Something remarkable happened today. Something I've been unable to do for many years.
I napped.
Let me repeat that: I NAPPED.
Feeling strangely tired around noon following a phone chat with my parents, I laid myself down in bed about 12:45pm and slept unassisted--no CPAP, no drugs--not waking up until around 2:30 or so.
That is the first time I've truly been able to nap during the day in about... must be five years. Before this, I've tried, but always been unable to. Either the sleep apnea or the CPAP mask or some combination thereof prevented it. But now...
Napping is one of the two things my sleep apnea has rendered me unable to do for years, the other being to simply sleep in. Looks like the surgery not only worked, but I'm slowly relearning how to sleep as well. That nap felt good, if a bit disorienting, and we'll see how I feel tonight.
Regardless, that nap alone makes this a very good day.
Sunday, June 30, 2013
Saturday, June 29, 2013
Ten days...
Hard to believe it's been ten days since surgery. I've more or less settled into a routine now, though I'm not enjoying all of it.
In truth, the food situation is starting to get to me. Eating and cooking was a very big thing in my life beforehand, and it's very difficult to not be able to eat normally for fourteen weeks or more... doubly so to be allowed very little but liquids or purees.
In truth, the food situation is starting to get to me. Eating and cooking was a very big thing in my life beforehand, and it's very difficult to not be able to eat normally for fourteen weeks or more... doubly so to be allowed very little but liquids or purees.
Friday, June 28, 2013
A few brief notes for day 9...
Food:
- Unlike some other soups I've tried, beef barley soup doesn't taste that good pureed unless mixed with enough yogurt and V-8. Good soups for puree are tomato-based, chicken noodle, and cream of (pretty much anything).
- You can puree a PBJ sandwich in cola and honey and comes out pretty well, though it's so rich you can't eat the whole thing at once.
- Greek yogurt takes to grape juice quite well. blend them, and you've got a surprisingly refreshing afternoon snack.
- My current recipe for a happy breakfast: 1 can vanilla ensure, 1 heaping tbsp of chocolate protein powder, 1 cup of orange juice, 1 large spoonful of peanut butter and 15ml orange-flavored nutrition supplement.
Recovery:
- Slept less well last night. Heard snoring while lying on my back but couldn't tell if it was waking me up. I'm starting to seriously think I need a new mattress and possibly pillow.
- TMJ pain is lessened but still present, mostly low-level with some occasional twinges.
- Left side jaw swelling is down about 40%; swelling bulge is still there on my left lower jaw.
- Right side swelling is down about 60%; another week and I might have something approximating my final profile on that side
- My right ear is starting to pop, though still not fully cleared.
- Coughing less frequently, but still doing so occasionally.
- Can still open my jaw enough to take pills... for now.
- Have constant low-level sensations in my chin and occasionally fleeting pinprick ones on my lower lip.
- Bleeding is slowing out of my right nostril, stopped completely out of my left.
- Current weight loss: 17lbs.
- I spent all morning playing video games, and then all afternoon to this point writing. For this evening? Probably a walk and more video games, plus a run to Lowes so I can install new fan blades on my bedroom ceiling fan. Productive enough day 9, I think.
Thursday, June 27, 2013
Daily update, day 8
And now... the daily update. Definite across-the-board improvements over the past day and a half or so, and I've got some pictures to share as well.
Thoughts on the First Week...
Hard to believe it's been a week now. I'm over the worst, quite easily, and it's all downhill from here... even if it is a very long slope.
In fact, in some ways, it feels like it's been forever since surgery... and what came before it. My apnea is now a memory, and now my day-to-day life is taken up in simple recovery and healing. I measure my progress in a little small victories, like being able to take a walk, swallow a pill, drink from a glass, or simply stop drooling. I take joys in simple pleasures like an Orange Julius or can of tomato soup, and am getting a little more adventurous with my blender, to the point I've already come up with a couple recipes that have made my morning meals much happier affairs.
Okay, but cut to the chase--having been through the procedure and knowing what I've been through/how much further I have yet to go--would I do this all again?
Hell yes I would. It worked, and everything else--the pain, the pressure, the puree diet--pales in comparison to that simple fact. There is no longer a CPAP machine sitting on my nightstand; I just go to bed now and be done with it. I'm still learning how to properly sleep again, I think, but that just means it's only going to get better over time.
This surgery was indeed life-altering, and so many new doors and possibilities open to me now that endless sleep deprivation should be a thing of the past. When I'm recovered, I will have my life back. No, better yet... my life starts anew and I can finally move forward with several longtime desires and dreams. Second chances like this are so rare in life, and I'm lucky enough to have had the ability to get one like this. Better yet, I *chose* this, and now know I chose correctly, even if there are another 13 weeks of recovery to get through.
