surgery coming up

[Guest]

I've got uppp, tonsillectomy, and nasal septal reconstruction surgeries coming up next week. I was just curious how long it will take for me to benefit from the surgeries.

[Guest]

I just had UPPP two weeks ago. Pain is really bad for about a week. Then much better. Good luck.

[rested gal]

First Guest, here are some discussions that might be of interest:

Surgeries: UPPP MMA etc. Note particularly the very well researched, informative posts by BillinSeattle/Seattle Bill - he's been through about every surgery possible for OSA.

Jun 27 2005 subject: Tongue Too Big..Cant Breathe

Jun 19 2005 subject: UPPP anyone?

Jun 15 2005 subject: I had the surgery, still having problems

Jun 03, 2005 subject: surgical approach to OSA

May 30 2005 subject: Somnoplasty vs Pillar vs UUUP?

May 23 2005 subject: All I hear is NEGATIVE info on surgery for Apnea!

May 20 2005 subject: Surgery Options for Sleep Apnea - NEED ADVICE!!

May 19 2005 subject: help with study results

May 17 2005 subject: surgical and xray overview for OSA indicators

May 16 2005 subject: MMA/GA 4 months ago...

May 04 2005 subject: pillar procedure

Apr 30 2005 subject: Surgery and my throat?

Apr 24 2005 subject: Somnoplasty (Radio Freq. Tissue Reduction)

Apr 18 2005 subject: Important week, I must decide between UPPP and MMA/GA

Mar 12 2005 subject: Had UPPP and osa is back in full force

Feb 22 2005 subject: decision...surgery?

Feb 02 2005 subject: 2 weeks out from MMA/GA...whew!

Jan 22 2005 subject: Brother considering MMA surgery

Jan 12 2004 subject: surgery option experiences wanted

Dec 02 2004 subject: Has anyone out there had an MMA?

[Billinseattle]

Hey there,

Well, for all of that work, you'll have to be patient.

First you'll need to get through the recovery phase...figure 2-3 weeks. Then your airway morphs and transitions for a bit (no joke) as swelling comes down, etc...Most people benefit from the nasal work after a week or two. Benefit from the UPPP/TA might take a month or two .

What I discovered after my UPPP/TA was that I became a "silent apneic." My snoring was reduced ...but my apnea was still there (by educated observation from my bed partner). This was confirmed by a sleep study...which showed very little impact on my apneas (but improvement in snoring and some improvement in my O2 sats).

You'll kinda have to wait & see what benefits you get after a month or so.

Best of Luck,

Bill

[Guest]

just a quick question for u bill. Is your apnea weight related at all? I know these procedures don't seem to be as helpful for people who are over weight. I don't fall in the overweight category. Its merely a structural problem. My lingual tonsils are huge. and I mean huge. My snoring is moderate and has only come on in the last couple of years so i don't think the uvual is as significant a point of obstruction. My fatigue has lasted many many years, begining in my early teens to now (25). In addition, I have very congested nasal passages. I read a lot of posts about people who didn't have their apnea cured through surgery, but they don't give their background information.IE how bad their apnea is, obesity as a factor, age, other health problems etc. What Im interested in are the peoples stories and profiles that have actually benefitted from these surgeries. I need to reduce the ahi from 12 to 0 which is not that much. The 3 docs I went to have pinpointed significant points of obstruction which they believe are the problem areas. I hope these surgeries will do the trick.

[Billinseattle]

Hey,

First, there are actually very, very few posts about surgery fixing apnea. Only two procedures work with any degree of certainty...and both are very extreme. One is a tracheotomy (hole in the windpipe); the other is a upper and lower jaw advancement with tongue advancement (an MMA/GA...what I had).

The nasal surgeries are well tolerated and take about 1-2 weeks to get over. They work well for breathing through your nose in general...and will allow you to use CPAP better. IT IS NOT A CURE FOR SLEEP APNEA.

