Re: For those of you who have had MMA
[Sleepnet.com's Homepage] [Sleep Disorders] [Sleep Links] [Search]

Re: For those of you who have had MMA

[ Follow Ups ] [ Post Followup ] [ Non-CPAP Forum23 ] [ FAQ ]

Posted by Captin Cannuck on April 01, 2008 at 13:06:17:

In Reply to: Re: For those of you who have had MMA posted by bredren on March 31, 2008 at 05:38:46:

Question: What is the best source of info to get prepared for the pre/post surgery?

Answer: The best source of all is this site - read the site and take notes. Pay attention to the MMA blogs. You wrote the doctor. That is good. I hope he gives a good answer. Docs are busy though (esp. in Canada). They don't need to drum up business b/c they have a huge waiting list, and ... it sounds bad, but they frankly don't need your business at all. If you don't sign up for the operation, they will just take the next guy in the queue. They will get paid the same anyways. The only benefit is that they have no interest in selling you any operations that you don't need. Their answers were more synical and much less "pie in the sky". Because of socialized medicine, Canadian surgeons can just as easily utilize their O/R time giving a patient an operation that he does need. For example, you already observed that most Canadian docs don't do UPPPs. The same is true in the European Union (see the Irish sleep apnoea website on that). I feel that in USA this is not always the case. American doctors need to fill O/R time and need to find buyers for their operations. Nobody on the table means they paid the rent for the O/R time, but had no revenue - a net loss for them. For this reason, they WANT you to get the MMA, the UPPP, or whatever is going. And, the thing is that good customer service means providing informaiton to customers (communicating frequently, giving full answers etc.). I doubt that Canadian surgeons will be very communicative. They were not so with me. When they wrote me, it was just very brief answers at best. Interestingly, and conversley, I typically got very very good information from prominent American doctors including K.L., Dr. P. (Atlanta) and many others. One thing to keep in mind: Remember, docs like these famous ones are kind of in their own league. They are not desparate for business. They have a demand for their time because of their fame. One example: I wrote Dr. N.P. at Stanford. He didn't answer my letter. Instead one of his junior partners did and provided lots of info, even suggesting that I have a redo of my UPPP. Upon consultation, Dr. K.L. told me that that would have been an absolute disaster had I done that. "Don't let anyone touch your palate" said KL "it'll mess it up even worse". The point I am trying to make here Breden is that an answer is not an answer. You have to think about if the person who gives you the answer is on his game and also if he has a motive for you to get a certain operation. Not all docs have your best interest first and foremost at heart. That is the truth of the matter.

Q. How long ago was my surgery?
A. My surgery was in November of last year. I am now about five months post-op.

Q. Are there any residual effects?
A. Yes, I have some residual apnea. I have improved greatly. I feel about 80% better than I did before the surgery. I would call the surgery a great success. On this point, I want to tell you something. You have to be realistic about MMA. Usually it is not a cure for most people. It will usually result in a significant improvement in your OSA. It IS definitely worth it. Some people do get a cure (AHI below 5.0). Most people improve very much, but not entirely. In my case for example, it is possible for me to sleep without CPAP now. Since the surgery, more often than not, I am waking up feeling great. I truly feel alert. I am waking up on my own. I feel a sense of energy. I am dreaming a lot. These are some things I notice. I have not had follow-up PSG. About MMA - if you read the studies, you will find that they will talk about a reduction in a group of people. For example, maybe a study was done on forty people. The conclusion you read is that they went from pre-op average of 41 AHI PLUS OR MINUS 15 to a post-op AHI of 9 PLUS OR MINUS 11. What does that mean. It means that some people after the surgery got a cure, one lucky guy got an AHI of one. Some people made it into the single digits but had mild apnea afterward, and some people came out with an AHI fo 12 or 15, etc. The point is that EVERYONE IMPROVED, but don't set your heart on a "cure". Most likely it won't happen. Probably you will have apnea for the rest of your life. No easy way out. On the other hand, after MMA, it will be much better. In my view it was worth it. If you end up going back on CPAP, but you are getting a better sleep than you did before MMA, its a victory. No quesiton about it. CPAP is not the enemy, sleep apnea is the enemy. CPAP, like MMA is a tool in the arsenal to fight OSA. You can use as many tool/weapons as you want in the battle. You can use them together if you want. Whatever produces the best outcome. That is my opinion.

Q. Does anyone know for certain that cpap doesn't work for us?
A. Well, a PSG study would show the effect of positive air pressure on your blood oxygen levels and also show how much you were experiencing awakenings due to apnea events. On the other hand, PSG tests do not show the "jolt" like sensations that I experienced. I was in great discomfort due to OSA. According to PSG tests, when I used CPAP my AHI was below five. It looked good on paper, but it didn't reflect the truth about what was happening to me. I would explain my situation like this:
- Without CPAP - Extreme discomfort, relentless jolts all night long, every couple fo minutes awakening me. Daytime dizziness.
- With CPAP - Some discomfort, but persistant jolts awakening me about three or four times per night. Felt unhappy about the jolts. Felt very depressed. No way out of nightly torture sessions.

- After MMA - Sleeping much much better. No comparison. Occasionally though, there is a jolt (e.g. maybe one jolt every other day or so, but a significant reduction). Waking feeling much much better. Debating about whether or not CPAP is beneficial. May return to CPAP or may not. Feel much happier.

So.. to reiterate, CPAP did help me before MMA. I am thankful for CPAP. I think CPAP is excellent, it just wasn't enough. I needed the surgery.

Q. Can a good doctor help determine the potential for success?
A. Absolutely. You have to find a good doctor. They will be able to judge your potential for success by looking at x-rays. You have already seen K.L. in Palo Alto. If you go to Halifax to see Dr. G., he will be able to tell you. They will tell you. If it is not good for you, they will tell you that too. Again, the best thing for you to do is book an appointment with Dr. G. in Halifax as soon as possible. You will have to wait for a year. Who knows where you will be in a year's time. You can always cancel the appointment. By the way, there are two waiting lists - one for a consult and the other for the surgery itself. As you know, in Canada the bad news is that there is a shortage of surgeons. There are big waiting lists. In Toronto if you go to an oral and maxillofacial surgeon, they can see you in three months. Dr. G. in Halifax has one year. Much longer, but the thing is - it's like a restaurant. When you go to a restaurant and you see a big line-up outside, there is a reason; it's because the food is good. You gotta go where the food is good, brother.

Follow Ups:


Post a Followup

E-Mail  :  required - same address used when you registered (will not show up in posting)
Password:  required (sent to you when you registered)

Subject : Re: For those of you who have had MMA

Comments:....note: including your email address here will result in the removal of your posting (See removal policy)

PLEASE ONLY CLICK THE SUBMIT FOLLOW UP BUTTON ONCE!!. Thanks, Sandman

[ Follow Ups ] [ Post Followup ] [ Non-CPAP Forum23 ] [ FAQ ]