Surgery and my throat?

[wdcgator]

What a wonderful message board. I just found it this morning. A lot of great information here.For what it is worth I had four operations on my throat to stop snoring and keep my wife in the same room with me at night. None of them worked. I wish I had known how painful it would be the first time but I went back three more times. I now have a terrible gag reflex all the time. I choke a lot and cough a lot. It was the worst and dumbest elective surgery I have ever had. The BIPAP machine with an oxygen generator tapped in gives me the best nights sleep ever. My wife is used to all the humming and noise. Best of luck to everyone here. I actually purchased the BIPAP on e-bay before they cancelled the auction. Way better machine than CPAP for me any way. It breathes when I breathe and is not a constant hurricane....

Thanks for this forum...http://www.wallycrowder.com

~WC~

[billinseattle]

WC,

Good work on the Bipap ! A buddy of mine recently got a nice off-label one as well. My only concern/ comment is that it is appropriately calibrated to your requirements. As it seems to work, it might be. But, I wouldn't completely make that assumption.

Did you get tested for Apnea as well as trying to eliminate your snoring ? Loud snoring frequently is associated with obstructive apnea. If you have machines set at a level to treat snoring, they may not be at a level to treat obstructive apneas. Clearly this would be a incompletely treating you and a disservice .

Which procedure (s) did you have ?

Throat surgeries hurt by their very nature. I'm not thrilled by them...and don't endorse or support (unless they are a last resort) as they are high on the pain-to-benefit scale.

Good luck,

Bill

[wdcgator]

I took the machine to a local company who cleaned and serviced it and set it at a low like 3-4 setting as I remember. I sleep real good with it and no more snoring. As for the operation. Stupid me just fell for the hipe at the time 7 years ago. Wish I had my throat back..I should have waited and slept in another room..All the best. ~WC~

[GaSnorer]

I was wondering what kind of throat surgery you had - I am scheduled for a tonsillectomy, adenoids removed, along with shortening the palate in the back of my throat. I have had a sleep study and my apnea is not severe enough for a CPAP machine (and I REALLY did not want to go with a machine, I'm only 41) but my ENT did say that this surgery was up to 85% success at curing and almost 100% at making it better. I do need to lose about 25lbs and stop drinking alcohol several hours before bed but I think this will help to kick off the two things that I need to do. Please let me know if anyone else has had this surgery and if it's been successful.

Thanks,

GaSnorer

[wdcgator]

i would have the tonsils and adnoids out but "DO NOT" remove the uvula and back of the throat.. Just my suggestion. I would give anything to have the chance to have never done it.
You can lose weight just put your mind to it. You said it. Just stopping drinking will accomplish everything...... Good Luck...

[Billinseattle]

GA,

I believe that your estimates are highly individualized and probably very optimistic.

Getting the tonsillectomy and UPPP will be painful...everytime you swallow. Even just getting the T & A done is pretty painful. It is doable, with the right pain meds and tricks.. But, expect to lose weight and essentially be on thick liquids for about two weeks. Since there are irreversible minor side-effects to having a UPPP (retrograde liquid regurgitation...soda fizz with everything, foreign body sensation....a marble stuck in the back of your throat, and possibly inability to use some CPAP devices in the future because of a lack of sealing ability) , I would call the UPPP a high pain to benefit procedure.

In most cases, the UPPP doesn't completely work (won't eliminate apnea, might eliminate snoring in some) and relapses with time. In which case you might be left with CPAP in a year or two anyway.

Getting rid of large tonsils may be helpful for both snoring and OSA. But even this is seldom curative. See if the ENT will do a "capsule-sparing" tonsillectomy. This will reduce the raw surface area, result in somewhat less pain and also reduce post-op bleeding risk. A slight modification in the UPPP by making a uvula flap insteading of cutting it out may reduce the chance getting a foreign body sensation later as it scars down. Peri-op steroids (a choice made by your surgeon) will also substantially help the pain if it is available.

I took the opposite approach. I was diagnosed with OSA when I was 40. Didn't want surgery because I was young. Tried every type of mask & machine available...but couldn't make them work. And then tried various procedures in three phases...ending up having my jaw and tongue advanced at age 42. Now, my OSA is gone. I live without the need for any device...but there is no free lunch. Actually, the UPPP was more painful (but doable) than the jaw advancement.

