Another personal account for those who crave information...like me.

MUG SHOT
(before surgery)














More Details:

Photos - Before and After

Sleep Study Results

X-Rays - Before and After

Snoring - Before and After (with audio)

Arch Bars and Teeth Cleaning

Summary

My Shopping Lists

Food

More History - A Timeline

Minor Complications

Misc pics




My Favorite Links:

Roger's MMA Site

Non-CPAP Option Forum 20

Non-CPAP Option Forum19

Stanford Sleep Clinic

Dr. Kasey Li

Dr. Powell and Dr. Riley

JADA Article on MMA Surgery

Chest Journal Article on MMA Surgery 

Study on Appearance After MMA Surgery

WikiPedia - Sleep Apnea

Some eMedicine aticles



Read This Book:

The Promise of Sleep




























Kodak's suggestion for a souvenir





























Helpful Tips:

- If you drink coffee, go decaf before the surgery.  The ICU is bad enough without caffeine headaches compounding the problem.

- Buy a strainer, and obviously a good blender.

- A hand blender worked great on soups and was easier to clean than the standard blender.

- Have your teeth cleaned before the procedure.  You won't get to brush the inside of your teeth for up to a month. 

- Instant Messaging is a good way to interact without talking. 

- Benfiber

- Liquid Tylenol 

- Get your prescription pain medicine before the surgery and take a test dose for adverse reactions.

- Whole Foods is a great source for good soup.




















 Time Fillers:

- Create a website!

- DVDs

- TiVo

- email and IM

- playing with Photoshop

- jigsaw puzzles













































































































































































































Mmmm. Bagels.


My 1-10 pain scale

1 - A general "awareness" of the area

2 - Actual pain, but you're able to ignore it if sufficiently distracted.

3 - Pain that interrupts your thoughts.  Such that during a conversation, you're actually thinking more about your pain than what the other person is saying.

4 - Fortunately I don't feel the need to describe anything beyond 3 :)




My Fancy Post-Surgery Tomographic X-Rays


 Today is June 4th, 2006.  Twelve days Post-Op.

I decided to create this blog to share my experiences with folks who are considering Maxillomandibular Advancement (MMA) surgery for the treatment of Obstructive Sleep Apnea.

I found Roger Arrick's (aka WesternJoe's) blog incredibly helpful and it inspired me to share my experiences with those who might be interested. My username, CupertinoJoe, is in homage to him and I would like to acknowledge his site as the end-all-be-all site for Apnea MMA surgery. This site is merely an addendum for further reading.  Thank you Roger!

I also want to thank GP and TS for meeting with me in person to talk about their experiences.  That was great.

And Thank You to SeattleBill, Sleepy-In-Seattle, MikeInBoston and all of the other folks on SleepNet for the invaluable information. Even though I've never posted, I read the forum regularly and rarely had a question that you guys hadn't already answered for someone else.

Sincerely, 

CupertinoJoe

cupertinojoe at gmail dot com

About Me

I'm a 39 year old single male. I'm 5'6" and 155 pounds. Relatively healthy and enjoy cycling. I could be in better shape, but who couldn't.

I've been snoring reeaallly loudly since I was a teenager and always felt like my sleep was less than effective. Since college I've tried to treat the problem as allergies. I went to many different doctors and never made much progress. At some point along the way I heard about sleep apnea and felt that I may have it, but when I learned the treatment was sleeping with a mask, I turned away. I was unable to accept the mask as a solution and only have myself to blame for wasting several years of my life.

The Invisible Vampire

"Your family and friends may think you're crazy, but they don't have sleep apnea. They don't know how it can drain away your life like some sort of invisible vampire." -- sleepy-in-seattle

That's exactly what the apnea felt like to me. I've probably had it for 15-20 years, but the last five have really been wearing me down.  I was fairly functional during the day, but when I got home from work I could barely muster enough energy to watch TV. I felt like my life was wasting away. And "fairly functional" is debatable. The effects of sleep deprivation were having serious implications on my job. Stress and anxiety were the order of the day. My boss even dubbed me the "official worrier". Even though I'm prone to stress, I can tell now (post-cpap) that the sleep debt was the driving factor in most of my grief.

Do you doubt?  Have a listen to my ever so restful sleep.

