Last day with chompers

It's the day before my surgery and I am lucky enough to wake up even earlier than usual. K gets up with the birds and was up at 6am. I can't believe I raised a morning person! He's slowly going to kill me! Anyway, he got up and proceeded to cough and cough and slurp his nose until about 7:30am when I decided it was not a good idea for him to go to school. After texting his TA he wouldn't be there and calling his bus driver not to come get him I was on a quest to find a sitter for him. I tried my mom all morning with no answer. Where the heck could she be so freakin' early?! Finally giving up about 8:20am I called C to tell him he's gotta take one for the team and come home-- I had major work to do today. Not 5 minutes after he agreed, my mom called to see why I've been calling. Uhg! Mom!? After she agreed to watch K I called C back to tell him he didn't need to come home. Turns out he was already on the way so I then had to call my mom back again and tell her never-mind. Whata mess! C was home from work by a little after 9:15am, just in time for me to leave, dropping off littleC at daycare and to be in the office by 10am. Phew. I'm already exhausted and my day just started!
Last day of work before my surgery tomorrow was crazy. About 20 minutes after arriving to work I got a call from Dr S's office. Panic and dread immediately filled me. 'He'd better not be cancelling my surgery again' -- is what popped into my brain. It was Natasha calling to see if I was all ready for tomorrow. I said I'm fine and I'd see them tomorrow at IMC. The next thing out of her mouth I should have guessed... "Oh, we changed your surgery to Riverton instead of IMC" Me, about ready to explode with frustration at her and that office: "Um you guys told me IMC, I even got a call from the RN at IMC yesterday to go over health history, meds, etc". Her response was "Yea... (long silence) We had to change it due to a scheduling conflict". A scheduling conflict?! WTH? That was the same excuse as last time! This office is really pissing me off and definitely not going to get a referral out of me. Nor are they instilling any confidence! I got off the phone and bitched to my coworkers about the latest drama when one made a genius comment- 'what about the authorization?' Oh boy am I glad she said something. Let me tell you...that call to Natasha was hilarious! In her words, "Oh I'm glad you thought of that, I didn't even think to do that." Seriously?! Sigh... Now I just had to preregister with the hospital and I'd be ready. Hopefully... Unless they change it again.
I had a huge report to get done and combining that with mildly annoying people and the beginning of a major panic attack things weren't looking good. And then a little past noon it got worse... The fire alarm went off. I was sequestered in my cubie trying frantically to finish everything I needed before going on my leave of absence and I DID NOT have time for a fire drill! I was pissed. I had just waved the rest of my team off in their request to go to lunch so I could work through lunch and now I have to slowly walk down 4 flights of stairs and clear to the middle of our parking lot. Unhappy was putting it mildly. After about 15 minutes outside we got the call it was safe to go back in. Oh joy! Had this not been my last day before being off I would've definitely taken the chance of being outside with my purse/keys and bolted for home. Fat chance this time. In the building I went and decided I might as well hit up the cafeteria for some lunch before heading back upstairs with the masses to get my work done. I chose an enchilada mostly because it was something I'd need to use my chompers for. :) LOL I gotta take advantage while I have 'em. Heading upstairs I carried my plate, my purse, keys & lack of will to go on. Soon after, the boss came over and stood beside me as I'm working and scared the living shit outa me. He was wondering when his report was going to be done. My response, "not for a while". It was a rough one.
Finally in the late afternoon I checked my voicemails at home and noticed the hospital had called to give me my arrival time. 10:15am. Sweet! I get to sleep in! That was a good thing. Still needed to preregister but no one had called yet. After searching for the number to call (which is funny since the call center is just a couple floors beneath me) I called and registered myself and got all that done. I was set. Oh my God...this is really happening! I'm freaking out.
At 6:30pm I left the office and met C for a childless last meal at Red Robin. I had a lovely Terriaki Chicken Sandwich and cheese fries with a yummy chocolate shake. Then picked up the boys and back home for a nice bath. Shaved my legs, pits and whatever else needed it and soaked for a while. I know this will be the last time for a week or so. After bath I still had to fill out my health history form and medication info and send it in to the hospital. After that I had to be a 'wife' for the last time for a few weeks...(wink)...and now it's sleepy time. Nothing to eat/drink after midnight for me. Clear liquids ok until 4 hours before the procedure and I can take a sip to take my morning pills.
I've made a list of groceries and honey-do's for C while I'm in the hospital and I will pack an overnight bag (basically my laptop and toiletries) in the AM.
Good night!