That's fine. I know I can do it, and I will. I have the success of the surgery and the support of my friends and family to draw upon. I don't need anything more than that. There may yet be setbacks, but I'll deal with them as they come.
My surgery worked. My sleep apnea is history. And that's ultimately all I needed to know.
In fact, in some ways, it feels like it's been forever since surgery... and what came before it. My apnea is now a memory, and now my day-to-day life is taken up in simple recovery and healing. I measure my progress in a little small victories, like being able to take a walk, swallow a pill, drink from a glass, or simply stop drooling. I take joys in simple pleasures like an Orange Julius or can of tomato soup, and am getting a little more adventurous with my blender, to the point I've already come up with a couple recipes that have made my morning meals much happier affairs.
Okay, but cut to the chase--having been through the procedure and knowing what I've been through/how much further I have yet to go--would I do this all again?
Hell yes I would. It worked, and everything else--the pain, the pressure, the puree diet--pales in comparison to that simple fact. There is no longer a CPAP machine sitting on my nightstand; I just go to bed now and be done with it. I'm still learning how to properly sleep again, I think, but that just means it's only going to get better over time.
This surgery was indeed life-altering, and so many new doors and possibilities open to me now that endless sleep deprivation should be a thing of the past. When I'm recovered, I will have my life back. No, better yet... my life starts anew and I can finally move forward with several longtime desires and dreams. Second chances like this are so rare in life, and I'm lucky enough to have had the ability to get one like this. Better yet, I *chose* this, and now know I chose correctly, even if there are another 13 weeks of recovery to get through.
That's fine. I know I can do it, and I will. I have the success of the surgery and the support of my friends and family to draw upon. I don't need anything more than that. There may yet be setbacks, but I'll deal with them as they come.
My surgery worked. My sleep apnea is history. And that's ultimately all I needed to know.
Wednesday, June 26, 2013
Called Dr. Jelic...
Told him I'm definitely feeling some chest congestion this morning, and told him about the TMJ pain I had last night, though that seems to be considerably better now. He asked if I was running a fever, and the answer is no: current temperature 97.7 (can't take my temperature by mouth with my jaw wired shut, so I do what the hospital did--take it in my armpit!). Also asked is my cough productive? Yes.
He said that given that, it's likely nothing to be alarmed about. His instructions are to continue taking the antibiotic (first thing I did on getting up this morning) and motrin (or ibuprofin in this case), and also take deep breaths into lungs and hold it, try to expand them to help squeeze out any fluid or something to that effect. For the TMJ pain, he speculated it might have gone into spasm, so he suggests use warm moist heat on it as per post-op instructions.
The joint does feel a lot better this morning, even though the hydrocodone has worn off. I was able to sleep again after taking it, and didn't wake up until close to 9. When I did, I found the pain had radiated outward to the supporting muscle groups, which would certainly seem to imply the joint had spasmed and now everything around it was trying to compensate. I'll start the moist heat after breakfast, I guess.
He said that given that, it's likely nothing to be alarmed about. His instructions are to continue taking the antibiotic (first thing I did on getting up this morning) and motrin (or ibuprofin in this case), and also take deep breaths into lungs and hold it, try to expand them to help squeeze out any fluid or something to that effect. For the TMJ pain, he speculated it might have gone into spasm, so he suggests use warm moist heat on it as per post-op instructions.
The joint does feel a lot better this morning, even though the hydrocodone has worn off. I was able to sleep again after taking it, and didn't wake up until close to 9. When I did, I found the pain had radiated outward to the supporting muscle groups, which would certainly seem to imply the joint had spasmed and now everything around it was trying to compensate. I'll start the moist heat after breakfast, I guess.
Here comes the pain...?
It's 3am, just a few hours short of 7 days after surgery, and for the first time since the second day after... I'm finding myself in some serious pain. The location? Right TMJ (jaw joint), or just behind it, in the vicinity of my right ear. It woke me up. So I just broke out the hydrocodone for the first time in four days to try to get me through it. Waiting for it to take effect before going back to bed.
I wonder if that's a delayed consequence of the TMJ issues I've had. I think I'll drop Dr. Jelic a line tomorrow and see what he says.
I wonder if that's a delayed consequence of the TMJ issues I've had. I think I'll drop Dr. Jelic a line tomorrow and see what he says.
Tuesday, June 25, 2013
2nd Post-op appointment
Had my second post-op appointment yesterday. It consisted of an examination preceded by me brushing my teeth for the first time using a small, soft-bristled toothbrush, with instructions to only brush the braces. The rubber bands came off briefly only to go on even tighter than before, making it doubly difficult to open my jaw--which I need to be able to at least slightly in order to get my pills in.
In another week at my next post-op appointment, I'll be taught how to remove the rubber bands/reattach them myself, in order to clean my teeth and take medication more easily. But for now... they need to stay on full-time.