Now I Know

Over the course of 2005 I learned everything I could about sleep apnea and treatment options. I had two sleep studies done, confirmed that I had the condition, and started using a CPAP (auto-PAP, actually) in June, 2005. I had mixed feelings of joy, to know that I finally found the source of these problems, and disappointment with my options. But just to understand the problem was a huge relief.

Now I know why my sleep is so miserable.
Now I know what good sleep feels like.
Now I know how "normal" people feel.
Now I know...
        Sleep is a good thing.

The Inner Debate

So my options are to sleep with a CPAP for the next 35 to 40 years or have extreme surgery. (Note, the doctors don't seem to consider it all that extreme or complicated. But when you're talking about rearranging your own face, it feels pretty extreme.) This inner debate raged on in my mind daily from January, 2006 into April. Sadly, all that new found energy from my cpap-enhanced sleep was being spent pondering the big decision. Fortunately I had a calm, clear head to reason with.

Ultimately the decision distilled down to: If I'm every going to have this surgery, now is the time. So, considering my frustration with cpap, the amount of regression that seems to have occurred over the last several years, and the lack of potential new solutions on the horizon, I concluded that, Yes, this surgery was inevitable at some point in my life. If I decide not to do it now, I will surely have to do it 5-10 years from now. Therefore, I should go ahead and get it over with and reap the rewards now, even if I don't feel quite ready for it. For me, the timing was right. My job is stable enough to leave for a month. I have good insurance. And I currently live within 20 minutes of the best doctors in the world. I can't imagine a better scenario. I am very lucky.

In early April I scheduled the surgery for May 23, 2006. It was sort of a passive-aggressive move on myself. I was having a hard time accepting the decision that I had made so I told myself, "Go ahead and schedule it for two months out, so you can have some time to bail out if you want to." But once the ball starts rolling, it's easier to just deal with the emotional wake than to try to stop it. The strategy worked. One 5 minute phone call was all it took.

Pre-Op

After scheduling the surgery things started to move pretty fast.  I started telling folks at work and friends and family that didn't already know.  Somehow I became more at-ease with the decision after I started talking openly about it.  I had been fairly concerned about the potential "you're crazy" reaction.  (Which I did get from a few folks)  But as I explained my situation to them, it felt more and more like the right thing to do. 

Until May 11th.  That was the day of my pre-op appointment where we took all the x-rays and photos and discussed the details of the procedure.  That's when it really hit me that I was about to do this thing.  That was some serious anxiety and I ended up leaving work just because I couldn't concentrate at all.  All of my confidence just flew out the window.  Apparently this is normal though, and I tried to keep telling myself that and just ride it out.  I had some good friends to talk me through it and by the next day I felt a lot better.

I was sort of expecting another anxiety fit as I got closer to the Big Day or possibly as I hit the gurney.  But it didn't happen.  Everything went pretty smoothly after that.

It helped to be busy.  I was pretty preoccupied trying to wrap things up at work, since I was going to be out for 4 weeks, and getting ready for my convalescence at home.  I stocked up on smoothie fixin's, protein powders and anything else I could find listed on the web as good suggestions.  Zero-day was here before I knew it.

The Big Day

My surgery was on Tuesday, May 23, 2006 at 7:30am.  My mother and I arrived at Stanford Hospital at 5:30am and checked in at the Ambulatory Surgery desk.  After filling out a small amount of paperwork I was given my wrist bands and then taken in for a quick check of blood pressure etc.  Then on to the pre-op room where I donned the gown and booties and climbed into a  bed.  (Leave it to Stanford to have designer hospital gowns by Karen Neuburger.  Sheesh)  Shortly thereafter my mother joined me and we waited for the anesthesiologist to come and "hook me up".   It was interesting to watch the pre-op room grow from the quite anticipation of a few patients at 6am to the full blown pre-op hustle and bustle of nurses and anesthesiologists prepping and rolling people out of the room by 7am.  At some point around there I was rolled into the operating room as my anesthesiologist kept me chatting away about a recent vacation.  The last thing I remember is hearing the nurses say hello to my surgeon as he walked in the room. 