In retrospect, knowing the odds of success with the UPPP (in the medical literature less than 30% in a poorly done subjective study),I would've skipped it as a waste of time , money and pain.

Your mileage may vary. If you have apnea that is mild-moderate, and the right anatomy (ie, huge tonsils), this operation may work for you. That is what I'm hoping since you were quoted such good numbers. If you work the angles right, the T & A and UPPP are certainly doable.

Good luck,

Bill

[wdcgator]

Bill said it way better than I could. Having the laser surgery on the back of my throat even causes be to cough way too much. It may sound dumb but even after a love affair with my wife I have to cough and can't stop. The pain you speak of is the worst pain I have ever felt and I am a stuntman. Even my broken back did not hurt as much. It takes exactly 14 days for the pain to subside. You can't swallow and even pure liquid codeine does not work. After the operation it actually gets worse on day 5-8 going into the ear canals... Oh well, enough negative. I just know 7 people like me personally that hate having their throats burned out.

[Billinseattle]

Now the flip side,

While I don't endorse the UPPP for reasons stated earlier...you can manage the pain.

First, modified techniques help. Old school surgeons are rougher on tissue and remove more tissue. (* you don't have to be old to be "old school" and not every old surgeon is "old school"). Avoid the old school surgeon ! The ENT sub-specialty has undergone a generational change in technique in the last 15-20 years. Surgeons who practice with newer techniques will have results that are improved with less pain and side-effects. Not taking as much uvula and constructing a flap; Not taking as much soft palette; not using as much electro-cautery; modifying the tonsillectomy (ie, since it isn't being removed for infections, it doesn't matter if some tonsil or capsule is left behind) , etc... All of these variations will help.

Second, the right drugs help. Steroids have been used for years to help pediatric patients with swelling and pain after throat surgery. If your surgeon uses them (on adults), then it will likewise help your swelling and pain. Post-op from my UPPP/tonsillectomy I was prescribed a prednisone taper . I had very little pain until day 8 when it was finished !

Third, pain meds. As an adult...and as a young guy, we are in the worst category for pain. We have more of it (a recent study verified this) ! Codeine may not cut it for a UPPP. Vicodin...is especially weak(it is commonly used on small old ladies; it has too much tylenol and not much narcotic) Oxycodone elixir (which is more potent) may be required to get you through....and surgeons should be compassionate enough to recognize it. Some surgeons are notoriously overly- optimistic in terms of estimating recovery time and the amount of peri-op pain (as if it had anything to do with their skillor technique). Hogwash. Patients should be able to say I'm intolerant of pain, or this drug isn't working for me...and have another one prescribed. If T#3 elixir works (codeine) great. If not, ask for something better.

Third pain meds, continued. Another option should be using local anesthetic sprays. Some knucklehead in the past made themselves toxic (probably by using the whole can in one sitting) with benzocaine spray. Therefore, most surgeons won't mention or endorse this option. Short 1-2 second bursts in the right spots worked to eliminate my UPPP/tonsillectomy pain for 3-4 hours. This minimized my use of narcotics...significantly. Unfortunately, you might supress your gag reflex, so you shouldn't eat or drink after using these sprays.

While narcotics work in some ways, they will not eliminate the pain as the pain results from having raw surface area in contact with anything (including saliva) that passes by.
That is the unique torture of any adult throat operation.

Fourth, hydration and nutrition. Coat those raw surfaces and keep them moist ! If you hurt, you won't eat or drink. This will further dry out those tissues and make them hurt worse. Not ice cream, but non-acidic juices and protein drinks (Boost, Ensure) kept those surfaces coated and wet. This really helps. Plus you get nutrition to help heal. Even if you have very little pain, plan on eating a liquid diet for 10-14 days.

I'm no stuntman. I'm actually a pain-intolerant wus. My back hurts when I break wind.
Nonetheless, I was able to plod through the UPPP/TA because of a combination of having an enlightened modern surgeon (who modified techniques, used steroids and knowingly prescribes big gun pain meds for younger patients) and by having a sense of enlightened self interest (I expected pain and sought out solutions to mitigate pain). I think I had moderate pain days 8-10 post-op and was able to stomp on it with the tricks noted above. I still had some pain days 10+, but it tapered off .

If you must have a UPPP (and do try to avoid it), you'll certainly remember the peri-op period , but it is manageable.

Bill