In another week at my next post-op appointment, I'll be taught how to remove the rubber bands/reattach them myself, in order to clean my teeth and take medication more easily. But for now... they need to stay on full-time.
Monday, June 24, 2013
Some Before and After X-Rays...
Had my second post-op appointment today and asked for digital copies of pre-and-post surgery X-rays.
The pics
As promised... these aren't all that pretty for the most part, but they need to be seen. And now that there's improvement in the swelling, I can show a progression as well.
Sunday, June 23, 2013
Day four nearly done...
Well, yesterday was an active day for me. Had two friends over for a couple hours, took a couple half-mile to milelong walks, watched a lot of TV (Mark got me hooked on TLC's Pawn Stars), didn't try to nap for the first time in my convalescence.
Today I woke up more tired despite having my best night's sleep yet. Went to bed at 10:30, had a little trouble falling asleep but once I did, I slept decently, waking up only twice. Still having the weird/fever dreams, which I wish would go away, but I definitely slept...
And all without the CPAP. No mask. No need. That's what this was all about, right?
Today I woke up more tired despite having my best night's sleep yet. Went to bed at 10:30, had a little trouble falling asleep but once I did, I slept decently, waking up only twice. Still having the weird/fever dreams, which I wish would go away, but I definitely slept...
And all without the CPAP. No mask. No need. That's what this was all about, right?
Saturday, June 22, 2013
Day three...
Today's the day that my swelling supposedly starts to turn around. I'm certainly ready for it to do so, considering the way I look right now. My previous record for swollen cheeks was when I had my wisdom teeth out. This dwarfs it, quite easily.
Friday, June 21, 2013
First Post-Op appointment today
It involved a lot of tooth/nose cleaning and some x-rays. He also put the rubber bands on for the first time since I was having trouble breathing through my mouth before this. I still am. Just have to be patient. I'm also told that I have less numbness and more sensation than normal after this surgery. Talk about mixed blessings... I felt most of my nose being scoped out. It really needed it though. Starting tonight, I use the prescription mouthwash. Not allowed to brush my teeth until day 5.
Sleep is problematic. The X-ray shows there's a hell of a lot more open space in the back of my throat now, but I'm extremely congested and my soft palate is badly swollen. What feels like is happening is that I'm breathing through my mouth as I fall asleep, but my body immediately tries to switch over to nasal breathing as soon as I do so--after all, nasal breathing was all I did for years through the CPAP machine, so that's how my nighttime breathing is now programmed. Since the nose is badly stopped up, I hit a wall and wake up with a snort again. So I now have a breathing path, yet I can't get my body to use it. Lovely.
Dr. Jelic also says that for people that have had sleep apnea for a while, there's tendency to not allow yourself to fall into a deep sleep as something of a survival mechanism to try to avoid situations where it's harder to wake up to breathe. So I'm probably getting some of that as well.
So basically... even with my airways opened up, it's apparently not going to be instant for me. Swelling needs to go down, nose needs to clear, and in some ways I have to relearn to sleep. Can't come soon enough, but in the meantime... I'll be sleeping in an upright position. Patience, Matt. It's only day two.
As for things generally... today hasn't been that bad a day. Some pain, certainly. Swollen? All to hell. But I'm figuring out how to swallow, and was able to down more food today. Even managed to pop one of my RA pills, though that will be more difficult now that the rubber bands are in. Had the appt this morning (next one on Monday), and was able to take a walk this afternoon.
I do have pictures of myself from the immediate aftermath of surgery, courtesy of Mark, but I'm going to wait to post them until I have other pictures showing the swelling receding.
Sleep is problematic. The X-ray shows there's a hell of a lot more open space in the back of my throat now, but I'm extremely congested and my soft palate is badly swollen. What feels like is happening is that I'm breathing through my mouth as I fall asleep, but my body immediately tries to switch over to nasal breathing as soon as I do so--after all, nasal breathing was all I did for years through the CPAP machine, so that's how my nighttime breathing is now programmed. Since the nose is badly stopped up, I hit a wall and wake up with a snort again. So I now have a breathing path, yet I can't get my body to use it. Lovely.
Dr. Jelic also says that for people that have had sleep apnea for a while, there's tendency to not allow yourself to fall into a deep sleep as something of a survival mechanism to try to avoid situations where it's harder to wake up to breathe. So I'm probably getting some of that as well.
So basically... even with my airways opened up, it's apparently not going to be instant for me. Swelling needs to go down, nose needs to clear, and in some ways I have to relearn to sleep. Can't come soon enough, but in the meantime... I'll be sleeping in an upright position. Patience, Matt. It's only day two.