Oh and one last thing for today. Here's my 'boring' before pics to be able to see the difference when I post after:

Streesful Lasts

Well, my surgery is now in 3 days and my doc's office hasn't called to cancel this one so I'm thinking it's going to happen this time. I kind of got over my freaking out stage after the other one was cancelled and had a few weeks 'off' from worrying but this last week before the surgery has been pretty bad. My blood pressure has been going up within the last little while and I'm sure this and work stuff and home drama hasn't been helping it. I finally caved and emailed my awesome PCP about meds and told him what my BPs had been (150s/902-100s!) and within a half hour I had not only an email telling me to come in STAT but a phone call at both my home and cell. I guess it was pretty bad. I was swelling up and had gained a lot of weight in a really short period of time. After going to the doc last Thursday I got put on a very small beginning dose of Lisinopril and had some blood work and and EKG done. All my blood work and EKG came back normal so my doc and I are kind of thinking its just all the stress in my life right now and my BP may go back to normal (which is high-normal anyway) after the beginning of the year when I expect stuff to calm down. I love Dr M. He always knows exactly how to treat me and what to say. He lets me be my bossy self and tell him exactly what I want and barring anything actually harmful it's done. So that night I took my first BP pill. Friday morning I woke up without swollen feet and ankles for the first time in a week. I stepped on the scale after my shower later that afternoon and holyshi*...down 11 lbs! Yea, that's how swollen I was. To loose 11 lbs overnight in water made me understand why I felt so bad. My BP had also started to lower to a low high and I'm getting better each day. Because of that crappy feeling and lack of money (due to the change of surgery and Jager the dogs cancer surgery) I haven't been able to fully live out my "last requests" like I had planned. I did get to go to Training Table for a Turkey sandwich no tomato and cheese fries with dipping sauce last weekend but it took a lot of begging of hubby and the boys were pretty bad. Not really...but its really about the food for me. I made a quick stop at Jimmy Johns for a sandwich before my nail appointment yesterday so that's crossed off the list. And I think C and I are going to drop the boys at my mom's and go to dinner at Olive Garden Tuesday evening for my 'last supper'. I still wanted to try Moochies but I guess that will have to wait until next year. I also have a whole bunch of work stuff I need to do and I really only have Tuesday in the office time to get it done. A huge report for my boss that hopefully we can bend to look even better in our favor so we can get rid of this horrible consulting firm that has a contract with us for another 3 years. Stress at work is probably one of the biggest reasons for my BP issues. I'm going to have a real hard time not being there for everything happening. Oh well. I've been reading as many blogs as I can find on people's experieces with this surgery and feel like I have a good idea of what to expect but also think I will never quite know until its too late. So far I haven't read one persons account saying they regret it so that is reassuring. I just want to sleep. I want more energy. I want to dream. I want to be able to move when I first wake up from an afternoon nap and not be completely paralyzed. This disease OSA, along with Hashimotos Hypothyroid and osteoarthritis is what stops me from moving and losing weight and being out with my kids and family and cleaning the house. I'm praying this surgery helps my OSA and I am one of the 95% success rates. I hope the new thyroid med I just changed to also helps and I'm one of the 60% that do better on it, a natural drug, than the synthetic I've been taking for 10+ years with little help. And if those two work maybe I'll have the energy to get out and loose some weight! Here's hopin...

