that last (7th) week.
I am fortunate to have had so much time off, actually.

The feedback I'm getting at work (about my appearance) is very good. The general consensus is, is that I look more rested, a "little bit different", and a little bit younger. Hmmm. I guess that's pretty good, eh'?

My energy level is great. My boss told me that I didn't have to "hit the ground running" when I returned, but there is just so much to do that it's tough to pace myself. It also doesn't help that I'm a little on the hyper side, but so far I'm holding up pretty well. I need to build my stamina a little bit, but I'm doing pretty well and getting A LOT accomplished. They definately saved plenty for me to do so I wouldn't be bored upon my return :-)

As far as the MMA/GA part goes, I think any further recovery is going to be slow.
Now that the Ouch Bars are gone, and the swelling is pretty much gone, it's just going to be a matter of time for my nerve-endings to connect so I can get some feeling back in my mouth.
Right now, most of my top and bottom teeth are still numb, as is the roof of my mouth (my hard pallet) and most of the area around my chin.
All that numbness is still making it quite tough to eat, limiting what I can eat. Dr KL said that I shouldn't push it, because if I try to eat foods that are too hard, it could slow down the healing and even possibly cause a set back. Wouldn't want that, now, would I?
Needless to day, I still get kind of bummed around meal time.

....and one more sTrAnGe thing that's happening is my chapped lips....make that my chapped lip - *singular*. The top one is fine, but the bottom one gets all dry and always needs to be moisturized. I don't understand why that is, but I'm sure it'll get better eventually.

Oh!! ...and I booked a night at the Bay Sleep Clinic here in San Fran for my 3-month follow-up sleep study. I can't wait to know what my numbers are now. I'm bettin' they will be good. Paul thinks so too because he says I sleep quietly (even on my back) and I continue breathing without gasping, snoring or snorting.
....and I really don't feel exhausted any more. Tired? Sure, but at least I'm not falling asleep at the wheel on my way from home from work at 4:30 in the afternoon, like I once did. (uh, ya, I kept that from you for a *reason* ma!)

So, there you have it. I have made more interesting and informative updates, but this is all ya get this time.

much love;
Pinski
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6 Week Update - ...and doing pretty well !

2008-07-16T22:36:00.000-07:00

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Hey, Mom!

Things are coming along pretty well. I thought that since the Ouch Bars have been removed, things would really change a lot (especially in the eating department), but they actually haven't all that much.

I suppose it was an unrealistic expectation to think that I could miraculously start eating a lot of food that I couldn't eat before, but I have since learned that it's just going to take time before I can eat like a normal person.
Since our company from Ireland has been here for the past few days, we have been going out to eat a lot, but it took a few meals to realize what I should have already known. When I "bite off more than I can chew" (ar,ar!) I wind up bummed with a really sore jaw, and being that I'm a slow learner, I've done this more times than I care to admit.
Let me just say: I desperately miss double-bacon cheeseburgers, pizza and steak! Oh well, I'll live....

I know I've posted a series of "Before and After Pics", but I thought I'd just put some "Then and Now Pics" right here.

.......THEN..............

..........and NOW.

So, what do you think? Significant? Not? I'm still getting used to the different-looking me. I definately like my profile better (what with a chin now, and my nose it a little "tipped-up"), but from the front, I'm still trying to get used to it. My nose seems wider and I feel like my cheeks are chubbier, making my eyes seem sunken. I *do* like the fact that those deep smile lines on either side of my nose have softened. Some people say I look a little younger. Not as much as I'd like, but beggers can't be choosers!! :-)

Sleep continues to be great, although I don't think I'm having much luck transitioning in to a "nose breather" as opposed to a "mouth breather", like Dr. KL said I probably would. I still wake up with a very dry mouth most of the time which is just like it used to be.

Fortunately, I *think* I'm starting to get a little bit more feeling in the left side of my teeth which is enabling me to eat stuff a little bit easier. Still not EASY, but a little easier.

We have had a great time with Vince and David and I think they've really been enjoying San Francisco and the Bay Area. They'll be heading back to Ireland (via NYC) on Saturday and I will have one more week before returning to work on the 28th. Hopefully, they'll have fond memories of their vacation, and if they forget any part of it, they can refer to the 1,754 pictures they took!! :-) kidding...

Anyway, that's about it for now.

Much love:

Pinski

Week 5(ish). Goodbye Ouch Bars!!

2008-07-11T16:30:00.001-07:00

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Hi Mom!

Sorry I'm a little late with my weekly update, but I wanted to wait a few days so I could also include the good news that I got my Ouch Bars taken out today. Yay!

Before...................................After!! Ta-Dah!!

Actually, it was a pretty easy procedure. Other doctors actually consider it an out-patient surgical procedure, but this was done right in his office, using only novicane and it was really not bad at all. I did save a dose of pain meds for this occasion (previously okayed by the doc), so that may have made it even easier.

Daisy was there to help the good doctor and the whole procedure took less than a half an hour. In fact, it was even easier than getting a cavity filled.

Any way, the Ouch Bars are now out of my mouth, and I am allowed to start chewing soft foods, and not just soup, smoothies, yogurt and pulverized food from the Cuisinart. Alla-Louie!! This will be a big boost for my mental health, as I was getting really tired of my dietary limitations.

Before leaving, I asked if everyone in the office would pose for a quick pic for the bloggie, and even though a couple of the ladies deemed it "a bad hair day", I convinced them that it's only going to be in my blog, and not in People magazine....so they reluctantly agreed.

Left to Right: Linda, Daisy, Moi', Juanita and Dr Li. (A fine lookin' bunch, they are!)

So, I was 193 lbs. on surgery day, and now I'm at 178. (down 15#). I'm hoping to only gain about 5 pounds back, so I have a bit of eating to do! I figure 183 lbs. is a good weight for me.

Also, after I return to work on the 28th, I'll definately start going to the gym again, since I've gotten a little"soft".

I talked to my boss the other day, and he let me know that when I come back to work,

I don't necessarily have to "hit the ground running" and can take a little time to re-acclimate. That's a good thing, since I'll have been away for 7 weeks. Wow. Time flies.

Tomorrow, our friends from Ireland (Dave and Vince) will be visiting for the week and staying with us for a few nights, so we will take them to see all the sights (Golden Gate Bridge, Chinatown, Union Square, Fishermans Warf, Golden Gate Park etc.) and we are even going to go to the Monterey Bay Aquarium on a day trip. I've not done a whole lot in the past 5 weeks (other than some semi-long walks, and re-finishing this table:-),

...so it will be a good way to start building my stamina so it won't be so tough getting back to work.

I'm going to hold-off on this weeks "Before and After" pics because I'm really not looking any different from last week, but I will post some next week for sure.

Lastly, my sleeping (the whole reason I've gone through all of this) has been fantastic. I am so rested, have been sleeping quietly. and feel like even though there's been some rough spots, it's been totally worth it.

Well, that's about it for now, so toodles!!

love always;

Pinski

1 Month Update; Time continues to fly!

2008-07-02T07:45:00.000-07:00

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Hey Mom;

Wow !! It's hard to believe that a month ago today, I went under the knife for my MMA/GA operation. In some ways, it seems like it happened months ago, and in other ways it feels like it was only last week. Would I do it again? Yes, I would. This whole experience has come with a lot of challenges, but all in all, I think it has benefitted me a lot.

Of course, I wasn't too crazy about having to go in for "ICU Part Deux", but that couldn't be avoided. I guess that's what makes me "unique".

I won't be able to really know HOW MUCH I've benefitted until I do another sleep study (which won't be for another 2 months), but Paul has said I am sleeping as quiet as a mouse (and this is while sleeping on my back, which is amazing!) , I continue breathing, and no more gasping!
Also, I used to be able to nap in the afternoons (when given the opportunity) quite easily, and now napping is not as easy as it used to be. I think that's because I get a much better and restful sleep at night now and don't need the naps as much.

However, I still have a long way to go. Especially in the "getting the feeling in my mouth and chin back" department.
After the first surgery 4 weeks ago, I was able to feel much of my chin still, most of my pallet (the "roof of my mouth"), and most of my teeth on both sides, but after the 2nd surgery, my chin is tingly but much more numb, my pallet has nearly no feeling yet, the teeth on my left side have nearly no feeling as well, and the teeth on my right side have very little feeling. I'm sure that with time, I will gain more feeling in my chin, pallet and teeth, although I know it will probably take quite a bit more time.

At this point, (as I have mentioned before), I'm really getting tired of the liquid diet I'm on and can't wait to start nibbling on soft foods.
Fortunately, last night Paul and I sat down to our first real dinner at the table in over a month.
On the menu was crab-stuffed salmon, creamed corn, and a nice ripe sliced avocado with italian dressing on it. All with no chewing required. It was really representative of things starting to "get back to normal".

Pain-wise, there's not that much now. Just a lot of "tightness".... as if my teeth and jaw were in a vice. I went ahead and took the pain meds for possibly longer than I needed to. There were a few times when I missed taking the pain meds on time, and it was quite uncomfortable, so that's why I continued with them.

I'm still getting used to my new look. I do like my new profile. I have more of a chin now (yay!), and my nose is "tipped-up" just a litle bit. From the front is a different story. My right cheek is still a little bit swollen on the right side, so becasue of that, my eye loooks a little "sunken" and my nose seems wider than it used to be. Also, the crevices on either side of my nose have lessened and I'm told I look a little bit younger. Hmm.