As for things generally... today hasn't been that bad a day. Some pain, certainly. Swollen? All to hell. But I'm figuring out how to swallow, and was able to down more food today. Even managed to pop one of my RA pills, though that will be more difficult now that the rubber bands are in. Had the appt this morning (next one on Monday), and was able to take a walk this afternoon.
I do have pictures of myself from the immediate aftermath of surgery, courtesy of Mark, but I'm going to wait to post them until I have other pictures showing the swelling receding.
Thursday, June 20, 2013
Home again...
I was discharged about an hour and half ago, though not without one needless snag. They forgot to take off my IV clamp from where it was taped to my arm, so we had to turn around and go back to get it removed. Very sloppy on their part. In all honesty, I wasn't too impressed with that place. Things seemed a little haphazard, and the quality of the nurses and attendants was very hit or miss.
The good: the procedure seems to have worked! I was drifting in and out of sleep last night, but didn't feel any apnea episodes. Got woken up by the hospital staff a lot, but that's a different story.
The bad: the hideously swollen lower jaw, the numb chin, the difficulty swallowing, the post-surgery nausea, the uncontrollable drooling. Fun times. But all expected and in the end, all temporary. And very much worth it for no more sleep apnea.
The ugly: the way my lower jaw looks right now. I won't be winning any beauty contests for a while, not until this swelling goes down. Dr. Jelic said I could expect the swelling to peak on the third day and subside thereafter, down about 75% at the end of the second week. Can't come soon enough at this point. I'm currently wearing an icepack sling pressed against both cheeks, trying to get some of the inflammation down. It's going to be a constant struggle for a while.
There are some pictures of me taken by Mark right after surgery, but I'll spare folks them. They're not pretty. Pictures will follow when the swelling subsides and I have a better idea of what my real appearance is going to be.
And a huge thank you and hug to Mark for taking care of me this week. Having you here was a godsend, and you've made this endurable.
The good: the procedure seems to have worked! I was drifting in and out of sleep last night, but didn't feel any apnea episodes. Got woken up by the hospital staff a lot, but that's a different story.
The bad: the hideously swollen lower jaw, the numb chin, the difficulty swallowing, the post-surgery nausea, the uncontrollable drooling. Fun times. But all expected and in the end, all temporary. And very much worth it for no more sleep apnea.
The ugly: the way my lower jaw looks right now. I won't be winning any beauty contests for a while, not until this swelling goes down. Dr. Jelic said I could expect the swelling to peak on the third day and subside thereafter, down about 75% at the end of the second week. Can't come soon enough at this point. I'm currently wearing an icepack sling pressed against both cheeks, trying to get some of the inflammation down. It's going to be a constant struggle for a while.
There are some pictures of me taken by Mark right after surgery, but I'll spare folks them. They're not pretty. Pictures will follow when the swelling subsides and I have a better idea of what my real appearance is going to be.
And a huge thank you and hug to Mark for taking care of me this week. Having you here was a godsend, and you've made this endurable.
Wednesday, June 19, 2013
All is as well as can be
Hello, Mark here. I'm watching over Matt for the next couple of days post-surgery. I'm late in posting this because I stayed at the hospital for a while after I was allowed upstairs to see Matt. As the title suggests, he's doing as well as can be expected. Surgery went until around 4:30pm or so, and the doctor told me the procedure went as expected, although there's some additional swelling due to Matt only being off the Celebrex for the past week and a half or so. He says it's temporary and will go down in the next couple of days.
Other than that, Matt's in his room as comfortable as he can be, which is to say: not very. Swallowing is uncomfortable and I imagine coughing is pretty darn painful. Vital-wise, he's okay, reasonably alert, and very tired.
I'll be bringing him home tomorrow around 2:00pm or so, and we have an appointment at 4:00pm with his doctor at the doctor's office. Hopefully if he's up to it he'll make a blog post between coming home and our trip out again, but if not he'll probably touch base with the world tomorrow evening.
Other than that, Matt's in his room as comfortable as he can be, which is to say: not very. Swallowing is uncomfortable and I imagine coughing is pretty darn painful. Vital-wise, he's okay, reasonably alert, and very tired.
I'll be bringing him home tomorrow around 2:00pm or so, and we have an appointment at 4:00pm with his doctor at the doctor's office. Hopefully if he's up to it he'll make a blog post between coming home and our trip out again, but if not he'll probably touch base with the world tomorrow evening.
Final final thoughts
It's 5:15am. Leaving for the hospital in 15 minutes. Even with the valium, I was only able to sleep for less than four hours last night. Not so much anxiety--the drug prevents that much at least--as the fact they also had me take a large steroid dose before going to bed, which causes my heart to race and makes it hard to sleep, Valium or no. Oh well. In a couple hours, I'll be knocked out for the better part of the day, so... no big deal.
I said it last night, I'll say it again: I'm ready. May my life begin anew today.