A tonsillectomy is probably overall a good idea. It will "debulk" the upper airway and allow more airflow at less pressure. In adults it hurts much more than in kids. No matter what, at some point in the surgical ladder, if you have big tonsils, everyone will recommend that they come out to facilitate whatever other procedure is being done.

The UPPP (UP3) is notoriously a high pain/ low gain procedure. It seldom works. It is based on poor literature and studies. When it does work, it is prone to relapse within a few years. The best numbers in the medical literature are 30-50% based on non-scientific post-op subjective questionaires. It tends to relapse sooner in larger people.

Conceptually the UPPP is an elegant idea. Practically, it is like building a narrow mineshaft without the shoring. It is doomed sooner or later to failure. By the way, there will be less pain and side-effects if the uvula is "flapped" and not totally cut out. The uvula is seldom the problem...and its removal is seldom an interegal part of a fix.

THE UPPP IS NOT A CURE FOR SLEEP APNEA in the vast majority of people.

I had all of these surgeries. The nose surgeries went fine as described above. The UPPP/tonsillectomy went ok (did I mention most people describe this as the most painful event of their life ?) ...but according to a follow up sleep study done 3 months later, it didn't do a thing for my apnea (it did improve snoring and O2 sats).

My background is that I am now 42 and generally in good health with no other medical problems. I was pudgy, but not obese or fat. Probably 10-15 lbs over ideal body weight. About average for a middle age guy. No "dunlap" over the tighty-whiteys (soory TMI). I probably snored and have had apnea since my late teens by most accounts. I decided to do something about my apnea 2 years ago. I tried and failed 8 masks and 3 machines. My apnea was so bad (AHI 92, O2 sats down to 57% and avg 84%) that I repeated the sleep study in disbelief.

After not tolerating the machines...I started looking into surgeries. I opted for surgeries now, as I am healthy and have a lower surgical and anesthetic risk...rather than do it sometime later when my severe apnea would likely lead to other complex health issues.
Before I started on the surgical road, however, I was very sure that no other machine or device worked for me.

According to my reading, my surgeon's personal communication, and postings on various boards, there is a distinct sub-population of people with OSA who have anatomic issues that lead to airflow obstruction. This obviously worsens with muscle laxity as we age , and with increasing weight. The primary cause though is anatomic. Either brachy-cephalia (fore-shortened facial structure) or enlarged tongue bases. Amongst Asians and other ethnic folk (of which I am one), brachy-cephalia predominates.

People with anatomic obstructions seem to benefit most from surgery.

I hope this helps.

Bill

[Guest]

first off bill your apnea is really really bad. Mine is not even as close to that . Second your problem is related to the shape of your skull which cannot be changed. What I'd like to know is if there is any correlation between the Brachycephaly that you mention and failed surgeries. I guess what I'm trying to ask is: I don't have a recessed jaw, I don't have Brachycephaly, I'm not fat at all, I have highly obstructive points that can be removed and my ahi is not that bad- so wouldn't I be a good candidate for surgery? My 3 ent doctors and myself believe so. The 3rd ent doc that is doing the surgery believes that the surgery should cure the apnea(of course he does not garuantee this). This is coming from one of the best surgeons in the country who is the director of a hospital ent clinic, univeristy proffessor and a director of one of the best private medical facilities in the world. I know that the uppp is a high pain low gain procedure, but what the doc has mentioned to me is that he doesn't acutally plan on removing the uvula, he plans on trimming it and mainly the tissue at the roof of the mouth. The opening is somewhat narrow and surgery can increase airflow through widening it. I think there is acutally a laser involved that will create scar tissue which stiffens and shrinks the palate. Will this procedure be as painful as the complete removal of the uvula?And is this the definition of a uppp or some other variation of the procedure?

[Billinseattle]

Well,

Anatomic problems lend themselves to surgical solutions.

I'm glad you got several opinions and consultations. That helps...and should give you more confidence if they are in agreement.