I stopped by work on my way home from my last Dr KL appointment and those who saw me said they thought "I look different". Not having facial hair probably contributes to the "looking different" as well, but I think the overall change is fairly subtle.

So lastly, I've update the "Before and After Pics" page with more photos, but I don't think you'll notice too much of a signifigant change from last weeks pics. Maybe a little less swelling.

Well, that's about it for now. Thanks for al the e-mails and care packages throughout all of this. It's really helped. Have a great 4th of July!!

much love;

Pinski

Week 3. Improving Slowly but Surely

2008-06-25T12:03:00.000-07:00

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Yo Mama!

How's everything going in your neck of the woods? It was great hearing from you the other day and I'm glad to hear everyone is doing well.
Earlier this week, Pauls mom RoseMarie and Alex came up to S.F. for a long weekend and dropped in to see us. They also went up to Petaluma to see RM's sister Nanette and her family.

While they were here, we went out for a couple of meals, which was a little bittersweet. Don't get me wrong, I LOVE them to bits, but watching them eating hash browns and sausage one day, and caeser salad and fish and chips the next kind of bummed me out a little, since all I could really eat were poached eggs, cream of wheat, part of a mushy pancake and really mashed potatos. (not in the same meal, mind you) Pity party for Pinski!! Actually, at dinner I ate some light extra-flakey fish that required no chewing, so that was quite scrummy.

I know. The day will come when I will finally be able to start eating soft foods. In fact, I'm slated for my Ouch Bar removal on July 11th, so mark your calendar! After that, look out!
Dr KL will remove them in his office while I'm under "twilight sedation", which means for me I'll be out cold and won't remember a damned thing. Can you say "Cheap Date"?
No bother!! I like it like that!!

UPDATE!!: I have been informed that the Ouch Bar removal process is not one utilizing "twilight sedation". I assumed it was, but apparently it's just a matter of getting shot-up with a lot of novicaine. I'm hoping he'll throw in a little nitrus oxide just to make it more fun, but I guess I won't know till it happens.

Well, it's Week 3 and like the subject line says, I'm improving "slowly but surely". I've updated the "Before" and "After" Pics page with Week 3 (Day 21) pics, so make sure to check it out.

BTW, here is a candid shot of MY "Ouch Bars" that Paul took this morning. They are woven with wire around my teeth (not bolted or screwed in to my jaw), so it should be a pretty easy procedure taking them off. I won't miss them. No sirree. Right now, each of those little silver things sticking out (where the rubber bands can attach) are embedded in to my lip, and although there are no sharp edges, they are still rather uncomfortable. I know I could use wax, but it's REALLY not that bad....but with a little more than 2 weeks before their removal, it wouldn't surprise me if I eventually break out the wax.

Attractive, aren't they?? As you can see on the right, there are rubber bands from the top to the bottom. They are only on the right because we are at the stage of "fine tuning" my bite before the Ouch Bars come off. Dr KL said that he will be removing the rubber bands all together on Monday, which is great because it's not really the Ouch Bars themselves that cause the Ouch. It's really the pressure from the rubber bands. My bite feels pretty good, but honestly, it's still so hard to tell because of all the numbness that I still have.
I really can't feel any of my teeth on the left side. The right side is better but not 100%. Also, my chin (from the Genioglossus) is still numb but it starting to get tingly, so that indicates that the feeling is slowly returning. Unfortunately, shaving is a huge pain in the *ss. Shaving my chin is especially difficult and weird. Almost like it's not actually MY chin that I'm shaving.

The nasal infection that I reported last week is getting better by the day, but still not completely gone. Still taking the antibiotics for that for a few more days. Eeeuu. That whole thing was uber-gross.

Also, the popping in my ears is still happening. Dr KL said this will eventually subside, but for now, it's still kind of strange and a bit annoying.

Pain-wise, I've reached a point where I'm starting to lessen the dosage of my pain meds. Sometimes I'm okay, and other times...not so much. I'm going to have to ask Dr. KL his opinion on how to wein myself down from my pain meds "gracefully". Unfortunately, I'm almost out of meds, so I'll have to see weather one last prescription is in order or if it's time to just suck-it-up and bite the bullet with stuff like Tylenol etc...

On the food front, I have not been eating much soup becasue I'm sick of it. Almost in all forms (except for maybe the ones with bacon in it:-). I have blended the chunky style soups, noodle soups and any other kind of soup you can imagine. Now, I'm just primarily drinking the protein shakes with any kind of fruits I can think of. Yesterday, I broke out the Mini Cuisinart and pulverized some delicious chicken chow mein, (and removing some of the vegetables that didn't get pulverized enough). With a little soy sauce, it was really really good. (both taste-wise as well as for my mental health!) I am still not supposed to chew anything (and I'm not) but just by putting the mushy stuff in my mouth and leaving it there for a few seconds before swallowing it, was still really nice.

Lastly, I think Paul is doing better. I was a little worried about him - especially after what I refer to as "The Stanford Bleed-Out" incident, but I think things are getting back to normal, and I don't think he's permanently traumatized over that now. Poor Boopie. Who'd have thought that in only 6 years, he'd have to go through, 2 elbow scoping operations, 1 hospitalization for a bowel obstruction, and 2 (MMA/GA-related) surgeries. I'm glad he hasn't ran for the hills. Apparently he still likes me enough to stick around, so I consider myself very, very lucky.

So, I think I'll close for now. Not the most clever letter I've written, but I just wanted to keep you updated on what's been going on.

All my love;
Pinski
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Wowzers! 2 weeks fly by when you're having fun!!

2008-06-18T09:27:00.000-07:00

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Hi Mom;

I can hardly believe it's been 2 weeks since my MMA/GA surgery. I've decided that other surgery at day 7 or whatever doesn't count as anything but a followup procedure (reserved for only me;-)

It's a little tough being able to tell how I'm feeling "in general". Right now, it pretty much depends on what time of the day you ask me. At times, I feel like a million bucks and seem like everything is right on track. At other times, I feel kind of crappy. I really wish I were feeling fantastic all the time, but realistically, the crappy times eventually pass and I'm back to feeling good again.

In general, (like many other people at the same point of their recovery) I feel like my mouth is in a vice, under a great amount of pressure.
My pallet is still quite numb and it feels like I'm wearing my orthodontic retainer all the time.
Luckily, I was given these neat little stiff-spongy things (they look like a lollypop from a distance) and by trimming them down, I am able to clean a good amount of my teeth and tongue. I still can't feel many of my teeth either, but just knowing I've cleansed them and rinsed them as good as I can for now, makes me vewy-vewy happy.

After Monday's followup appointment at Dr. KL's, I seemed to be doing pretty well, but by the end of the day, both of my sinuses were not clearing out very well. I had also been experiencing really bad (but infrequent) headaches, and an occasional bout of reflux. Not fun. He let me know that the oxycodone he prescribed didn't have Tylenol in it, so to buy some of the liquid kind when my head started to hurt. I also asked him about pain management. Seems the oxycodone works pretty well most of the time, but since I take 2 tsp. every 4 hours, there are times when halfway in to hour 3 that the pain starts to return. Dr KL suggested I take 1 tsp. every 2 hours, in order to keep a steadier stream of meds.

Later that day (towards the evening), I could tell there was something "not quite right" with my sinuses, not only because they weren't clearing out easily like they did before, but they seemed to be emitting a rather unpleasant smell as well. I also started having a tough time swallowing.

Realizing that my sinuses have been through a lot, (the left one having a breathing tube put in it for each of the surgeries, and the right one being "slightly deviated" and repaired during the first surgery), I thought about the possibility of a nasal infection. Especially because of that new and quite unpleasant smell. Also, the contents of both sinuses were now the same and also new. I won't describe it, other than to say....kinda brown, flemmy and smelly. Dr KL is out of town, but told me to call him if anything came up. I sent him an e-mail that said "NON-EMERGENCY question" in the subject line, and proceeded to describe my newest issue.

He called about an hour or 2 later, and told me that I should have called him, but I told him that I wasn't sure if this issue was really THAT critical, and that I decided I could wait as long as it was going to take. He understood and then asked me for my pharmacy's number, to prescribe some anti-biotics. Apparently my description led him to think I indeed do have a sinus/nasal infection.

I got that filled today and started taking it. I hope it starts working. I also have a 99.7 temperature. Not high enough to be alarmed about, but definately worth keeping an eye on.

So, I guess I'm just in a holding pattern, trying to behave myself by not overdoing anything, and just trying to take as good of care of myself as I can.

I updated the Before" and "After" Pics for you to check out too. Now that I look at the Day 7 pics, I think there is more swelling in my right cheek today. My guess is that he has something to do with that nasal/sinus infection. Paul thinks the swelling in my cheek has actually gone down a little bit in the last 4 days. At first I looked like I had a half-of-a-tennis ball stuck in my cheek, but today it only looks like 1/3.

So, there you have it! I hope you and dad had a good weekend, and it was a Happy Fathers Day for him. He's the best, isn't he?

love to everyone:
Pinski

ICU Part Deux: (An addendum that doesn't really count)

2008-06-14T09:40:00.000-07:00

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Dear Mama;

Sorry I've been out of touch "blog-wise" for the past few days, but that's what happens when they throw you back in to the hospital again. d-OH!!

