Pictures of up my nose

It'd been a couple weeks since my initial appointment with Dr. S and I was still waiting for my insurance company to get the authorization underway. I had called every other day for  the last 10 days with no information. I had decided to just give up. Then after just getting to work, my cellphone rang. It was Dr. S's office calling to say they have scheduled my surgery and I needed to come in for a few more pictures and to sign papers. Yikes?! It was getting real! Natasha from the doctors office informed me that they hadn't received the authorization from my insurance yet but where not worried as they usually have no problems. That made me feel a little calmer. She then said that they would probably need more pictures for the authorization so I needed to come in as soon as possible. I needed to run home on my lunch break anyway so it was no problem to add one more stop. Then she told me the date. Wednesday August 21st. Holy shit! No, I thought to myself. I can't do it that soon. I have training at work on a new system, it was K's first week of school, I had stuff going on that I could not be out of commission for. But, I guess my schedule meant nothing and it was when the doc and the assistant surgeon could be together. I reluctantly agreed to the date, said I'd be in the office for my pictures at noon and hung up the phone. The first thought through my brain, "OMG (my boss) is gonna kill me." We had this training at work literally in the making for 18 months. There was a lot I needed to be there for. I wasn't about to rely on my coworkers to reteach me the new system when I got back. I didn't trust them to mostly, but I also knew they wouldn't have time since we were already so behind. I had purposely not told anyone about the surgery before because I kind of thought it was a long shot on the insurance authorizing it... or me even doing it. But it had just become real. I had to fess up. I immediately sent in my request for a LOA. I didn't know exactly how long I'd be out but I knew it was going to be longer than a few days and I'd need to be official about it. I'd get all the info at the doctor that afternoon, I thought to myself.
I arrived at Dr. S's office about 12:30pm after running to my house first. They were always so nice there and I still felt like a rich person coming in for a nose job and a day spa appointment there. But, alas my problem wasn't so luxurious. Its an actual medical problem. Natasha pulled me into a room and we bent in strange positions to get the pictures up my nose and from above to prove that I wasn't indeed just getting a nose job to fix a bent nose for the insurance company. That's all I had to do. I then asked about how long I'd be out of work. She said "a few weeks" but said to ask the doctor at my next appointment. I made an appointment for the following Monday and was out the door. I was going to have to break it to (my boss) soon, I guess.

The consultation

It was a blistering day in July when I had my first consultation with Dr. 'S', DDS, MD, Board Certified Oral and Maxillofacial surgeon. I dropped my boys off at the sitter and made it to my x-ray appointment the half hour before on time. It was easy enough. Just smile big for the camera while it rotates around my head and takes pictures of every angle of my jaw and head. In and out in under 15 minutes. Then down the street I went to the actual doctor appointment. I pulled into the parking lot and somehow missed the huge visible sign stating which building I was to go to and walked into the building across the way. It was hot, like over a hundred...and I was exhausted, as usual, from lack of sleep but this guy was supposed to help... at least according to my sleep doctor. I finally realize I'm an idiot and got into the right office building. Dr. S's office is amazingly beautiful...like a day spa. I immediately wondered whether this visit would even be covered under my medical insurance because I felt like it was considered cosmetic. Of course, that was the medical insurance background personality of me thinking...I needed to remind myself I had a legitimate medical condition- Sleep Apnea. Big time Sleep Apnea. I stopped breathing somewhere around 80x an hour. I don't know the specifics but I was led to believe this was a lot... even "severe". They told me my 'sats' but I don't remember those. Anyway, I digress... After checking in with the nice receptionist and signing (electronically, of course) all the necessary forms that I had already filled out online I sat down. There was a TV screen with a video of the good doctor on the wall talking about some procedure as well as other patients giving their recommendations. I felt sort of like I was in an infomercial, but if these people weren't actually paid actors I guess it was comforting. My name was called and I went back to my room. It was a very plain room with a dentist looking chair and some cabinets, a single chair and sink. The nurse informed me that I get to be in a "photo shoot" first. A zillion excuses start running through my brain. I hate cameras. I hate pictures of myself. I didn't put any make-up on...'er...I did, but it just melted off. But I guess it was for the doctor and insurance so I had to do it. She took side shots - of which who really looks good in that profile? - front shots, head shots, shots with me holding some stuff in my cheeks pulling my mouth open for my bite...it was embarrassing, but I did it with a smile. She then proceeded to tell me she 'has to inform me of the risks of the surgery'. I think to myself, "Um, I haven't even said I *want* the surgery yet, or even knew exactly what the name of the surgery was...much less talked to the doctor...why are you telling me this?" But, I let her ramble. And that she did. Ramble, on and on. Risks a-plenty! Shiest! I'm in trouble. I had already read some blogs, done my research and had a pretty good idea what to expect but hearing it firsthand was a little frightening. Here they are, now you can freak out too:

• Pain and swelling can last as long as 6 months
• Facial appearance changes 
• Numbness of the lower lip and chin for months, but can be permanent for some people.
• May need corrective braces for teeth or jaw if teeth are not aligned correctly after surgery.
• Weight loss. Due to the liquid diet for up to 6 weeks. (this one isn't bad but is gonna suck)
• Can affect TMJ (which my ENT seems to think I have, but the oral surgeon does not so who knows...)
• General surgery complications: Anesthesia side effects, breathing difficulty, loss of blood, stroke, heart attack, etc.

The good things and info about this surgery though are: 

• This is the only procedure that serves as the most effective treatment for severe OSA - and - it's 95% successful! Other OSA surgeries are below 50%.
• It is only for patients how have moderate to severe OSA who have also failed one or multiple basic methods of treatment. (CPAP- I rip it off in my sleep due to being so claustrophobic, Weight loss surgery - Yea, right! I wish I could get it paid for. Nasal surgery along with tonsils - Wouldn't even make a dent in my apnea and I'd still have to wear a CPAP mask)
• The jaws do not need to be wired shut anymore, they are just banded. However, its pretty much the same endgame.

So, the risks/rewards/info section with the nurse section was done, now it was time to meet the doctor and see what he has to say. Nutshell? He said, Hell Yes. 'You meet every single criteria for this surgery' is what he said. Let's get it done. I agreed, half heartily and left the room. Off I go to the insurance ladies to start the paperwork for the preauthorization. Working for the company that provided my insurance benefits I had a feeling this was going to take a long time and be one of those surgeries they deny as 'experimental/investigational' or not medically necessary. I was told she had all she needed and would send the paperwork to my insurance to get the authorization done. I was out the door... and Freaking Out!

PreSurgery

PostSurgery

The photos above where taken from the website below. It's a great reference and blog of one of the first surgeons in the LA area to have done this surgery. He's got lots of patient experiences that helped me to understand a bit of what to expect:  http://www.sleepapneasurgery.com/max_advance_exp.html