8 Month Update

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Yo, Mama!

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

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

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

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

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

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

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

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

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

xoxoxo:
Pinski
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TMJ : Here We Go Again!

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Hey, Mom!

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

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

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

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

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

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

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

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

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

It should be a(nother) real adventure.

Much Love;
Pinski

6 Month Update

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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

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

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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

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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!

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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 !

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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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