DISCLAIMER:

First, I have to say (and I'll explain why a little later), this doesn't happen to everyone. In fact, I'm not sure it's happened to anyone, but unfortunately it did happen to me.

That's why I'm titling this with the key word ADDENDUM in it, because it's like a sidenote. I really doubt that anybody who has an MMA/GA procedure would have to anticipate something like this happening to them. ...and by the way. Dr. KL said this is the first time (in all the hundreds of surgeries he's done) that he's seen something like this too.

Secondly: This blog is gonna be gross. No way around it, because that's how it was. ...but I know you're tough, mom!! (Although I must admit, I'm glad you weren't here for this one)

Lastly: For as bad as this may seem, other than feeling robbed of 3 days of my exceedingly- exciting life, I feel like the whole experience looked worse than it really was.

So, a brief recap: Remember how on day 6, I started to bleed profusely on and off for no apparent reason?

<from a couple of blogs ago>
So, then he said that if I start bleeding like that again, he will want to admit me to the hospital and go in to see why it's happening, because he hasn't seen that happen before. So, I've decided that I dont want to go back to the hospital, so I am on EXTREME "I'M NOT GOING BACK TO THE HOSPITAL" ALERT. Meaning. I'm not going to much of anything for now. Well, at least I'm really going to try.

Well, so much for that plan.

All was well on Wednesday. Things were looking good. Practically sunshine, lollypops and rainbows. I was taking it REALLY easy, and around 9 p.m. we were just about ready to finish watching this really bad movie when I realized it was time for my pain meds. So, I walked to the kitchen, poured them in to the little cup, tilted my head back and BAM!! Gushing blood again!!!

I kind of wimpered (I actually felt like crying becasue I knew what was in store) and yelled for Paul to come in and to get me some ice (since we'd been through this before) and it didn't take all that long to get things under control.

At first, I didn't want to call Dr KL on his cell and tell him about it, (thinking it was just another one-time fluke), but since it was actually the third time it had happened, I decided I would be a total dumb-ass not to call him.

He answered immediately, I told him what had just happened, and told us he'd call us back, but to get ready to come back to Stanford. Within minutes, he called back and told us where to meet him. (On the same non-ICU ward where I had stayed previously). He would set me up with a room for the night and go in and see what was up the next morning.

So, we got there, and Dr KL was (of course) already there. They got my room squared away, and he said he'd be back bright and early. I went in to the restroom to pee, and as soon as I tilted my head down, BAM AGAIN!! Again, I yelled for Paul to go catch Dr KL and asked the nurses to get me ice and a bucket. Unfortunately, this time I couldn't get the bleeding to stop. I don't know if it was because when I ice with pressure, I have to switch off arms, and this time they weren't letting me do that becasue they had put the blood pressure cuff around my left arm or why that was.

Dr. KL was back by then and was looking all around trying to see where all the blood was coming from, but he couldn't pinpoint it just by looking. I was trying not to choke because it was coagulating too quickly before I could spit it out, and it was sticking to the rubber bands that were attached to my "ouch bars".

I eventually got the bleeding to stop. ....and then it started again. And that happened several times, again and again. Then, it just didn't stop. By that time Dr KL was on the phone to Dr B the anesthesiologist to ask him to come in then, and Paul was on the sidelines, very quite and as white as a ghost. I told him to split, knowing what he'd been through the past couple of days, assuring him I was in the best of hands, and he did take my advice.

There were a lot of nurses trying to take off my clothes and get me in a gown, while I'm holding this bucket full of blood, spitting out coagulated glob upon coagulate glob. It was really pretty disgusting.

FINALLY, they got me on the rolling bed, and wheeled me up for emergency surgery.

Unfortunately, because of how "last moment" all of this was, the emergency room team was asking about all kinds of paperwork, (even a doc that I needed to sign) and it was a little bit chaotic. They seemed ready for me, but not "officially" ready until all the "I"'s were dotted and the "T"'s were crossed.

...but can I just say this: Dr KL is probably the most caring and incredible doctor I have ever had to privledge to meet. I am certain that there is absolutely no better doctor I could have had, and no way all of this could have happened in such a timely and professional manner, had it not been for his do-diligence. He kept his cool, got done what needed to be done and after a rather awkard (probably 30 minutes) of just waiting for everything to happen, finally wheeled me in for the surgery. 3 cheers for Dr Kasey Li!

Hip-hip Hooray! Hip-hip-Hooray! Hip-Hip- Hooray!!

One thing I forgot to mention to the doctor (and I'm sure you will remember this, mom) because I really didn't make a connection until then, and that was: Remember back in 93' when I had my (out-patient) UPPP surgery and you came out here to help take care of me? The surgery went well, but after 5 hours back at home, I still couldn't stop spitting up blood?......and the doctor made us drive (actually, I drove on liquid Vicadin and you held the spit-bag and tried not to fall apart) to Burlingame to re-operate on me?....and that doctor had mentioned that never in all the surgeries had he previously done, had this ever happened before? Sound familiar?

Anyway.......

Crap. So, I wake up yet again in the ICU. I felt okay. Turns out, that Dr. KL didn't really find any specific place from which I was bleeding profusely, so he went in and cauterized as much as he could. Just on the top, since that's where all the bleeding was coming from.

Later that morning, he told me that he'd decided we'd better have hematologists check me out to see if there's something wrong with me in the blood clotting (or in this case blood not-clotting) department.

That morning, I was given 2 units of blood. Did I mention I bled alot? Oh, right. I think I did.

The ICU is a nice place. I like the peeps there. My first ICU nurse Jason was a really nice guy and a really good caregiver. This time, the nurse I had for the longest aount of time was Kim B. Great nurse as well, and such a happy disposition. She said I cracked her up, especially when each hematologist came in and started asking me the same questions over and over. Hello!! Compare notes people! I'm surprised anybody could even understand me at all because my voice sounded really bad. Actually it still does, so I'm not saying much today. They also drew blood in order to test it.

Oh, and get this: I have no idea how, or when or where it happened, but when I woke in the ICU, the top of my left foot hurt. ?? HUH?? Like it had a cramp in it or something. Well, throughout the course of the next 2 days, it's gotten a lot worse. Swelling. Pain spreading. Gawd!! It hurts WAY more than my stupid jaw at this point! ... and nobody knows why! What a hoot!

...but IMO, it's kind of cool, because it shifts the focus from my jaw, elsewhere.
What a sight! I'm hobbling around like a gimp, and my voice is as raspy as Tom Waitts!

Unfortunately, I can tell a lot of differences with my mouth and jaw between after the first and after the second surgery.
Now, my top teeth are even more numb than they were, my pallet (a.k.a "the roof of my mouth") has a lot less feeling and my ears are really popping a lot. Oh well. It's still not all that terrible.

Finally, after almost a full 24 hours of the ICU, I was moved back to the C2 Unit at about 1 a.m. to the very same room I had the first time, but this time I had the bed by the window. It was nice seeing all the familiar faces. I almost felt like Norm from Cheers. (well, not really, but you know....) .

Then, that morning was Friday the 13th. Go figure.... Dr KL had been in and out so many times to check on me that by that time, I had lost track. He had come in early that morning and said that I was doing well, and if Hematology agreed, he'd like to let me go home later that day. Unfortunately, he hadn't heard a squeak out of the Hematology people, so we needed to wait until they gave the okay. Paul was there and our hopes were up that I would be going home, but The Hema-peeps never contacted him...or me...or anybody. Finally Dr KL paged them and contacted them on the (I think) 4th page. (Glad THEY weren't my surgeon!!)
It turns out that even though I had some irregular "levels" in my bloodwork, they didn't want to prescribe anything for me, but wanted me to stay another night just to make sure it wasn't going to happen again. GAWWWW!! So close.

Oh! ONE good thing about that Friday the 13th! I did have my first poo!

...but I digress. Anyway, Paul headed home and I settled in (with icebags on my foot) for another night in the big house.

......and today, they finally let me out!! Yay!!
This is Nurse Laura, removing my last I.V.

So, we're home now. I'm relaxing, sipping on pureed bean with bacon soup and thought I'd drop you this little (HA!) note.

Also, it looks like I've lost about 15 pounds all-tolled. In my humble opinion, I had 10 too many to start with, so I'm *feeling* like I'm only 5 pounds down. I'll try to make it back up, and I'm sure I eventually will.

Don't worry mama. I'm fine, and Paulie (as usual) is taking good care of me. Bless his little thumper.

much love;
xoxoxo
Pinski

This just in..

2008-06-11T17:47:00.000-07:00

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....from The Department of Redundancy Department:

Nice people are so nice!!!!

Hi Mama!

Writing again so soon, you may ask? Well, ya.... Especially when it's either this or getting in trouble for talking!!

Anywaze, upon waking from a quite-overdue nap, Paul had just returned from being out (having Coffee at our groovy neighborhood Starbucks)

"I have presents!" he informed me.

AAAhhhh. Beautiful flowers!.....from my barista friends at Starbucks! They are just so thoughtful. This also includes my pal from work Jen, and my "mo" friends in Ireland, Vince and Dave, who have also sent me flowers.

So, being the shutterbug I've become lately, I thought it was time for yet another photo-op.

[Left to Right]: Me, The Bunch from the Starbucks ...<---->....Ted modeling the flowers from Jen
Bunch, then Jen, and then Vince and Dave.

Also, speaking of pix!
As my swelling goes down and there's some change, I'll be updating my "Before" and "After" Pics, page, so refer to that page in the archives to see them!!

who loves you mama??

xoxo:
Your Sonny, Pinsk.