The surgery lasted about 4 hours.  My upper and lower jaws were moved forward and rotated such that the chin moved farther than my upper jaw.  So the upper jaw was moved forward 6-7mm and the lower jaw moved forward 12-14 mm.  The result, which can be seen in my x-rays, is an enlargement of my airway from about 3mm to 9-10mm.

I think I remember being awake around 1:00 and seeing the surgeon and my mother, but the rest of that day is pretty much a blur.  Ironically, the only thing I really remember is asking the surgeon some details about the procedure and him saying "Don't worry about that now; you won't remember any of this."  I also remember having some nausea and spitting up some blood.  I spent most of the day in the post-op recovery room because they couldn't find a regular room for me until about 9 o’clock that night.  I didn't really care at that point.

Sympathy shot

I think I slept okay that night but I was pretty drugged up.  It wasn't until the next morning that I really started to become conscious of my situation.  There was pain but it wasn't a sharp incision-like pain.  It was more of an ache in the whole lower half of the face.  It was a squeezing pressure like someone was standing on your face, uncomfortable and annoying but not a wincing pain.  As the nurses give you your pain meds they ask you to rate your pain on a scale of 1-10.  I was usually around 5-6.  The highest I got up to was about a 7, but I have to admit I was gaming the system a little because I was hoping the pain meds would take me down to a 2-3 if I got a little more of them.  It didn’t really help though.  Later I asked the nurses about this and they said that the pain meds are there to get you down to the 5-6 range.  So if you're at that level the meds are working and your body will take care of the rest.

Day 1 was a long slow day. I tried to sleep as much as I could.  The nurses were great accept for some minor complications with the catheter.  I did get a little annoyed that the only way to get help was to talk over an intercom.  This would have been fine if I could talk!!  Here's a tip:  Ask your nurse to tell the dispatcher that you can't talk, then when you ring them they can just send someone to check on you instead of making you repeat "Mu cafiiier ii-uu wukee"  three or four times.

The pain seemed to pick up a little in the afternoon with a major headache.  I suspect that this was aggravated by caffeine withdrawal.  I typically drink 2-3 cups a day and suddenly stopping can be unpleasant.  My efforts to increase the pain meds were mostly to deal with the headache.  One of the nurses brought me some coffee with an ice cube in it, but I think it was too little too late. 

Later that afternoon the surgeon came by to check on me and brought a scope to check out his work.  He did some looking around and then sucked a bunch of gunk out of my nose.  Man, that was nice!  I could breathe like I had never breathed before.  It felt like my airway was the size of a dryer vent.  Wow!  I was also taking Afrin which helped a lot too.  Then he left me with some instructions for the day: to breathe deeply, to drink, and to walk. 

By that evening I was walking around pretty good.  Especially after they disconnected the IV rig.  But I didn't drink very much.  Maybe some chicken broth and some tea and water, all through a big syringe.

So I was feeling okay that evening, but that night was rough.  I started having some painful heartburn and nausea, presumably from the ridiculous amounts of saliva (see below Days 3-5).  They were giving me as much nausea meds as they could and I think at one point they had to contact the doctor to authorize some stronger stuff.  That was the worst part of this whole experience right there.  That night sucked.  At the time I swore it was worse than any tequila binge or stomach virus I've ever had. But in retrospect, there was no heaving, just burning and nausea, so it couldn’t have been that bad.  Maybe you just forget the pain.

Day 2 was better. After the last dose of nausea meds (a suppository, ick) I finally got some relief and fell asleep.  The next morning I felt better but still not great.  I was hoping to go home that day (Thursday, May 25) so I tried to convince myself that I felt better.  It actually seemed to work.  The doctor came by about 2:00 and checked me over.  He asked how I was doing and I said emphatically. "I want to go home!" .  Apparently that's a good sign, so he discharged me.  

On our way home from the hospital he had me swing by his office so that he could clean out my nose again.  The wind-tunnel breathing was back and I felt good again.  I really appreciate the attention that he paid to keeping my nose clear.  Congestion can easily turn a bad situation into a miserable one.

Back at home, I settled onto the couch and started the long wait.  The worst was over.  It was done.  No more consternation.  No more fear and anxiety about the crazy surgery.  And if all works well, twenty years of sleep apnea....gone!

Post-Op

Days 3-5: Back home

The first few days home were pretty slow. Eating from the syringe was a chore. I spent most of my time either eating or sleeping. Watched a little TV. Pretty low energy. Lots of drooling.

