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

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!

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

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.

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!

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...

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)

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!