Day 6 (a,k.a "The toughest day so far")

2008-06-11T09:23:00.000-07:00

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Dear Mom;

Woo! I wanted to make sure yesterday was REALLY over before telling you about it.

Not the best day I have had, to say the least.

Things were going along pretty well up until then. Hadn't really gotten much "quality sleep" because of my nasal challenges. That is, the deviation on the right side was fixed and is still healing, and the left side kept being stuffy because the breathing tube went down that side, so breathing out of my mouth dried out my mouth so bad and I couldn't sleep.

Pain has been managed pretty well, but it's definately there.

So, after the "Non-Eventful" doctor appointment, I figured things would just continue to progress slowly (i.e. "Status Quo").

Went to bed Monday night, and really started sleeping well for the first time. There's some progress!
Okay, so my alarm startles me awake at 1 a.m. (as not to miss my pain meds and antibiotics) and the startling makes my chin hurt. Hmm. Not as "dead" as I thought it was. Even though the Genioglossus pretty much nummed everything out, I'm feeling *something*, so I guess that was good. I also noticed that the rubber bands, used to "re-rubber band" my "Arch bars" were WAY TIGHTER, and because my bite isn't evened out yet, the place where (only) 2 of my teeth touched, was quite sore as well.

By the way, when you wrote back and referred to them as "ouch bars", I decided that term had to stick.... Thanks, Ma!

Anyway, took the meds, went to the bathroom and set the alarm for 4 more hours out, and was back in dreamland before I knew it. By the way, oxycodone works great for pain, but ever since I've been taking it, my usually "fun and interesting dreams", have been....well. STUPID

...but I digress. Fast-forward to 5 hours later. The alarm goes off. I get up and walk to the kitchen, take my liquid pain meds, and wash it down with a couple gulps of water. Then, I start walking to the bathroom, and suddenly OUT OF NOWHERE, I feel blood literally GUSHING down my front teeth (from the inside insision - above my top teeth, not from my nose). This was not a trickle which really startled and worried me..

In the bathroom, it was like a scene from a gory movie. Blood, blood and more blood. Blood tastes gross, and it coagulates rather quickly. It's consistency reminded me of blackberry Jello...only warmer...and grosser.
I finally rushed to the bedroom and told Paul that I was bleeding really badly.
Poor him. Waking up to his boyfie all panicked and covered in blood.....
We got some ice out, leaned my head back and applied pressure, which started to slow
down the bleeding fairly quickly. Realizing this was a legit emergency, we called Dr KL's office and left a message, plus I sent him an e-mail asking him to call me as soon as he could (It was 5:30am at that time).

Luckily, the bleeding finally stopped, I rinsed out my mouth really well with saline stuff, and layed back down on the bed. Soon there after, Dr KL called. His advice was pretty much what I had already done (ice with pressure), that I *might* have broken a stitch, and said I should come in to see him later that day and to call him on his cell next time there's an emergency like this. I didn't have that number, but I do now!!

At about 1 in the afternoon, I called Dr KL's office and explained to Daisy that I wanted to make an appointment to see the doc. She said she would call me right back. So, in the meantime, I walked over to the washing machine, and leaned over to take stuff out and BAM! I felt the pressure "break", and the blood started GUSHING again. This time, a little worse. So, more pressure, ice and it eventually stopped. This time, I handled it, and Paul just kind of stood there in horror.
Dr. KL called back RIGHT THEN, and I told him it just happened again.
So, I scheduled the appointment to go down there later that afternoon.

Okay, so let me say as a sidenote. I could be a better patient. BUT I AM TRYING!!! One of my big goals was not to be over-needy and to start doing stuff for myself as soon as I could, so it wasn't too overwhelming for my caregiver (P.Smitty). Well, it turns out I've been frustrating him (i.e. p*ss*ng him off) because when I get bored I'll wash the few dishes in the sink, or throw in a load of laundry, instead of resting. I'd love to sleep, but I just can't...and I get bored!!...and he doesn't see that as being a good patient. So, I went from one extreme (needy) to another (too self-sufficient).

I say this because I really don't see these bleeding-out episodes as being caused by the fact that I am a bad patient. Sure, bending over to get laundry out of the washer provoked the second episode, but I honestly can't think of why it happened the first time. It just did.

We got there before the good doc, so Daisy had a look. I told her how tight the rubber bands on the "ouch bars" were, and she said that might be part of the cause but it was too tough to really tell. Daisy decided that since it was hurting too much, she sould wait for the doc to get there, which he finally did.

First, he cleaned out the coagulated blood stuff from the rubberbands, removed the wax from in front of the "ouch bars", and then he took the ruber bands off. After looking around he could not tell where the bleeding was coming from. (huh????) I told him exactly where that was, but he said the icing and pressure must've stopped it up enough to not be able to tell now.
Then, he put on rubber bands that weren't as stiff, took out a few little boogs in my nose, and replaced the wax in just one little part on the bottom jaw.

So, then he said that if I start bleeding like that again, he will want to admit me to the hospital and go in to see why it's happening, because he hasn't seen that happen before. So, I've decided that I dont want to go back to the hospital, so I am on EXTREME "I'M NOT GOING BACK TO THE HOSPITAL" ALERT. Meaning. I'm not going to much of anything for now. Well, at least I'm really going to try.

Paul had had enough blood and guts for a day, so after we got home, and we got some meds and a protein shake in me, he left for Starbucks and promised to swing by The Cove to get me mashed potatoes and white gravy. I made sure to make the potatos really runny, but I still focused mostly on the gravy!

This was definately the toughest day so far.....so now, they can only get better, right??

Dudette'. I do NOT want to go back to the hospital.

I'll keep you posted. ...but so far, so good!

with love;
Pinski

P.S. ..and I thought *I* had problems! Check out what Premium Unleaded costs at the Chevron station across the street from our apartment. Oy!! I'm glad we have a really little car!

A Rather Non-Eventful Dr KL Appointment

2008-06-09T16:04:00.000-07:00

Hi Mom:

Greetings from Captain Cow-Breath! Moooo! ....or is that E-w-w-w-w?

Well, I'm feeling a lot better since this morning's "pain aversion therapy session".
After taking my pain meds, I was able to crash for another un-interrupted couple of hours, which was exactly what I needed. Haven't had much success since then, but I'll keep trying until I get it right.

We *just* got back from Dr KL's office. Since it is in Palo Alto (and we are in San Francisco) it's always a little hard to judge how much driving time to allow for.
Fortunately, we left an hour before the appointment, and we got there in about 45 minutes. Just about right.

After Daisy took 3 different x-rays, Dr KL came in, cleared out the few boogs in my nose (while I sung the praises of the Neti Pot) and changed-out the rubber bands in my archbars. Remember my telling you about getting flack for talking too much the other day? Well, Dr KL said that often times he can tell how much someone has been jabbering because their arch-bar rubber bands will break -- and I am happy to report that none of mine have done that. So there!!

Then, he showed me the before and after x-rays, and promised to e-mail me the x-ray so I can post it here in the near future. Huh! Nearer than I thought!!

........BEFORE MMA/GA

.........AFTER MMA/GA..............

I was especially pleased with how much of an air passage I have now! Considering what he had to work with (meaning, such a thin upper jaw bone and all the fixed bridges right where they didn't need to be), I am really really pleased with the progress so far. Yay! I have high hopes that my sleep experience will only get better now.

He also answered a few questions I had. Like:
Why are my ears poppoing so much? Turns out the internal "guage" that senses altitudes and makes your ears to that, is very close to where I was operated on, so it is very sensative right now, but will eventually stop. Makes sense!
When can I start brushing my teeth? (See intro) For now, i am only allowed to brush the front part of the teeth I can easily see, (not the back, behind the rubber bands) and stay away...far away from brushing the gums. I'll have to stick with mouthwash or saline solution for a while longer.
How Long before my stiches start to dissolve? Around 10 days.
Is all this brusing I have normal? Yes.

....I'm actually feeling much better than this grumpy look I have on my face!

Unfortunately, it might be worse before it gets better, but I got time. I can't recall planning any upcoming super-model photo-shoots, so I'm good. ;-)

In all, a fairly non-eventful appointment. If I have any problems, I can go in on Thursday or Friday to see him, but if not, I'm scheduled for another appointment next Monday.

Lastly, please humor me while I tell you something you already know.
Paul is a saint. I am often times a crappy patient, and he's stil just the best. We snap a little bit at each other now and then, but I know I couldn't have done this without him.

So, at the expense of sending out a "For all you do....This Bud's for You!" message (which wouldn't seem appropriate because neither of us drink), I just had to throw that in, and just let you (and especially him) know that I love him and DON'T take him for granted.

...and I love you too, mama!

xoxo:
Pinski

P.S. And these are the OTHER ones in the house who always manage to put a smile on my face, weather I'm feeling like it or not!
(l to r) : Raster and Ted.

4:00 a.m. letter to me mum....

2008-06-09T04:09:00.000-07:00

'ello Mumzie!

...er, I mean, Hey Mom.! (Yes, I know I'm not British...it's just fun saying that)

Ugh. Where to start. It's 4 a.m., I have an hour until my next round of pain meds and things are pretty uncomfortable right now. Nothing I can't handle, but you know how sometimes it just helps to "talk" to divert your attention elsewhere?