You're right, my apnea was very severe. Yours is not. Which leads me to ask have you tried a TAP device and/or variants of PAP devices ? You sound like a low risk candidate for surgery.

There is no free lunch though, and the UPPP has some side-effects that mostly can't be controlled for by the surgeon, which can randomly plague you (such as retrograde liquid regurgitation, persistent foreign body sensation, inability to seal some CPAP devices). The pain wasn't an issue for me; neither were the risks of the side-effects. It had to be done.

For your degree of apnea, the nasal surgeries and tonsillectomy alone could do the trick. What you will be getting sounds like a modification of a UPPP. Lasers scar less...so you'll have less chance of side-effects like the persistent foreign body sensation that happens after conventional UPPP. Less painful ? Maybe...and that is a trully subjective maybe. A uvula flap will be better. A capsule-sparing tonsillectomy will avoid some of the pain and morbidity from that. Laser and RF use are a plus, and are more tissue sparing.

Two things that you are wrong on...brachy-cephalia has many variants. Most folks look pretty normal. I didn't have a recessed chin or jaw either. You can change the shape of your face and skull. The jaw is elongated; the maxilla is slid forward and screwed in place. The base of the tongue comes with the jaw in a procedure done at the same time.
My AHI was 92. It is now 3. This was done literally changing the shape of my skull by 1 cm.

The other thing that you may want to consider in picking your surgeon is...who is actually doing the operation. In teaching centers, ENT fellows and residents may be doing your procedure. Proctored, of course, by the professor and chairman. While he may bail out the ENT fellow if he gets in trouble, you don't want to be in that position. Personally, my bias was to find the slickest private practice guy with the biggest numbers (of procedures/ year) and the best stats (lowest morbidity rate).

Finally, I have found that if someone has trained doing a procedure and makes his living doing it...he'll recommend that procedure. Cynical, but true (it works as well for the DME CPAP vendors). Surgeons also are notoriously optimistic in terms of recovery times and success rates. The problem is, most ENT surgeons never see their patients after a couple months. Consequently, they don't get feedback if you have relapsed in a year or two. I'm not trying to be discouraging. I was actually fixed by surgery and am an advocate for surgery if you need it as a last resort.

The majority of us have our main problem in an proportionately enlarged tongue base. The airway is a complex column that permits airflow along many points. This is why serial or phased surgeries and procedures are recommended to most surgical prospects. I don't doubt that you'll probably have a good initial result from your procedures. The UPPP is notorious for relapsing at some point. The airway that they construct for you in your throat is literally millimeters ! It is not supported over time.

On the other hand, if someone has a longterm successful outcome, they rarely post that years later and hang out on message boards (so there might be more successes out there than we hear about). Also, you are not fat; and you are outwardly free of anatomic defects (but unless you've had a CT or nasoscpic exam, we don't trully know this fact)...so it seems you are a good surgical risk. Hopefully, your apnea is mild and you are young enough at the time of surgery that in the future some stent, struct or yet uninvented option will be there for you (and me) if our oprerations fail.

Good luck,

Bill

[Guest]

thanks for the insight bill. It was much appreciated. The surgery is tomorrow so I will let you know how it goes in a week or so.

[Billinseattle]

Best of luck.

Remember to stay hydrated...that'll reduce the chances of bleeding and keep those tissues moiist. Nutrition is also very important, especially for a thin guy. Protein shakes, Ensure, etc will help you heal faster and not lose so much weight that you will avoid actual muscle wasting.

It'll get better day-by-day.

See you on the other side.