Denial

Denied! "Not Medically Necessary"-- that's what my insurance -SH- says about the turbinate and septoplasty part of the surgery. The MMA/jaw and genioglossus/tongue part is covered and medically necessary but not the nose part. This was the original decision of the authorization proposal but I got the review committee decision today after the appeal letter was sent in by me and Dr S. Basically, the reasoning... I'm fat. Yep. My insurance company called me fat. I'm hurt, I admit it. I also admit I'm fat, however that doesn't change anything. According to the appeal review because I didn't got out and loose half my body weight like 2 different physicians said to I cannot have the nose part of the surgery. Because I haven't tried "alternate, less invasive methods". Gah! Wow?! Where ever do I begin with that, I think to myself... Maybe if they would have gotten records from say oh, my PCP that I've seen for 10+ years and knows the constant struggle with weight is not so easy with a few medical conditions? But no, they have the two pages of office notes from a first time visit to an ENT the week before Dr S's initial consult for an ear infection and then Dr S's notes from my initial consult which includes the referral from my sleep doc. Oh well... It's ok. I'm conflicted though. I would know for sure we'd tried everything and done it all in one surgical stay and time off work. That this drastic MMA surgery has the best capability to reach its full potential of curing OSA 95% of the time. But, on the other hand... I'm so very claustrophobic that having my nose done too and all stuffed up at the same time of my jaw and tongue all swollen and banded shut I'm pretty sure that'd kill me! And by kill me I mean both literally and mentally! It'd be in my head the whole time that I was suffocating if I had no breathing capabilities. So, I'm going to try to not be annoyed that I didn't win my appeal and try again with the actual valid medical records from my PCP-the one who knows- and try to forget they called me fat and just let it go. Its a good thing. They don't think its medically necessary as well- that my septum isn't deviated enough (or at all?) so maybe I'll just hold on to that hope that my nose is fine- even if it is small and always infected... but at least it'll be an open passage to which I will breath while banded shut! Denial... I can live with that. :)

5 days before surgery

I'm in pure panic mode about the upcoming surgery. I have only 5 more days left to do so many things but I have rearranged my life for this and it's happening...well...
Nope, just kidding...it's not.
The boys and I had to run our lab mix to the vet for a surgery to get a large mass removed from his thyroid and my cellphone rings. It was Dr S's head secretary, Lauree. She's the one all the young little receptionists have to ask all their questions to. As soon as I heard her tone of voice I knew there was a problem. Lauree proceeds to tell me that the doctor has had another surgery scheduled longer than mine and its at another facility and he can't 'facility hop' the day of my surgery. I think to myself, 'OK, so it'll change a day or two...no biggie'. Then she continues to say that he feels strongly that I still have the nasal septum repair and turbinate surgery that my insurance company has denied as not medically necessary so he's continuing to appeal that denial. Then comes the date. September 18th. Oh. My. God. Anger cannot even begin to describe my feelings. I have literally put my life on hold for this. I have my leave of absence papers filed and approved at work, my actual work duties covered, babysitters arranged, hubby took off work, I've paid a whole bunch of bills early that would've been due when I was off and low on money- in turn putting us in a bit of a pinch for a couple weeks, and lastly had the consulting company that is working with our company schedule their next visit (from out of the state!- so airfare/hotels/etc) for when I would have returned from surgery - but now for when I will be gone. I'm beyond pissed off. Livid would be a better description.
Well, I guess I will make the most of this. I guess its good that the insurance authorization will be approved (hopefully) so I can have the entire surgery. I guess its good that I will be OK for K's first week of school. Now I can go to all the restaurants I've been wanting to eat at before I can't chew for months. I can learn the new system at work better before going out on leave. Its OK...right? Sigh. I guess it has to be, I have no choice.

Week before surgery

Well, with less than a week until surgery day I'm about ready to have a complete and utter panic attack. I'm so scared! I've had many surgeries, I've never been this scared for a surgery or any procedure in my life... even my kids' surgeries weren't as scary! I keep reading through all the blogs and patient experiences I can find and the phrase "life changing" is said pretty much every time. I'm literally praying for that! I need it to be. I need my life back. I need energy, less pain, less meds! I know this will lower my risks of a stroke or a heart attack. I know my organs have been deprived of oxygen for so long that they are in desperate need of help. These are all the reasons I'm putting my face on the chopping block, so to speak. I'm hoping to drastically reduce or even cut out my naps that I require I'm not working. My kids are growing up and napping while they're napping is no longer feasible. LOL! I want to be the mom who is *happily* awake in the morning with her kids while they get ready for the day....not the one that they as a toddler and kindergartner get themselves fed and watch tv while mom sleeps in till 9am. I want to wake up without a headache or even worse a migraine! I want to wake up refreshed...not in a state of confusion and achy. These are the reasons I decided to do this. Well, that and the two doctors recommendations that no surgery less than this would help my severity of sleep apnea.

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