I've crushed up 3 asprins, and mixed them with warm water (yuck), so that's going to have to do for now. Why the asprin? It's the arch-bars. But more about that in a minute...

Okay, first things first. Lots of comments about the "before/after" pics. Let me just say that it's *entirely* too soon to know how my mug is going to turn out, and no, I haven't entered the "Witness Protection Program".
Will my nose be different? Will my face look longer? At this point, that is THE LAST THING I'm concerned about!!...although while out for a little walk last night, Paul and I were sitting near Starbucks with a couple of friends, and one of them said to Paul: "So this must be your boyfriends brother, eh'?" To Which Paul replied: "Nope. It's the boyfriend." Strange that I don't look like myself right now. It's like having aninimity that I don't really need!

Yesterday, I had a couple of issues to address that had been pressing.
The first was a solution for icing my face. For me, those "stockings" the hospital provided are not that great. Between the paper-lined ice "envelopes" and the stocking itself, there was little if any cooling action going on. So, I went to Walgreens and bought a box of the "double zip-lock (quart sized) storage baggies and a big ole' bag of ice.
At home, I used a nice, old, thin tea towel to wrap the well-sealed ice up and then used blue painters tape to secure everything, making sure there was only 1 layer of ziploc plastic and 1 layer of tea-towel between my cheek and the ice. Much cooler, thankyouverymuch. ...and I need to ice.
The second thing I really wanted to address was this stuffy nose of mine. When I went in to Dr KL's the day I got out of the hospital, he cleared out my nose and that was fantastic, but it gets cloggy again and again. I asked him if a neti pot might be a good idea, and he said yes. So, what is a "neti pot", you ask? It's a little gross but effective. Imagine a little tea pot filled with warm salene solution. Then, you tilt your head sideways over a sink and put the spout up to and in your upper nostril and pour the water. It goes though your sinuses and out the lower nostril, loosening and flushing out a lot of boogs and stuff that keep you from being able to breathe.
For a demo, check out this "Neti Pot YouTube demonstration" In this case, the relief, far outweighs the grossness level. It has really helped me sleep at night, by keeping my nose much clearer.

Another thing I needed to do (but wasn't *quite* as successful...yes, I know, I know Learian!) is to not talk so much. Paul allows me to talk a little, as long as my teeth stay together, making my jaw not move. You see, with the thin upper jaw bone and the bone graft Dr KL did to help make it more solid, it's not good to talk and open my jaw. Even though I am rubber-banded together, the pressure of talking kind-of "works against" what we're trying to accomplish. I promised I'd do better today, and even carry around my white-board if need-be.

Okay, so lets talk about why I'm writing you at 4 a.m. My archbars hurt! Don't get me wrong,
I'm glad I have enough feeling in my lower lip to even be able to *feel* pain, but I woke up today and felt like these danged things are *embedded* in to my lip. Glad I'm going to the Doctors today to have it looked at. He gave me wax, but I'm going to wait until I get there and let him dig around to see if the archbars are indeed hooked in to my lip, or if it just feels like it. It's hard to tell just by looking.
..and speaking of numbness, there is plenty of that. My chin is dead. Can't feel a thing, and shaving it yesterday was like shaving someone elses chin. My upper teeth, pallet, lips, cheeks and nose are a little bit numb, but my guess is that I'll get more feeling back *there* before I do in the chin area. Seems that area had the most nerves disturbed by the MMA/GA surgery.

Lastly, heartburn. I know,I'm talking about a lot of different "issues" this morning, but I'm just trying to deal with one at a time, when it comes up. So far, over-the-counter "Pepto" has been working just as good as the by-prescription Pepcid. Definately one of the most challenging aspects of all this, as of late.

....but I'm trying to be a trooper and just work though it. Okay, time for pain meds, and hopefully another couple hours of shut-eye.
Oh, pain killers, don't fail me now......

xoxo:
Pinski

"Before" and "After" Pics

2008-06-08T14:13:00.000-07:00

Before (with facial hair)

Before (without facial hair)

After - Day 3 (Post MMA/GA) Wow. My nose is so different right now.

Day 7 (Swelling has gone down a little bit)

Day 14. Left side looking better than the more-swollen right side.

Day 21. (Week 3) Still somewhat swollen on the right side

Day 28 (Week 4)-

Day 42 (Week 6) - Not too much swelling left

Welp. It's done!

2008-06-07T20:29:00.000-07:00

Hi Mama;

Holy Crap! I can't even begin to tell you what the past few days have been like.....but I'll try!

I hope I can be detailed enough. You see, since I've been on the pain meds Paul says I'm easily distracted, but I think he's full of -- HEY LOOK!! A CHICKEN!!

Okay, where to start: How about this:

DAY 1:

Up at 3:45 in order to get to Stanford at 5:30 for check in. Slept really crapily the night before, but I figured that didn't really matter.
Checked in and hung out in the pre-op area. Um, NO Karen Newburger robes!

Met Dr B my anesthesiologist. Very nice guy.

After asking all the typical questions and hooking up the main I.V., it was finally time to give me "a little something to relax me" and wheel me in to the operating room. Well, being such a "cheap date", I *barely* remember the operating room. I don't even remember seeing Dr. KL before "lights out".

This was taken after I was given "the little something"

.....and then I woke up. It was over. ...and that was that!! Oh Gawd. I've really done it now, I thought....

Paul said it was in the recovery room for longer than usual because they were looking for space in the ICU. After I finally got settled in, Paul was able to come in and see me.

I had the ice pack on and I think I was half in shock. Not that much pain at that time.

Dr KL came in and told me that everything went well. He was able to fix my slightly deviated septum, and he went with the Genioglossus Advancement instead of the Genioplasty.

I later learned that I unfortunately have a "thinner than usual" upper jaw bone, so the good doc had a little tougher time securing it after he advanced it (about 8mm.). Fortunately, he was able to take some of the bone from the Genioglossus Advancement and graft it to my top jaw in an attempt to make it stronger. I'm going to have to take it easy for awhile. In all, including my lower jaw advancement and the GA, the chin is out about 13mm. Not bad.

My ICU nurse's name was Jason. Totally cool guy and he stuck with me through almost the whole ICU experience and was there with morphine "every hour on the hour"!

Paul took a few pics of me when I got there. I was pretty out of it.

........my attempt at a little "ICU Humor".................................................

Not sure why, but I didn't sleep for one minute that first night. I think it was the morphine, in combination with the fact that my nose was totally clogged up. I couldn't breathe through it and I absolutely could not swallow AT ALL becuase of the breathing tube that was down my throat through the left nostril, and the deviated septum was fixed on the right nostril.

Day 2:

The next morning, I was put in a regular room. I had several nurses, and honestly, I was only impressed with one of them. But, love-love!

Dr KL came by a few times to check on me, cleared out my nose, and discussed the surgery .
I was concerened at first because my teeth seemed to only be meeting in one place (my incisers...clear over on the right), and started to feel rather uncomfortable. He assured me that my bite was fine. He adjusted the rubber bands on the archbars which seems to have helped.

I also opted to stay another day - mostly because I was really suffering from re-flux and heartburn, but was still in a fair amount of pain as well.

Day 3;

Anyway, We finaly checked me out of there this morning and headed over to Dr. KL's office to get a quick "nose clearing" and for him to check me out. We got home around noon, and I've just been taking it easy since then. Learian came by and brouht me a pitcher of home-made smoothie and to check up on me. I tell you...she has been so nice to us and has given us so much good advice. I don't know how we could every repay her for all she's done.

So, I'll download some before and after front and profile shots in my next bloggie.

There's still a good amount of swelling, but I figured it's time to put em' up here.

I hope you didn't worry too much. By now, I'm an old pro at these surgical procedures.

.....although I will admit. This was definately the most heavy-duty of them all up to this point.

who loves ya, Mama???

xoxo:
Pinski

The final countdown !! Surgery at 7:30a.m tomorrow.

2008-06-03T18:51:00.000-07:00

Hi Mom;

Well, it's the night before my MMA/GA surgery, and we're just about there! I hope I've dotted all my I's and crossed all my T's because it's getting down to the wire now. Tomorrow is the big day. Yikes!

List-wise, I think I did alright and have pretty-much everything I need (and then some!) for now.

On the food front, we were originally going to buy a lot of Ensure, Boost, Instant Breakfast and such, but after talking to a few people and doing a little bit of homework, I found (what I think) is a better solution. We went to a nutritional-suppliment-style shop and got some 900 calorie per serving protein drink (in both chocolate and vanilla) that has a better blend of vitamins, protein, carbohydrates, not too much fat and not too much sugar. We also got some powdered fiber stuff so I will poo.

For now, I'm not too worried about having a lot of soups around, although we did get several cans (to be blended if needed) and if we need anything else, Paul will go to the store (which is not far away). That way, it'll also give him a chance to get out of the house and have a break from moi'.

As far as "food accessories" goes, we have:
Mini Food Processor, Regular blender, one of those hand-held mixers with a bunch of attachments, a couple of those easy-squeeze ketchup bottles that I can use (by cutting the end off to make the hole in the top bigger) in addition to the feeding syringe I'll get from the hospital, a bunch of "bendy" straws (Thanks Shelby!), a strainer and a funnel.

For "non-food accessories", we have;
Ultra-Sonic Humidifier, 24 hour digital timer so I don't miss taking my pain meds on time, TV tray, lots of Burts Bees Honey lip balm and Smith's Rosebud Salve (courtesy of Learian), lots of Kleenex (for drooling;-), and a nice robe that I can also use at the hospital (unless they provide a better one).