The Drool. Oh, the drool: It was difficult to sleep because of all the saliva. I had to take Maalox to deal with it. After a while I just started carrying around a spit-cup, but that didn't help too much at night.. Apparently the drool is just the result of "irritation in the mouth" from the arch bars and the stitches. Fortunately it didn't last more than a few days. Pretty much gone by day 5.

Colorful Mucus: I was hacking up thick bloody, bright red globs of mucus (Sorry for being so vivid, but I was surprised by how red it was.). Initially there were 4-5 globs a day tapering down to one a day for awhile. However, I don't think I had as much congestion as some other folks because my doctor was very thorough about clearing out my nose. Plus I was still using Afrin for the first 5 days. The combination made my airways clearer than I've ever experienced. I can breath!!!

Some pain: The pain is pretty persistent but not intolerable. It felt like my face was in vice, plus the occasional headache. I took liquid prescription pain medicine every 4-6 hours and some antibiotics for the first 4-5 days.

So-so Sleep: Sleep is very difficult because it's hard to get comfortable sleeping propped up on lots of pillows. You have to keep your head elevated for the drainage but you don't necessarily have to lay on your back. Either on my back or side I was never really able to get comfortable. But I did manage to sleep. My nights, however, were punctuated by waking up drenched in sweat 2-3 times a night even though I didn't feel particularly warm. Maybe that's just a side-effect of all the meds?

Calories: As I mentioned, eating was a chore but I tried very hard to keep my calories up, as well as protein, nutrients and fiber (don't forget the fiber!) Click here for info about what I ate, er, drank.

Fiber: All bodily functions were back on-line by day 5 without much drama.

Days 6-10: Speedy Recovery

Over the next four days I started to feel significantly better. My energy was coming back and the pain wasn't as persistent. There were occasional moments, if I was sufficiently distracted, when I felt almost normal. The drooling cleared up and sleep got easier. Basically, I settled into the routine and started feeling better. 

Getting out of the house: On day 6 I went for a 45 minute walk and on day 7 I drove myself the 20 mins to the doctor's office.  It felt good to get up and around but it did wear me out pretty quickly. 

The Syringe: I ditched eating with the syringe after two days at home. It was just too much trouble. It was easier to stick to thin liquids that I could drink from a glass and suck though the gap between my upper and lower front teeth. Buy a strainer! It became my most used kitchen implement.

Who's that in the mirror?: The biggest issue for me at this stage was psychological. I can't really describe the feeling of looking in the mirror and seeing someone else looking back. It was just too strange. The closest thing is maybe seeing yourself on a video, where you have that "Is that what I really look like?" effect. But to have that feeling looking in the mirror is even more extreme. And it really hit me hard on day 10.

We decided to get out of the house and go to the mall. There was a sale at Banana Republic so I thought I'd try on a shirt. I took it into the dressing room, put it on, and then looked up into the mirror and BAM! I don't know if it was the lighting or that it just caught me off guard or what, but I looked totally different. And I didn't like what I saw. It really freaked me out. Very disturbing.

It happened again when I went to the doctor's office on day 13 for a follow up visit and the receptionist didn't recognize me. I took it better this time, but it was still strange. Hopefully this will get better as the swelling goes down.

Doctor visitOn day six I had a follow up visit with the doctor.  Everything was progressing well.  He cleared out my nose again and took me off the Afrin. 

Days 11-14: Leveling off

Sleeping okay. I'm sleeping 9-10 hours a night and usually wake up once or twice. The sleep is good but not yet great. Not as good as with the CPAP. The night sweats are tapering off but still happen every other night or so.

Off the meds. I don't have much pain during the day. Just discomfort and pressure. During the night the pain kicks in though. Maybe just due to the lack of distractions or maybe I'm putting pressure on my jaw in a different way. So I usually end up taking some over-the-counter liquid Tylenol during the night.

Some numbness. My whole chin and lower lip are very numb, but I can feel some pressure and have some muscle control. I tend to dribble a little when I drink because I can't feel if I have a good seal on the glass with my lips. I also have some slight numbness in my upper cheeks and the sides of my nose and the whole roof of my mouth. It feels like I'm wearing a plastic retainer in my mouth. I'm trying to be careful of hot drinks because I'm afraid of burning the roof of my mouth without knowing it. This may be a little unfounded since my tongue is perfectly normal. I haven't yet felt the tingling sensations that others have reported. I'm anxious for those signs of regeneration.