I said it last night, I'll say it again: I'm ready. May my life begin anew today.
Tuesday, June 18, 2013
Final thoughts...
Had my two pre-op appointments today. Got my final instructions, talked to the surgeon and the hospital, laid in my post-surgery liquid diet and got everything hopefully squared away. Turned out I was wrong about a couple of things... the hospital and anesthesiologist are not charging me up front; they're billing me with whatever insurance doesn't pay, which only looks to be 10%. Fine with me.
A couple things I heard surprised me. First was instructions to not shave beforehand, since that can apparently increase the chance of infection (makes sense if you think about it). Second was to take a Valium before bedtime to make sure I get a full night's sleep, and then again as I wake up tomorrow to make sure I'm relaxed for surgery. I've never taken Valium before. Should be interesting, to say the least. I expect I'll be quite loopy when I arrive at the hospital at 6am tomorrow. Surgery may take up to eight hours, and it could be evening before I'm wheeled out of recovery into my room.
Well, there's not much else to say at this point except... I'm ready. I've been counting down the weeks and the days for months now. I've wanted this for a long time, and I expect good things to come of it, albeit with a period of purgatory I will happily endure for the end result.
In short... I'm ready to sleep again. May it be so.
A couple things I heard surprised me. First was instructions to not shave beforehand, since that can apparently increase the chance of infection (makes sense if you think about it). Second was to take a Valium before bedtime to make sure I get a full night's sleep, and then again as I wake up tomorrow to make sure I'm relaxed for surgery. I've never taken Valium before. Should be interesting, to say the least. I expect I'll be quite loopy when I arrive at the hospital at 6am tomorrow. Surgery may take up to eight hours, and it could be evening before I'm wheeled out of recovery into my room.
Well, there's not much else to say at this point except... I'm ready. I've been counting down the weeks and the days for months now. I've wanted this for a long time, and I expect good things to come of it, albeit with a period of purgatory I will happily endure for the end result.
In short... I'm ready to sleep again. May it be so.
Fees, finances and fights with insurance
Well, just one day left. Still not really nervous, just more anxious
for it to happen. Plans for the day include my two pre-op appointments,
one with the surgeon and one at the hospital with the anesthesiologist.
After that... laying in supplies followed by dinner at a Brazilian Steakhouse, where I fully intend to
eat my fill. But before that... a little talk about the costs of this thing.
Sunday, June 16, 2013
3 Days Left...
I'm trying to spend my last few days taking it easy, and of course getting in all my favorite foods before I can't have them for a while. Tonight was sushi. Last night was paella--and very possibly my last time cooking for a few months. Tomorrow, it's off to the beach one last time, and then on Tuesday... Brazilian Steakhouse for the last meal.
People keep asking me if I'm nervous. My honest answer is... no, I'm not. At least, not about the procedure itself. The only thing that makes me nervous is one simple question: what if it doesn't work? What if I go through all this, and it's still not enough? I know the odds are strongly in favor of it working, but there's always that chance. Realistically, with an 18mm lower jaw advancement (nearly 3/4"!) there's very little chance it wouldn't have a significant effect. My goal is, of course, to get rid of that bloody mask, and be able to sleep through the night again. Will I get there? Even being able to sleep on my side unassisted again would be a huge improvement for me. Not be dependent on the CPAP.
This last Thursday kind of drove it home for me. We had a bad line of storms that came through with 50-60mph winds and knocked power out in my complex for four hours. That's not good for a CPAP user. I can't sleep without mine--not without sitting up, anyway (which presents its own problems), and I was wondering what I was going to do if the power didn't come back on in time. Fortunately it did, but... that's the danger of the thing. Sleep apnea can kill. My nightmare scenario has been, I take one of my sleeping pills, the power goes out, and drugged, I can't wake up enough to breathe. Realistic? Maybe not. But it's killing me slowly anyway through two to three hours or more a night of sleep deprivation.
THAT is ultimately why I'm not nervous about the surgery. I want this. I chose this over lesser options based on its success rate and relative certainty that more wouldn't be needed. I'm trying to help myself, and if I have to go through a form of purgatory in order reach the proverbial paradise of getting enough rest again, then so be it. It's a price I'll pay in full.
The actual financial price, however... that's something I'll discuss in my next entry.
People keep asking me if I'm nervous. My honest answer is... no, I'm not. At least, not about the procedure itself. The only thing that makes me nervous is one simple question: what if it doesn't work? What if I go through all this, and it's still not enough? I know the odds are strongly in favor of it working, but there's always that chance. Realistically, with an 18mm lower jaw advancement (nearly 3/4"!) there's very little chance it wouldn't have a significant effect. My goal is, of course, to get rid of that bloody mask, and be able to sleep through the night again. Will I get there? Even being able to sleep on my side unassisted again would be a huge improvement for me. Not be dependent on the CPAP.