Finally, the house has been cleaned (good advice I got from the sleepnet.com site), I called to make sure Juanita at Dr. KL's would be sending my disability paperwork out on time. I packed up most of the things in my office (since we will be moving out of our temporary digs and back to our permanent digs while I'm out), got all my loose ends at work neatly tied up and left my auto-replies in order to "pass the buck" on to someone who's actually there!

Good grief! I'm glad I made all those lists because there's no way in "H.E. double-toothpicks" I would have remembered all that!

Anything else that I forgot will have to be gotten by P.Smitty after the surgery....and speaking of Paul. Poor him. Like you :-), he's always been a bit of a worrier, so I'm trying to assure him that everything is going to be okay. Bless his little thumper. He's trying his best not to show his worry, but I can read him like a book!!

I'm also half-ready to jump out of my skin, though, but I'm working on trying to stay calm. I know it's "to be expected" , so it's nothing to get over-alarmed about. Luckily, I'm feeling good, no sniffles or sore back, so I think I'm in pretty good shape.

I hope you've enjoyed all of my communique's up until now. I think posting pix on the bloggie (like in the last entry) makes it more fun, so I'm looking forward to posting more pics.

..and speaking of pics! Paul and I went out for my last solid din-din tonight. We went to the Westfield Mall to the food court where I had Tri-tip, grilled vegetables and onion strings.

Before...................................................................................and AFTER!!!

mmm-mmm-good! Then it was one last small decaf at Starbucks and that's all she wrote!

....so wish me luck! I think it's all going to go fine, and I'll be sleeping like a normal person before you know it! Paul will call you as soon as he can (you're at the top of the phone tree), so keep your cell phone handy if you're not at home.

All my love;
xoxox
Pinski

It takes a village!

2008-05-27T08:42:00.000-07:00

Yo, Mama!

Hope this message reaches you in good spirits. Did you and dad have a decent Memorial Day Weekend? We did too although we didn't do a whole helluva lot. However, we *did* manage to squeeze in a very nice lunch with some MMA "alumni".

Before I tell you about that, I must say that sometimes it indeed *does* take a village.

You may ask: What do you mean by *that*, sonny?? Okay, I'll tell ya! When I got home from that first doctors appointment, and he had explained that I might need MMA surgery, I really didn't know a thing about it. Luckily, between Google and the internet, I was able to learn more than I could ever hope to know, all from my computer. Ain't technology great? As I mentioned, it first started with Rogers MMA blog, and then that led me to the sleepnet.com discussion forums. From there, there are also links to several different blogs (which I am proudly one of now) of other individuals and their personal MMA experiences.

....and I must say. You couldn't ask for a nicer and more helpful bunch of peeps. You have a question, and it gets answered.

Anyway, in reading the sleepnet site and blogs, I realized that there are quite a few "Bay Area" people amongst them, so I wrote to a couple of peeps individually, asking their advice and to ask if they would be willing to meet me for coffee (or lunch) to chat about MMA stuff in person.

The first person I contacted was "Learian", since it appeared she had such a "model" recovery.

Paul and I met she and her husband at Starbucks around the corner and had a really nice time. We both had a lot of questions (I as a patient, and Paul as a potential caregiver) and they were hella-helpful in answering our barrage of questions. We had such a nice time, that we met again for more coffee (Learian LOVES her cafe' mochas!) in Noe Valley a couple of weeks later.

There are a lot of great MMA blogs out there and a few of them are from the "Bay Area". One blogger ("Dreamette"..a.k.a Shelby) who is a clever and very funny writer, happens to live very close to The Emerald City (where I work), so I e-mailed her and invited her to lunch. Cool Chick!! We are also both big Morrissey (who by the way is a singer and lyracist) fans, and both of our boyfriends ARE NOT! Sheeesh!! I guess Morrissey is kind of like cilantro. You either REALLY like him a lot, or you REALLY don't like him at all!! To paraphrase:
Paul said : "Eh, I know him, and he cannot sing"
I said: "That's nothing - you should hear him play piano" ;-)
(Don't worry mama! I don't expect you to "get" that reference!)
Anywoo, she re-capped parts of her MMA journey and gave me some good advice about several post-op issues including pain management and great food possibilities....like warm cake!

Anyway, sorry to get sidetracked. So, it turns out Dreamette and Learian had always wanted to meet, but hadn't. Well, for as lovely and helpful as they both have been, I suggested the 3 of us (and our S.O's) all get together for lunch....so that's what we did last Sunday.

Learian's husband had a previous engagement, so she swung by our house "solo" and picked me and Paul up for the 20 minute trip, south to San Mateo. We met Shelby and Courtland at a nice restaurant and had a whale of a good time. I won't bore you with all the details (although it was anything BUT boring!), but we chatted for quite awhile, had a nice brunch, chatted some more, and then it was time for the photo-ops:

From Left to Right: Dreamette (a.k.a. Shelby), moi', and the lovely Learian!

Learian and Moi'...............................................................Shelby and Moi'

We're all pointing to where our little incisions are (or in my case "will be").

All in all, a fine time was had by all, and I sure hope it's not the last time we get together. I'm pretty sure it won't be, though!

It sure is nice to know that there are great people like that out there. Not just in the Bay Area but like I said: almost anyone you ask who's had MMA surgery.
I just hope that after I'm on "the other side" of my MMA surgery, that I can be as helpful to someone else as all of these folks have been to me.

The rest of the weekend was pretty non-eventful. Paul rented a movie that creeped me out, so I stopped watching it (I don't like seeing people getting tortured, but he just LOVES Diane Lane, so he opted to watch the rest of it [Untraceable] later).

Lastly, I stopped at Walgreens to get a small Dry-Erase board. I figured it'll probably come in pretty handy for the times when I have something to say, but still can't be understood.

"an euuu et nee a glsss um wada?", :-)

Poor Paulie! I'm sure he'll be okay! He just worries a lot! "no eely. m-mm fne!"

I also have some "before" pics, but they look more like mug shots, so I will refrain from posting them until after my surgery when there's some "after" mug-shots to go with em'!

xoxox:
Pinski

Pre-op Appointment with my awesome surgeon

2008-05-23T09:44:00.000-07:00

Dear Mom;

Sorry I haven't written lately. Things have been going really well. I’m trying start tying up all my loose-ends at work in preparation for the 6 ½ weeks off I’ll be taking…….IN LESS THAN 2 WEEKS!!!!

I was shocked to hear about the tornado yous guys had, and was relieved to hear that nobody was seriously injured. I bet it especially scared the be-jeebas out of Jane, since it hit so close to her house.

There really wasn’t that much to report up until recently, but yesterday was doublely-wubbuly eventful, what with my pre-op appointment with Dr KL and my teeth cleaning at Dr N’s! …and since you’re my mom, I knew you'd want to know all the gorey details, so all I gotta say is “watch what you wish for”!

So, I got up early yesterday (Thursday), shaved off my moustache and beard, (which sort-of disguises my "chin deficit".....awwww...) and left at 7, in order to make my 8 a.m. pre-op appointment with Dr KL. in Palo Alto. The whole experience at Dr KL's office is fantastic. The office is a beautiful facility, and the staff (Linda the receptionist, Juanita, the lady who handles all the insurance stuff, and Daisy the technician) are just the best. You would love them. They are all as nice as can be and very well-organized….but first things first:
After signing a couple of consent forms and giving Linda the biggest check I’ve ever written (gulk!), Daisy led me in to the room where I got a panoramic x-ray and some other type of x-ray, using a different machine. Then she took molds of my teeth. First the lower and then the upper. After all that stuff was done, Dr KL came in looking chipper and ready to explain everything, and answer my barrage of questions.
For starters, he brought in his "display skull" to show me exactly what he will be doing with my upper jaw, and lower jaw. Wow! The reality of it all is finally starting to set in.
He started by telling me that the anesthesiologist will be calling me the night before the surgery (not sure why, but great!). Since my surgery is at 7:30 in the morning, I have to get there at 5:30, which means Paulie and I will have to leave SF by 4:30 and get up at 3:45. (Yawn!)
As usual, no food before midnight. Got that.
The first thing he’ll do in the 5+ hour surgery is attach the arch bars, (but I think they are positioned higher than these on the link) and he explained how they will be attached to my teeth with wire by weaving the wire through my teeth, as opposed to using screws in my jaw to secure them)
After the arch bars are in place, and my teeth are tightly clamped together, he will “liberate (i.e. break-out the “buzz-saw” and “go-to-town” on) my upper and lower jaw, together from where they are. The upper jaw will be cut free first (sorry no video…I asked!) and then the lower jaw will be cut (i.e. “sliced” at an angle, in order for the bone to be able to fuse together). There will be a small incision on the (outside) lower part of either cheek in order for the good doc to sink a couple of screws in my lower jaw at just the right angle. Those will be the only external incisions, and the scars will end up being virtually unnoticable. Cool beans!
He will be doing what is technically called a “counter-clockwise rotation” moving my upper jaw forward 8-9 millimeters and the lower jaw about 12, meaning he’ll drop the back down just a little bit, to enable the lower teeth to move forward a few millimeters farther than the upper.
Then comes the genioglossus. I asked him why he usually chooses the genioglossus over the genioplasty and he said there are different reasons for doing each. He said he would determine which of the 2 procedures is best for me when he is in there, getting a better look. I trust he will do the right thing!