My energy is picking up.  I'm able to do short errands like going to the grocery store and even ventured out to the mall a couple of times. However, I get pretty worn out after a couple of hours. This is much better than I expected. I live on the third floor and thought that climbing all those stairs would really slow me down but it's not too bad.

I'm starting to talk now. Some friends came by to drop off a gift so I forced myself to talk. Initially this caused some cramping of my cheek muscles. Then later that night I tried talking on the phone and apparently I was understandable. In fact I had to use the BlueCross automated phone system this morning and it seemed to understand me better than when my teeth weren't banded shut! But then the doc told me that talking would prolong the recovery, so I'm trying to cut back.

Two week doctor appointment: I was hoping to get the bands loosened enough to get off the liquid diet, but no such luck. At least one more week of soup for me. Otherwise things went well. Cleaned out my nose a little and discussed my x-rays. My airway went from about 3mm to almost 10mm. Big improvement! He had wanted to move my jaws further but didn't think that the aesthetics would work. I'm happy with the compromise.

Three Weeks:

Smiling:   Some people have asked for photos of me smiling, so, here you go.   The reason that I haven't been smiling in my photo progression is because my smile is all messed up from the numbness and is fairly inconsistent.   The "straight face" makes for a better comparison from day to day.   But as you can see, there are some issues with nerves and muscle control that hopefully will go away soon.   If they don't...well...I'll deal with that later.   For now, I'm just counting on time to heal.

Sleeping:  My sleep is pretty good.  I'm still sleeping about 9 hours a night and wake up rested.  I've discovered that I can actually sleep on my back now.  I haven't been able to sleep on my back (and still breath) for 15 years.  Wow, that's kind of neat.  And, as I'm told, when I wake up my eyes are brighter and I'm not grumpy anymore.  Very pleasant.  I suspect that it will get even better when the pain is completely gone.  I still wake up at least once in the night and have to take some Tylenol.

Breathing:  I can breathe better in general too.  My airway actually feels wider because there's less resistance on the inhale.  My septum is still very deviated but it is a little better.  Before the surgery I could hardly breathe though my left nostril at all.  Now I at least get -some- air through it.  Nice bonus.

Eating:  I'm still on a strained liquid diet.  It's not really that bad.  I don't find myself craving normal food as much as I expected and eating dinner with other people is not as torturous as I had been warned either.  I guess I properly prepared myself for this aspect.

Hurting:  The vice-like pressure in my upper jaw is pretty much gone but has been replaced by pain in my teeth.  My new bands are attached at an angle that is pulling my lower jaw forward and the contact points are at my canine teeth.  The lower teeth are pressing against the upper teeth with the full force of the 4 rubber bands and it's causing a fair amount of pain.  I'm not sure what the objective of this process is, but I feel like it's doing bad things to my teeth.  I plan on asking about this during my next appointment in two days.

Resting:  I'm still taking it pretty easy.  Occasional trips to the grocery store and Blockbuster are about it.  I did go to the mall again for a couple of hours and did okay but I don't want to push it.  I've  heard a couple of stories of folks who tried to go back to work at three weeks and ended up prolonging the recovery, so I'm trying to heed that advice.  I'm scheduled to return to work in one week.

Talking:  Talking is getting much easier and clearer but it causes little muscle cramps in my lower cheeks/jaws.  This is a good reminder that you're not supposed to be doing that! 

One Month:

Happy Happy!

No more snoring!: Over a year ago, when I started this process, I made some recordings of myself sleeping.  My snoring was horrible and it would last for hours.  I can certainly understand why all those pillows have been thrown at me over the years.  So the other night I recorded myself again.  Not a peep!!! It was amazing!  Regardless of the apnea, that is a huge improvement in my quality of life.  That’s almost worth the surgery right there. Well, maybe not, but it is a great thing.  Check out my Snoring - Before and After.