This last Thursday kind of drove it home for me. We had a bad line of storms that came through with 50-60mph winds and knocked power out in my complex for four hours. That's not good for a CPAP user. I can't sleep without mine--not without sitting up, anyway (which presents its own problems), and I was wondering what I was going to do if the power didn't come back on in time. Fortunately it did, but... that's the danger of the thing. Sleep apnea can kill. My nightmare scenario has been, I take one of my sleeping pills, the power goes out, and drugged, I can't wake up enough to breathe. Realistic? Maybe not. But it's killing me slowly anyway through two to three hours or more a night of sleep deprivation.
THAT is ultimately why I'm not nervous about the surgery. I want this. I chose this over lesser options based on its success rate and relative certainty that more wouldn't be needed. I'm trying to help myself, and if I have to go through a form of purgatory in order reach the proverbial paradise of getting enough rest again, then so be it. It's a price I'll pay in full.
The actual financial price, however... that's something I'll discuss in my next entry.
Tuesday, June 11, 2013
A week to go...
I can't say I'm really getting nervous yet, but I'm starting to think about it more. Days like today, when I'm tired all day after not getting enough sleep (in other words, a usual day), remind me of why I'm doing this.
My typical night goes like this right now: Go to bed at around 11:30, take anywhere from twenty minutes to an hour to fall asleep. It's rarely quick for me, and I envy those who can fall asleep in just a few minutes. Hard to get comfortable with the mask, and there are invariably these ferocious little itches under it I have to scratch--particularly if I don't shower or at least splash water on my face first. Wake up 5 or 6 hours later tossing and turning, struggling to get fall back asleep. Sometimes I'm succeed, but usually I don't. Usually give up by 7 and get up. My average sleep--around 5-6 hours. On a bad night, 3 or 4. On a good night? I might get 7 or very rarely 8, but I usually can't reach that without chemical help, and that has its own drawbacks. I don't take sleep pills more than once every other week or so to make sure I don't get dependent and to minimize the inevitable rebound insomnia.
Sometimes, if I wake up soon enough--like 3 or 4 or so--I can fall back asleep after an hour or two of tossing and turning. I can also get up and work on the computer for a bit, give my nose a break from the mask. Rarely, I'll pop an Intermezzo pill (low-dose Ambien) so I can get at least couple hours more, but that leaves me hung over all morning.
One odd thing... the nasal pillows I typically use irritate my left nostril. Not my right, just my left, which I think is the product of a slightly skewed nose. My other masks aren't any better. My nasal mask irritates the bridge of my nose, leaving an angry red mark there (I can't loosen it or it loses the air seal), while my full face mask, which I only pull out when I'm stuffed up from a cold, is very hard to keep a seal without keeping it uncomfortably tight, and pinches when I lay on my side. I alternate every couple weeks between the nasal pillows and nasal mask to try to give my irritation a chance to subside in one spot while it flares in another. It's kind of no-win.
So yeah, sleep right now is just a long series of trade-offs for me. You don't know what I would give to just be able to nap or sleep in again, which is almost impossible for me right now. But in a week, hopefully I will be able to...?
It's like I told Dr. Jelic at my last appointment: I can take the pain, I can take the inconvenience, the liquid diet, the long recovery... as long as I'm free of the mask.
I just want to sleep again.
My typical night goes like this right now: Go to bed at around 11:30, take anywhere from twenty minutes to an hour to fall asleep. It's rarely quick for me, and I envy those who can fall asleep in just a few minutes. Hard to get comfortable with the mask, and there are invariably these ferocious little itches under it I have to scratch--particularly if I don't shower or at least splash water on my face first. Wake up 5 or 6 hours later tossing and turning, struggling to get fall back asleep. Sometimes I'm succeed, but usually I don't. Usually give up by 7 and get up. My average sleep--around 5-6 hours. On a bad night, 3 or 4. On a good night? I might get 7 or very rarely 8, but I usually can't reach that without chemical help, and that has its own drawbacks. I don't take sleep pills more than once every other week or so to make sure I don't get dependent and to minimize the inevitable rebound insomnia.
Sometimes, if I wake up soon enough--like 3 or 4 or so--I can fall back asleep after an hour or two of tossing and turning. I can also get up and work on the computer for a bit, give my nose a break from the mask. Rarely, I'll pop an Intermezzo pill (low-dose Ambien) so I can get at least couple hours more, but that leaves me hung over all morning.
One odd thing... the nasal pillows I typically use irritate my left nostril. Not my right, just my left, which I think is the product of a slightly skewed nose. My other masks aren't any better. My nasal mask irritates the bridge of my nose, leaving an angry red mark there (I can't loosen it or it loses the air seal), while my full face mask, which I only pull out when I'm stuffed up from a cold, is very hard to keep a seal without keeping it uncomfortably tight, and pinches when I lay on my side. I alternate every couple weeks between the nasal pillows and nasal mask to try to give my irritation a chance to subside in one spot while it flares in another. It's kind of no-win.