I mentioned to him that first and foremost, I want to be able to breathe better when I sleep, but I hope that asthetically, I will end up with a nice strong chin. He assured me I will be pleased with the outcome.
I also asked him about a possible chin implant, but he said that won’t be necessary and not a very good idea at that. Why? He showed me an x-ray of a patient with one who experienced “bone resorption”. Meaning, the patient had an implant that (over time) actually ate away at the chin bone….(euuuuu!)…so he removed it and did a genioplasty on the patient. Okay, okay! No chin implant already……;-)
So, since he will be moving my upper and lower jaws in unicin, my bite should remain relatively the same, meaning no braces for a third time. There will be numbness at first, but over several months, most of the feeling in my chin, pallet and teeth should (knock on wood) return.

Next, came the battery of questions from me:

Q1: What is the plan for pain management?
A. After a short discussion about my allergy to codine and the fact that vicadin sometimes doesn’t work well, he prescribed something else he thinks will work. He also gave me a keflex prescription to thwart away any infections - which he said was highly unlikely.

Q2: Does my bloodwork and EKG look okay, and will I have to bank my blood?
A: Yes to the bloodwork and EKG, and no to the banking blood.

Q3: Will he be addressing my deviated septum?
A: Possibly, depending on how high up in my nose it is. If it is low enough, yes. If not, no.

Q4: Will you take out my adnoids? (which by the way, I was shocked to hear they were still there because I was under the impression they were removed back when I had my UPPP surgery. ...but I hear they sometimes grow back, so I can't be sure what really happened)
A: No. Not at this time. He doesn’t want to complicate things and do too much.

Q5: What about that stupid stone in my salivary gland (that showed up in my x-ray)?
A: Nope. He said it might be a good idea to have the salivary gland and stone removed along with the adnoids… later.

I wish I would have asked him that if I promised to pee right before they put me under, could I skip the catheter….but I figured I already knew the answer to *that*.

Finally, he took a couple of pics of my teeth and smile, the appointment came to a finish, and on my way out, who do you think I saw? My buddy Learian!!! It's a small world, ain't it? As always, it was awesome seeing she and her hubbsband.
I had Daisy take a pic of me and the good doc, but my stupid camera always zaps the last pic when you take the SD card out of the camera ,(which happened to be the one with Dr.KL.. ANNOYING!) so I guess I’ll have to wait for the next photo-op.Which reminds me: I took some pics myself for you to check out, because in 2 weeks, your kid ain't gonna look quite the same any more. (awwww) I'll post those in a little while.

After that, it was back in the trusty Scion (I love that car!) and back up to The City to see my awesome dentist of 15+ years, Dr N. (I love ha!) to get my teeth cleaned...although she didn't actually have the honors..it was the new dental hygenist Zora. I wanted to get my "pearly off-whites" as clean as possible now, since they will probably be very grungy for awhile after the MMA and GA. Lovely! Looking forward to THAT! ;-) My 6 month cleaning was supposed to be in September, but I figured that I probably won't be able to open my mouth far enough to have it done then. Not a big fan of the teeth cleaning experience in general, though. That's because of the receding gums I was gifted with after my last round (as you recall, there have been two) of braces. Apparently my teeth moved too quickly and it caused my gums to recede. However, I managed to make it through all the scraping and polishing, so that was one more thing to strike off my "to-do" list.

Oh! And I also called Comcast to dump Showtime (now that Weeds is done) and signed up for Logo, so we can get the TV new series "Sordid Lives", which is based on my favorite movie of all time! It should be a hoot!!

So, there you have it. A day in the life of one of Americas Next MMA patients.

who loves ya, mama?!?
xoxo: Pinsk

The dreaded pre-op visit with my GP.

2008-05-05T13:57:00.000-07:00

Yo Mom!

This just in:

PRIMARY CARE PHYSICIAN ANNOYS PINSKI, BUT PINSKI (eventually) "RISES ABOVE".

Details at 11! ....or now!!

Okay, for starters let me say that for the most part, I really like my primary care physician, Dr. S. Well spoken, nice guy, very well educated, never tough to get an appointment, etc.....but when it comes to issues of sleep apnea, I'm not so sure.
As I mentioned before, I had to go to him to get orders for the EKG and bloodwork that I need for my MMA surgery (coming up in a little less than 4 weeks). The appointment was yesterday and I promised my friend Toni that I wouldn't "engage" with him when he started giving his professional opinion about sleep apnea (again). Lets just say, our opinions differ. You see, when he previously saw my sleep study from 05', and it said "moderate sleep apnea", he commented that my oxygen saturation "wasn't *that* bad" and not to worry about it. Okay, fine. Whatever.
So, this time he comes in, was very professional, asks me when I'm having surgery, and who the doctor is (not even asking what I was having done) Then he takes my blood pressure, listens to my heart and lungs, and illudes to asking what kind of surgeon Dr. KL is and where it's being done. I tell him Dr. KL is an oral-maxilfacial surgeon in Palo Alto and the surgery is going to be at Stanford. He says okay, and asks me if Dr. KL was going to do the Pre-op "write up" himself , explaining that there has to be a formal write-up to let the hospital and anesthesiologist know you are in good enough shape to have the surgery.
I tell him that the only thing that might be questionable is actually the whole reason *why* I'm having the surgery, my sleep apnea, and that I'm having a Maxillomandibular Advancement and a Genioglossus Advancement B-z-z-z-T! Shouldn't have even gone there, but really: How can you pass up a chance to say Genioglossus Advancement??
Without much expression except for a slight rise in his eyebrow, he looks at my sleep study and says (and I am para-phrasing) "Dr's are making too big of a deal out of sleep apnea."
I tell him "It says my sleep apnea is 'moderately severe' now, so that can't be good for my heart, long-term, right? Also, I wake myself up gasping, my partner worries I'm not going to start breathing again and die some day and I haven't been allowed to sleep on my back for the past 6 years because of all the snoring and gasping I do"
Then he says "It's not so much about your heart...what we should *really* worry about is if the oxygen saturation too low it can cause brain damage, but with your levels, it's still not that bad". Uh, WHAT???
I mention to him about my 25 RDI, and how I stop breathing for as long as 49 seconds some time and he tells me that he's a diver and he can hold his breath for over 3 minutes, "so if you're in good cardio shape, 49 seconds isn't that much".....and adds that If my RDI was in the 60's, he'd be a lot more worried. Hello??? So would I, but still.....
...and *then* he says "..but I guess you're having this done for 'the other reasons' (i.e. the noise, and trying to make my partner more 'at ease')". WTF??? So, I guess I need to have 60 episodes an hour and oxygen saturation levels low enough to cause BRAIN DAMAGE before gets onboard? Sorry Dr. S. The apnea train is a-leavin' without you!! Toot-toot!

At first, I started second-guessing myself, but soon realized that between my initial gut feeling about my apnea being a real problem and confirmation from *4* oral maxilfacial surgeons who specialize in sleep disorders, I just clammed up after that (a little late, but still not bad) "rose above", and let him say what he was going to say. He wished me good luck (which seemed patronizing, but I don't know...I guess it could have been genuine) and then got out of there.
I stopped at the desk to pay my deductable and he tells me "Come back either before the surgery or after you've healed so we can discuss your bloodwork". After I've healed??
I'm thinkin' "Okay, then I'll see you next year"
WhatEVERRRR Missy!!

So, even after all that, I'm still confident I'm doing the right thing.

Then, it was downhill from there. The EKG was a breeze, and getting my blood taken was easy, and Dr. KL will have the results FAXed to him early next week, in plenty of time for my 6/22 pre-op appt. with him.

Oh! and I'm making progress on the "list-front".
Paul suggested I centralize all my surgery-related stuff, so we bought a nice, sparkley (...okay what do you expect?) folder at Walgreens and it's got everything in it now: The lists. The disability paperwork, receipts, my sleep study. A pretty good idea, P.Smitty!

BTW, thanks for the pics of the new and improved window that got installed in your office.
It looks great, and now you won't have to get up on your tip-toes to see what the (crappy) weather is like outside!

On Saturday, Paul and I are flying to "L.A. - L.A. - L.A." to spend Mothers Day with Rose Marie and the crew. I hear it's going to be a full house, so it should be fun. Probably the last time I'll be going there for a few months. I think I'll bring shorts to wear so I can get some sun on my pale hairy legs and everyone can make fun of them! Oh boy!

much love;
Pinski xoxox

...and add THAT to the list!

2008-04-28T09:20:00.000-07:00

Hey, Mom! What up?

Last weekend was lovely in SF! Wish you were here. D, M & C were here for C's music festival, and it was great seeing them. They said you got snow that (Saturday) morning, so I'm sure they were glad to be here and not there! BTW, C's choir sounded great (they got first place) and the venue (St. Ignasius church...a place I'd never been to), was beautiful. The final concert was at Davies Symphony Hall, and Paul and I were able to go.

So, as I mentioned, I was going to make some lists and read up a bunch on the sleepnet.com site, which I did.

In looking at my big list (which I'm sure is bound to have more additions in the future), I'm thinkin' no matter how prepared I am with all the stuff I need to get, the things I need to do, the questions I need to ask, the things I should expect to happen, in addition to preparing myself mentally, I may be better-prepared, but I'm never *really* going to be fully prepared. Gulk!
(dang! There were a lot of commas in that last sentence!)