Caught a cold On day 19, I was feeling pretty good so my sister and I drove out to a local park and did some walking around along the creek and then a little 30 minute hike along a trail.  It felt great to be outdoors even though I was huffing and puffing for most of the hike.  When we got home I was wiped out for the day.   It was fun but I think I pushed it a little too far.  Then the next morning I woke up with a sore throat that became a cold.  I'm not sure how that happened during my limited ventures out of the house, but it did.  It was a pretty mild cold but it really set me back.  Fortunately I only sneezed once through the whole process.  Unfortunately, the congestion put an end to my wonderfully clear breathing.  Even though I’ve recovered from the cold, my breathing is now in the same constantly congested state that I had before the surgery.  That's a bummer.

A couple of bad nightsGenerally my sleep has been very good and seems to be about at good as with the cpap.  I’m sleeping about 8-9 hours a night now and wake up feeling moderately okay.  With the exception of the 2-3 nights before getting my arch bars removed.  In fact, the day that I had my bars removed happened to be a really bad night of sleep, on par with my pre-cpap days.  I woke up all cranky and angry.  The folks at the doctor’s office seemed disappointed that I wasn’t more excited about getting my bars removed, but I just felt sleepy through the whole process.  The doc didn’t seem too concerned about it and pointed out that even people without sleep apnea occasionally have a bad night of sleep.  That little piece of obvious-ness made me feel much better.  I was afraid that surgery didn’t take for some reason, considering that he wasn’t able to move my jaws as far as he had wanted.  My sleeping has improved since those few nights, in fact it's really  good, but I still have that little fear in the back of my mind that somehow, someday, the apnea is going to come back.  I suspect that this is a common feeling.   As WesterJoe says "You're normal, celebrate"

No more Arch BarsAs I mentioned, I had my Arch Bars removed on Day 27: June 19th, 2006.  The process was pretty straight forward.  He gave me four shots around the gum line to deaden my mouth.  Apparently the shots contain epinephrine and they sent my heart racing.  He had to give me a few minutes between the 3rd and 4th shots for my heart to calm down a little.  I haven’t had much dental work done so maybe that’s normal.  But it quickly passed and I was thoroughly numb so he began un-twisting the wires and clipping them off.  It only took about 10 minutes and then I was FREE.  My gums did bleed a little but not too much.  I remained numb for several hours after that.  The removal of the bars made a subtle change in my appearance.  Check out Day 27 in my photo progression.   

Back to work… “You look different!?!?” The next day, exactly 4 weeks after my surgery, I went back to work.  It was a strange experience to watch people’s reaction.  Most of them knew I was having “jaw surgery” but didn’t really register that there would be a change in appearance.   So almost every person that I saw began the conversation with “You look different?!?!” in a confused and inquisitive way.  I still have a little swelling in my cheeks that makes the changes more noticeable.  Hopefully when that goes away it will have less of an impact on people.  Christmas should be interesting when I see my relatives that I only ever see once a year.  I wonder if they will even notice.  But, for now, the folks at work are being great.  And after four days they seem to be getting used to my new face.

Apparently I talk too muchOn my first day back to work I was only in the office for about five hours but it felt like I was talking the whole time.  I was either telling folks about the exciting world of tomato soup or catching up on what had happened while I was gone.  By 4 o’clock my mouth was killing me.  It felt like I had a tooth ache in every tooth and my cheek and jaw muscles were sore from overuse.  That night I was back on the Rx pain meds once again.  I’m starting to run low on the good stuff and I’m afraid that I’ll run out soon.  Time to start rationing.  For the rest of the week I decided that if I can’t keep my mouth shut I had better just work from home, so I limited my time in the office to 4 hours and that seemed to help.  I'll try to make it for a full day next Monday. 

Two Months:

Life is slowly getting back to normal.  I am fully re-engaged at work, but I'm probably spending too much time there because I don't get tired like I used to.  It's nice, but I think I need to find a hobby. I don't want to spend all my new-found energy at work!  Sleep is good but the diet is still pretty limited, and I'm slowly accepting the new face.  There have been some ups and downs but I still think this was the right decision for me.

Sleep:  I'm sleeping for about 7-8  hours a night and wake up reasonably refreshed, but occasionally I have trouble getting to sleep.  I'm not particularly stressed out, but I'm not particularly sleepy either.  I seem to go though a cycle where I'm up late for 2-3 nights then I go right to sleep one night and get 8 hours and then 2-3 more nights laying in bed awake.  Interestingly though, I feel fine even on days where I may have only gotten 5-6 hours of sleep.  I'm amazed by the effectiveness of real sleep!