So yeah, sleep right now is just a long series of trade-offs for me. You don't know what I would give to just be able to nap or sleep in again, which is almost impossible for me right now. But in a week, hopefully I will be able to...?
It's like I told Dr. Jelic at my last appointment: I can take the pain, I can take the inconvenience, the liquid diet, the long recovery... as long as I'm free of the mask.
I just want to sleep again.
Monday, June 10, 2013
T-minus 9 days...
... and counting. No appointments this week, but I had a couple last week to get final molds of my mouth for a 3-D virtual model the surgeon is building to practice on. Took a couple tries on the upper jaw because my gag reflex kicked in hard when they put that goop in, and the stuff didn't set quick enough before he had to pull it. Waited a couple minutes and then tried again with a fresh mix at warmer temperature, which apparently did the trick.
Seeing that, Dr. Jelic noted that in his experience it's not uncommon for people with apnea to have very strong gag reflexes, theorizing it was due to the simple fact that the body has programmed itself to gag easily to keep the airway open at night. Not sure whether that's true or not, but he went on to say that he'd had a couple patients that had a much lower gag reflex after surgery, which would seem to suggest that it's more a function of the airway being too easily obstructed before surgery and much more open after. Dunno. But a welcome side benefit if it works that way for me.
Anyway... started one new preparation for surgery today. Went off Celebrex, the NSAID (non-steroidal anti-inflammatory drug) I use to control my rheumatoid. It's a good drug for me; doesn't seem to hurt my stomach and has no side effects. But, like most NSAIDs, there's at least a slight chance it could cause bleeding issues during surgery. So in the meantime... I'm going on a real steroid, prednisone, which I do once every month or two anyway to knock the Rheumatoid back to bay. He's going to pump me full of steroids anyway for surgery to control inflammation, so I'm just getting a head start on it. Only problem is... first two days of taking it cause me to have sleep problems. Well, more than I normally have...
This is also my last week of work before surgery. I've arranged for a month off if I need it, and thanks to the fact that my job has been willing to work with me on this, it'll be at full pay. I'm certainly grateful to my workplace and manager for that...
Seeing that, Dr. Jelic noted that in his experience it's not uncommon for people with apnea to have very strong gag reflexes, theorizing it was due to the simple fact that the body has programmed itself to gag easily to keep the airway open at night. Not sure whether that's true or not, but he went on to say that he'd had a couple patients that had a much lower gag reflex after surgery, which would seem to suggest that it's more a function of the airway being too easily obstructed before surgery and much more open after. Dunno. But a welcome side benefit if it works that way for me.
Anyway... started one new preparation for surgery today. Went off Celebrex, the NSAID (non-steroidal anti-inflammatory drug) I use to control my rheumatoid. It's a good drug for me; doesn't seem to hurt my stomach and has no side effects. But, like most NSAIDs, there's at least a slight chance it could cause bleeding issues during surgery. So in the meantime... I'm going on a real steroid, prednisone, which I do once every month or two anyway to knock the Rheumatoid back to bay. He's going to pump me full of steroids anyway for surgery to control inflammation, so I'm just getting a head start on it. Only problem is... first two days of taking it cause me to have sleep problems. Well, more than I normally have...
This is also my last week of work before surgery. I've arranged for a month off if I need it, and thanks to the fact that my job has been willing to work with me on this, it'll be at full pay. I'm certainly grateful to my workplace and manager for that...
Monday, June 3, 2013
Braces
Had to visit the orthodontist today because one of my braces came loose. A 'cleat', as they call it, which near as I can tell is a small anchor that's glued to the inside of my top back molars. I bit a piece of hard bread over the weekend and it popped off.
Sunday, June 2, 2013
Letter to Aetna
For my final post of the night, here is an excerpt of the letter Doctor Jelic sent to Aetna, my insurance company:
In plain English, my jaw's too small and a little off-center.
Matthew Stoughton presented to me on August 16, 2012 to discuss surgical options for correcting his obstructive sleep apnea. Matt is well-informed since he has been dealing with his condition since 2002 and has been treated with a variety of CPAP masks, pharmacology, and surgery. Surgically, he has completed all phase I options including FESS, septoplasty, turbinectomy, and UPPP, yet he still requires 9 cm of water pressure to achieve any sort of efficacy. Matt attempts to use his CPAP but cannot tolerate more than three hours with it. In spite of all previous interventions, Matt's September 1, 2011 sleep study identified an RDI of 46 with oxygen desaturations to 75%. The only option Matt has not pursued is a mandibular positioning device, but the severity of his OSA as well as TMD/rheumatoid arthritis eliminates this treatment option.