Bill

[verde]

I had a UPPP, Adenoidectomy and Tonsillectomy 5 weeks ago to treat Obstructive Sleep Apnea (I couldn't tolerate CPAP). I want to share my experience here not to scare anyone, but to put it out there so that if you experience something similar, you don't feel like you're the only one.
First, recovery and reaction to this surgery seems to vary widely among those who have it. Some people are back at work in 10 days. I had a much longer recovery time, though I do think that my experience would fall on one extreme on the chart of what's normal for recovery. I think it's important to know what the possibilities are though before you go into this surgery.
My ENT doctor insisted that the procedure would be fine as an outpatient surgery, and apparently for some, it is. I however, could have hugely benefited from a night in the hospital, hooked up to fluids and pain killer.
For post-op pain, my doctor prescribed Lidocaine gel gargle to pre-numb my throat so that I could then take liquid Acetaminophen w/ Codeine. The Lidocaine was impossible to gargle due to decreased muscle function in my throat and I ended up having a mild reaction to it in which my throat swelled and breathing became a little difficult. Scary. I then found that I couldn't take the Acetaminophen/Codeine liquid because I physically couldn't get my muscles to work in order to swallow. Consequently, I spent the night after surgery without pain meds, not sleeping and in terrible pain.
By the next afternoon, I was able to swallow tiny, tiny amounts of watered-down Acetaminophen/Codeine, which helped a small amount with the pain. I found that it was very important to take the next dose of pain reliever exactly on time or the pain would return full-force and then it would be more difficult to swallow the next dose.
Because of the pain and difficulty with nasal reflux, I wasn't able to eat or drink anything for 4 days (really, I wish I were exaggerating). After that, I started being able to get down tiny amounts of broth and water. It was a good 7-8 days before I could really even eat anything soft. Dehydration was sort of constant since I just couldn't get enough water down.
Thankfully, by the 11th day or so, I could start eating small amounts of things like bread, cooked vegetables and meat. I definitely still needed the pain medication 24-7.
By the 16th day or so, I could finally sleep laying flat, rather than propped up to reduce the pressure in my throat. At this point I was finally starting to eat very, very small meals and was able to start drinking more.
Around the 18th day or so, I started sleeping through the night as the pain was lessened enough that it didn't wake me during the night.
Throughout all of this, I couldn't work or really do much of anything due to extreme lack of energy and strength. Although it will certainly be different for many patients, I was really affected by the weight loss that comes with this surgery. When I went into surgery I was 113 lbs and three weeks later I was 103. I was really weakened by lack of food and ended up getting a couple of non-throat related infections due to reduced immune function.
Finally, around the 4 week mark, I got my energy (and sense of optimism) back.
Now, at the end of the 5th week, the pain is completely gone. I still can't swallow anything more than a sip of liquid at a time and food is still difficult as well (takes a couple of tries to get it down) but things are looking up. I'm really hoping my swallowing function will come back, though I know it may take a while longer.
Not sure if it has made any difference in my OSA as my next sleep study is a few weeks away still but I do seem to be less tired during the day.

[dindallas]

Hello Everyone,

Wanted to share my story with everyone thus far. I had my surgery this past Friday (8/20) after some time of debating whether or not I should do it. After much research and having read many negative stories about UPPP, the agonizing pain, etc. I decided to... Do It! The surgery went great! With my medication, I feel hardly no pain. My doctor used Coblation. He removed my LARGE tonsils, trimmed a little of my uvula, and also did turbinate reduction. After 2 long years of CPAP, I slept for the first time Friday night, without CPAP and my sleep was profound. I've never felt better. For those of you debating whether or not to go through with it, I say go for it. I'm not overweight, 32yrs, and even my doctor said I was a good candiate for the surgery with my huge tonsils which were the primary culprit of my OSA (Obstructive Sleep Apnea). Currently taking Oxycodone for pain as needed and also Amoxcyllin to prevent any infection. The surgery is not bad folks, I'm glad I did it! I will go back for a sleep study in a few weeks to see what my improvement numbers will be. My previous O2 levels from previous sleep study was around 81%. I will keep everyone posted and hope that by sharing my post UPPP experience that I can help others who are trying to figure out their next step. I've been there and am glad I did this for myself to prevent future complications from OSA later on down the line. I've never felt better..... Talk with everyone soon.-