My quality of sleep seems better than when I was wearing the CPAP.   Maybe that's just because I'm so much more comfortable without my head being constrained by that hose.  Man, I hated that hose.  You know that feeling of starting to roll over but the hose is stuck under the pillow and it just yanks your head back?  And the joys of waking up to the whistle of a leaky connection and having to get up and fiddle with everything to make it go away?  And don't forget that lovely masked look.  Well, all of that is gone now.  Sleep feels more natural and I occasionally have to remind myself of what it was like with the CPAP and before.  Even though it was only two months ago, CPAP seems like a distant and vague memory.  Don't get me wrong though.  I think CPAP is a wonderful invention and I'm grateful that it exists.  I don't think I would have considered this surgery without first experiencing what good sleep really feels like.  And surgery is not the right answer for everyone.  CPAP is a perfectly viable solution for many people.  It has its downsides, but so does MMA.  You have to make the decision that is right for you.

The Looks:  I'm still dealing with the change in appearance.  I haven't fully adjusted to that face in the mirror and I feel a little self-conscious around acquaintances at the office who know I look different but don't know why.  Although, it is getting better for me.  The other day someone that I hadn't seen since before the surgery and who didn't know about it, tapped me on the shoulder and when I turned around they said "Oh, sorry, I thought you were someone else."  But when I started talking they realized that it was really me.  The good thing about it was that it didn't even occur to me at the time why he said that.  It was only later that day when I thought, "Hmm, I should have asked him if I looked different"  when I realized what he had said.  He had already answered my question.  So, yes, it is strange, but I'm becoming less self-conscious about it.  I look different.  I knew that I would.  That was the price of my decision and now I just have to learn to live with it.  As I've said before MMA is not without its downsides, but so far I feel that the positives outweigh the negatives.  I wasn't exactly Brad Pitt before the surgery so looking different shouldn't be that big of a deal.

Pain and Numbness: The pain is pretty mild now and mostly limited to my teeth.  My teeth are sensitive to pressure and temperature so eating can be a challenge.  Whenever I get ambitious and try to eat something that I would normally have considered "soft", like a tamale, I end up regretting it and going back to eating mush.  The roof of my mouth still feels like there is some pressure but it is still very numb so that may be related to the stretched nerves.  The left side of my chin and lower lip are also still very numb, however the right side feels like it is almost back to normal. 

Still Eating Mush:  My diet isn't too exciting.  I'm eating lots of pasta, potatoes and beans.  The diet restrictions bother me occasionally but every time I try to push the limits I regret it.  It's interesting how the mind adapts to avoiding things that it associates with pain.  I don't crave steak or bagels or all the things that I expected to miss.  They just don't appeal to me.  Sometimes the limited diet even makes eating more interesting because I find myself wandering through the grocery store looking for soft foods that I would normally pass by.  And apparently I've been pretty resourceful at finding things to eat because I'm back up to my pre-surgery weight.  Oh well, so much for the "weight loss side-effect" diet.  I guess I better start exercising again.

Six Months:

The Scruffy Look

Wow.  It's amazing how fast time flies.  I can't believe that it's already been 6 months.  So far everything is going pretty good.  I had my post-op sleep study and my RDI is down to 7.  Pretty dang good.  That's about as good as I could have hoped for and is the same result that I was getting with my CPAP.  My sleep is great.  I've leveled out to a pretty steady 7.5-8 hours of sleep a night and my schedule is getting more regular. 

Lingering Pain:  The only remaining issues are the pain in my upper teeth and a patch of numbness on the left side of my chin.  I still have to eat soft foods.  I've tried to eat steak by cutting it into small pieces but it still causes enough pain to ruin the experience and make it not worth the effort.  Tylenol helps and I still take it occasionally at night because that's when I seem to notice the pain the most. I got a little too optimistic over Thanksgiving and tried to eat fairly normally but I'm regretting that now.  I'll try going back to soup and mush for a while to see if that helps.