During my evaluation, it became apparent that Matt has well-camouflaged, but significant, maxillary and mandibular hypoplasia that is the etiology for his disease process. Surgical correction for this problem includes a 10mm maxillary advancement (segmented and bone grafted to manage a maxillary transverse deficiency) followed by a mandibular advancement which will move his chin point anteriorly 18mm.
In plain English, my jaw's too small and a little off-center.
Complications
The decision made to get an MMA, there are still two complicating factors for me--other conditions I have which have some bearing on my surgery. The first is TMJ issues. The second is Rheumatoid Arthritis.
The right choice
By now, it is August 2012. Sometimes, you go looking for answers all over hell and back, only to find they were right there in front of you the whole time. Such it was with me. I had assumed there were no local options, based on previous experiences and that was foolish of me. A simple web search showed there were a couple candidates who might be able to help me.
Diagnosis, Doctors, and Decisions
At this point, I'm wondering if the rest of my life is going to be lived in a sleep-deprived haze. Even with the better CPAP and mask, I can only tolerate them for so long before I wake up and I can't get back to sleep with them. By the spring of 2012, I'm averaging only 4-6 hours of sleep a night--might be enough for some but definitely isn't for me--and it's starting to seriously affect me. I do more research, and start looking at other, more radical procedures--none of which seem available around me. I then arrange an overnight trip to UCSF hospital, which is reputed to have one of the best sleep centers in the country, seeking an authoritative diagnosis and treatment options...
The story of my sleep apnea...
...goes back ten years, starting at age 30.
I never had a problem sleeping before that, though I did have very bad snoring--I've had pillows thrown at me in hotel rooms before, and those I slept with eventually took to wearing ear plugs around me.
I never had a problem sleeping before that, though I did have very bad snoring--I've had pillows thrown at me in hotel rooms before, and those I slept with eventually took to wearing ear plugs around me.
Hello, one and all...
... and welcome to my brand-new blog. My name is Matt Stoughton. And in less than three weeks, I'm going to be attempting surgical correction of my severe obstructive sleep apnea, using the most radical procedure there is: Maxillo-Mandibular Advancement, also known as MMA.
It's a fancy word for jaw advancement. What it means is, they're going to break my upper and lower jawbones and move my entire jaw forward as a unit about two-thirds of an inch, resetting it in place with as series of screws and possible bone grafts. If all goes well--85-90% success rate for this surgery--I will be able to sleep through the night for the first time in many years. No CPAP machine and no pills, which are only partially effective with me anyway (and the latter seem to lose their effect after just a couple days).
And if it doesn't? Well, you'll read it here as well.
So why this blog? For several reasons. First, to let my friends and family know what's going on with me as my surgery approaches and as my recovery progresses, because needless to say... I'm not going to be able to do much talking that first week. Second, many other people have blogged their experience with this surgery. Their blogs have been huge help and wealth of information, letting me know what to expect and ultimately giving me the courage and certainty to go through with this. I feel it's only fair to do the same and let others who follow me know what it's like, for better or for worse.
This is a major procedure, with recovery time measured in months. There are side effects and possible complications that I'll get into later. As things happen, I will be posting pictures, observations, and yes, may occasionally complain or vent my frustrations. I have a pretty good idea what to expect, but doubtless there will be surprises along the way. So please bear with me as I enter what I expect to be purgatory on my way to the paradise that only real sleep I haven't known in ten years can provide.
It's a fancy word for jaw advancement. What it means is, they're going to break my upper and lower jawbones and move my entire jaw forward as a unit about two-thirds of an inch, resetting it in place with as series of screws and possible bone grafts. If all goes well--85-90% success rate for this surgery--I will be able to sleep through the night for the first time in many years. No CPAP machine and no pills, which are only partially effective with me anyway (and the latter seem to lose their effect after just a couple days).
And if it doesn't? Well, you'll read it here as well.
So why this blog? For several reasons. First, to let my friends and family know what's going on with me as my surgery approaches and as my recovery progresses, because needless to say... I'm not going to be able to do much talking that first week. Second, many other people have blogged their experience with this surgery. Their blogs have been huge help and wealth of information, letting me know what to expect and ultimately giving me the courage and certainty to go through with this. I feel it's only fair to do the same and let others who follow me know what it's like, for better or for worse.
This is a major procedure, with recovery time measured in months. There are side effects and possible complications that I'll get into later. As things happen, I will be posting pictures, observations, and yes, may occasionally complain or vent my frustrations. I have a pretty good idea what to expect, but doubtless there will be surprises along the way. So please bear with me as I enter what I expect to be purgatory on my way to the paradise that only real sleep I haven't known in ten years can provide.
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