So far, the big list is comprised of little lists broken down as:
a) Things I need to to get/have.
b) Things to do in order to be ready for the big day.
c) Questions to ask the doctor at the pre-op appointment.
c) Things to expect at the hospital and during recovery.

- Paul and I went "sailing" last weekend(*garage* sailing, that is) and I found a very nice "used only once" humidifier for only 5 bucks! Someone from the sleepnet.com forum had recommended I get one, so it was on my list. Like you, I love a bargain!
Sure, having lip balm, stool softener, a humidifier, lots of Ensure, instant breakfast, Odwalla's, 7 kinds of food choppers/blenders ;-) , mini toothbrushes, and stuff to help keep me from being bored will be really helpful, but I don't think I'm going to fully comprehend the magnitude of MMA surgery until I wake up in the ICU after it's over. HIGH ANXIETY!!!! ;-)
In all my reading, as similar as many people's experiences have been, there's still as many (if not more) differences. Some people have experienced little if any pain, and others have said it was the most painful thing they've ever experienced. ...and there's no way to know where in that range I'll fall until I experience it for myself. I'm visualizing being on the "not very much pain" side, of course!

- I also took care of some "to-do" stuff. Even though I had my regularly-scheduled teeth cleaning a couple months ago, I scheduled another one for right before the surgery. I figure it "couldn't hoit" since I won't be able to brush like I regularly do for a good while, and there’d be no way to open my mouth far enough and long enough for the regularly scheduled cleaning in September.
Also, I filled out the online medical disability form from work. Can you say convoluted? My HR rep told me that I will be eligible for full pay for up to 63 calendar days, which is good news. Since I’m taking a little more than 6 weeks off, I’ll be covered. Unfortunately, I won't be paid the same way. Instead, the state will be paying a certain amount every week, and work will make up the rest. I just hope it all works out like they say it's going to!
So, what's left? I still have to get a full blood work-up and EKG before the surgery, but that should be pretty easy to do. Even though I still have 5 weeks to get that done, I'll probably do it this week. That’s one less thing to worry about.

As far as the pre-op appointment with Dr. KL goes, I have a (yet another:-) list of questions to ask him (which I'm sure will get bigger)....such as: what *exactly* are you going to do? How far (in millimeters) will my jaw be moved? What about my slightly deviated septum? What about that weird stone in my salivary gland that showed up in my x-ray? Does vicadin come in 1/2 gallon containers? (only kidding!!!)

When it comes to things to expect at the hospital and during my recovery, I'm not that sure what to do yet. I'm thinking about making "ICU cue-cards" since talking might be a challenge. For instance, the cards might say:

* Could you please quiet down?
* May I please have some water?
* Okay, I admit it. This hurts.
* This catheter is not enjoyable. Please remove it as soon as humanly possible.
* Could somebody please suction the “boogs” out of my doze?
* Does this head-rap make my ass look big?

…you know! Stuff like that! :-)

Since I'm still 5 weeks away, there's still plenty of time to add to the lists, and hopefully finish what I need to do. As far as work goes (yet ANOTHER list!) I am going to have to pack everything up in my office, because we’ll be moving from our temporary digs back to our regular offices after they are finished being remodeled. Unfortunately, I won’t be here for the move back, so I want to make it as easy as possible on my co-workers, who will have to move all my stuff/crap. Poor them!

Lists, lists, lists!!
All I can say is I'm glad I'm writin' all of this down, yahearwhatI'msayin'?

xoxox:
Pinski

P.S. I’ll be posting some “before pix” soon, but not until the gi-normous “blemish” ;-) on my temple leaves me.

The "Committee Sessions" and things to consider...

2008-04-25T22:29:00.000-07:00

Ola Mama!

I hope my first letter about my MMA “issues” wasn’t too overwhelming!
It was for me!!

…and too bad for you it if was, because there's more where that came from!!

Now that the surgery is scheduled and it is an inevitability, I’ve been having periodic “committee sessions” in my head about a bunch of different things. So much to consider. So many things to plan for ….and so many things to worry about!! Oy!
Don’t get me wrong. For as big as this whole process seems, roughly 90% of me is really looking forward to it, and “getting on with my life”. (a quote used in every soap opera since the beginning of time)

From what I know and what I’ve read, being adequately prepared and having a positive mental attitude is key to a timely and easier recovery, so that’s what I’m out to do, first and foremost. Since I am no stranger to surgical procedures, I am lucky to have had those experiences under my belt. Those operations weren’t quite as major as this one will be, although that gnarly abdominal surgery I had when I was 12 probably runs a "close second". BTW, thanks for taking such good care of me through all of that.

So, I’m trying to be as positive as possible, but there’s still a part of me that thinks “poor me for having to go through this”.
Pity Party for Pinski!!! I guess that's to be expected (some what).

*Some* of the things to consider would be: a) The potential pain involved b) The possibility of unforeseen complications c) Not being able to eat regular food for a long time, d) The boredom that I’ll probably experience during my recovery period. e) How much this is all going to cost …and that’s what just comes to mind right now. I'm sure f, g and h, are soon to follow.
Do you suppose being part Italian and being raised catholic has anything to do with
all this worrying??? Ya, I thought so too! But that’s okay. I’m going to try to look at these challenges in small increments so they won’t overwhelm me, and I’m going to make a counter-plan for each of these “concerns”.
- For the pain, I plan on keeping a close eye on the amount of pain meds I take (and Paul will be a great help with this), and communicating with the doctor if it gets to be too much, instead of over-medicating.
- Un-foreseen complications? Don’t cross that bridge till you get to it, right? After all, I may never have to!
- Food? Okay, I could moan all day about not being able to eat steak, nachos, granola and all that, but it won’t be forever. I *will* eat that stuff again...Maybe not soon, but some day.
- Boredom? Well, “learian” said she slept a lot, so I’m hoping to do a lot of that, but I’m also going to have to find other things to keep me occupied. I’m thinkin’ People magazine….tmz.com...the Boob-tube….blogging;-)....practicing my Break-Dancing (only kidding!) …and I suppose I could also “make-like-a-teenager” and learn to “text-really-fast”!! Oh, the possibilities ….
- The co$t of it all? Well, sure. It’s going to take several years to pay this off, but it’s sure better than the alternative. I’m tired of being so tired!!

Some of the exciting unforeseen things I'm looking forward to are:
How my looks will change. As frightening as that may seem, I’m actually quite looking forward to that. (At the risk of ending up looking like Jay Leno, which I doubt will happen;-), I’m hoping that I have a stronger looking chin. I know, first and foremost, it’s about my health, and not about asthetics, but a stronger chin *would* be a nice "secondary benefit". Does that mean I’m a little vain or perhaps a bit shallow?? Maybe! ;-)
But mostly, I’m looking forward to getting a good, full nights sleep, waking up rested, and having the choice of sleeping on my side *or* my back. It’s tough to tell how much the apnea has been affecting me, really. I guess I’ll know after I experience what's different after it’s over. Will my daily dull headaches go away? Will I feel less fatigued? Will I not feel tired after I wake up? I won’t know until I’m on the other side of the MMA surgery, but I remain optimistic that many things will change for the better. Of all the blogs and forum postings I've read, most of the people don't regret having had the MMA surgery, and I don't plan on regretting it either.

So, this weekend I’m going back to the sleepnet.com site to do more reading. There’s still a lot to learn, and I am fer-shure going to start making some lists and checklists. I know I still have five weeks before the big surgery, but it will probably whiz by before you know it. I want to be prepared and ready for anything.

Now, if I could only convince "Mr. Caregiver" (a.k.a. Paul) that it’s all going to be okay. He can be a pretty big worrier too. I’m going to try like hell to get him to also read-up on the sleepnet.com site, and possibly some blogs to-boot. Just to get an idea of what to expect.

Well, that’s all for now. It was great talking to you the other night and I just want to tell you *again* how proud I am of you for quitting smoking after 50+ years. How long has it been now? Like 3 months? Absolutely FABU, dudette’!

Loads of love;

Pinski xoxoxo

Dear Mom: (The Intro)

2008-04-20T17:10:00.000-07:00

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!

Pinski's Excellent MMA Adventure

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

1 Year Update

10 Month Update

8 Month Update

TMJ : Here We Go Again!

6 Month Update

3 Month(ish) Update + First annual SuMM(A)it!

My Sleep Study: Before and After Specifics

Voot-Voot! The post-op Sleep Study results are in!

2 Month (8 week) update - Back to work for Pinski !

6 Week Update - ...and doing pretty well !

Week 5(ish). Goodbye Ouch Bars!!

1 Month Update; Time continues to fly!

Week 3. Improving Slowly but Surely

Wowzers! 2 weeks fly by when you're having fun!!

ICU Part Deux: (An addendum that doesn't *really* count)

This just in..

Day 6 (a,k.a "The toughest day so far")

A Rather Non-Eventful Dr KL Appointment

4:00 a.m. letter to me mum....

"Before" and "After" Pics

Welp. It's done!

The final countdown !! Surgery at 7:30a.m tomorrow.

It takes a village!

Pre-op Appointment with my awesome surgeon

The dreaded pre-op visit with my GP.

...and add THAT to the list!

The "Committee Sessions" and things to consider...

Dear Mom: (The Intro)

ICU Part Deux: (An addendum that doesn't really count)