Sleep Study:  As I mentioned, I've had my follow up sleep study and things look pretty good.  My RDI went from 42 down to 7.  That's still considered mild apnea (5 and below is normal) but that's about what I was getting with the CPAP, so I'm happy with it. 

Image Issues:  As I've mentioned before, the biggest issue with the whole procedure has been the new face.  I'm pretty much used to my new looks now and rarely think about it any more.  In fact, I've noticed that I've started identifying with my new face.  What I mean is, now when I look at before-and-after photos, the old pictures are the ones that look "odd" to me instead of the new ones.  It's wild how your brain adapts to familiarity.  I don't freak out when I look in the mirror anymore, so that's a good thing.

The Obsession Fades:  During the first half of this year I was fairly consumed with this surgery and sleep apnea, as you might have noticed by my website.  I had observed that most people who kept blogs seemed to fade away after just a few weeks of entries and I wondered if it was just that their lives had returned to normal and that they just didn't think about it that much any more.  At least not enough to have anything to write about.  Now, I can confirm that this is true, for me anyway.  I just don't think about the issue very much anymore.  It's nice.  (And I have to admit, if I hadn't had a "Coming November 2006" place-holder on the site for the last few months I probably wouldn't be writing this note right now.)  My point is,  life is pretty much normal for me now.  And I mean "normal" for a normal person.  Life is good. 

I'll try to update this page in the future to let you know how long it takes for my teeth to heal, but I'm not sure when.  Maybe February 2007?  Until then, I hope everything works out for you no matter what your decision turns out to be.  And if you're ever in the Bay Area and want to talk, feel free to send me an email.  Good luck to all of you!

Nine Months:

 March 3, 2007:

Time for a nine month update.  Sleep is still good but the total recovery is going pretty slowly.  In my last entry I talked about how my teeth were still hurting and that I was back to eating mush, so in January I contacted my surgeon.  He said this was very unusual and sent me to an orthodontist that he works with closely.  The orthodontist did a very extensive examination but could not find any obvious problems.  My alignment was perfect.  My teeth and gums looked healthy.  My range of motion was limited but not too bad.  He was stumped.  There were a few theories ranging from limited blood flow to nerve damage, so he proposed a plan to address possible causes one-by-one.  The first step was to address blood flow and possible internal swelling by doing a sort of physical therapy for my gums and taking lots of Advil.  He gave me a plastic wafer to chew on for a few minutes a day that is supposed to stimulate blood flow.  I call it my chew-toy.

The chew-toy and Advil are working.  My recovery started making progress again and in a matter of weeks my teeth were feeling much stronger.  Now I'm able to eat chicken and many firmer foods.  I haven't tried steak yet, but I can eat peanuts and carrots as long as I'm gentle about it.  And even when I do get over-aggressive enough to increase the pain, it only seems to last a few hours instead of a day or more.  I can definitely tell a difference from one week to the next.  It may take a few more months to go away, but at least there is observable progress.  My benchmark is a toasted bagel.  One month ago I would have to tear a bagel into small pieces in order to eat it.  Now I can actually take a bite and chew without thinking much about it.  I love bagels, by the way.

Three months ago, I was at a constant level-2 pain (see my scale to the left) and if I ate something firm I would shoot up to a level-3 and it would take 2-3 days to get back down to a 2.  In my last entry I commented about "regretting" eating certain things.  It was the 2-3 day recovery that caused the regret.  Now, I'm typically around level-1.5 and eating a solid meal only takes me up to a 2.  Nuts can send me to 3 if I'm not careful, but even when that happens I return to 2 in about an hour.  

So, in conclusion, the current status of my teeth is small amounts of residual pain in my upper gum line and a general "spongy" feel to my upper teeth, as though they are still loose.  When I eat hard things the pain increases for a few hours but rarely to a distracting level (level 3).  However, as I've been chewing more, I now have some pain in my left TMJ.  This is probably just due to a lack of usage resulting in tight ligaments and weak jaw muscles.  The new jaw pain seems to be subsiding also.  Recovery is progressing, but slowly.

P.S.: Hmm, in retrospect, that report was pretty focused on the negatives.  I should probably reiterate that my Apnea is cured!!!

Life is still good.

I'd also like to thank the folks who have given me great feedback about the web-site and to congratulate those of you who have made it to the "other side" over the last few months.  I hope Life is good for you too!