Thirteen months post-mma surgery. Still have the braces.

• Sleeping quietly and soundly at night.
• No signs of apnea coming back.
• Still in orthodontic treatment to adjust my teeth.
• Teeth fit together better, but still does not feel like they have a home position. This is tiring during the day. My orthodontist, Dr. Moody Williams, says will probably be a few more months.
• Still some minor pain when chewing chips or crunchy stuff. I’m not to be eating that anyway with braces. I think the pain is coming mostly from my teeth still being moved around with the braces.
• Eating regular food now is no problem.

Yes, I would do it all over again.

Dear Jim,

Thanks for the kind words. I have not had a follow-up sleep study. There is no comparison to my pre MMA condition. I thought I would die with a heart attack or stroke in the months leading up to the surgery. I would awaken in the night repeatedly gasping for air with the sensation of a heavy weight on my chest. I sleep quietly and soundly now.

The surgery has been a great success for me. All the swelling subsided within a few months. Amazingly, there was hardly any bruising from the surgery. I am still in braces, and only within the last month or so have my posterior teeth began to meet where I can chew effectively. However, since the teeth are moving because of the braces, I still have pain that prevents me from eating steak. A really tender filet mignon is manageable, but I still mostly eat soft foods.

To someone who does not know me, my appearance probably did not change much. But to me, the minor changes are apparent. The purpose of MMA is to open the airway. As you probably know, to do this, the surgeon, breaks your upper and lower jaw apart where they are attached to the skull, moves them forward and then reattaches with plates and screws. I’ve gotten used to my new appearance, and I know without doubt the surgery was the right decision for me.

There are other causes of sleep apnea other than skeletal, such as problems with the autonomic nervous system. I first consulted a neurologist. He sent me for the sleep study. I next saw an ENT specialist, who recommended I see a maxillo facial surgeon. I settled on Dr. Stephen Roser at Emory after a lot of research.

If you have severe sleep apnea, I encourage you to take action immediately. If it’s like with me, it will take longer than you expect to actually get all the tests done and finally get the treatment. Took me almost a year!

Best regards,
Richard

I have had people ask if it was worth it. My response is an immediate yes. But I do believe I was well prepared physically and mentally for the surgery and the recovery. I did everything I could to get really healthy before the surgery. Started 2 months prior with 1 hour cardio exercise every day — I mean every day without fail. I eliminated dairy, sugar, and ate a diet mostly of fish and vegetables with limited starches.

My voice has returned to normal after having suffered from left cord paralysis most likely due to intubation during surgery.

I had my last follow-up visit with Dr. Roser about a month ago. Got to see Dr. Optid, who is finishing up his studies at Emory and going into private practice with a group in Atlanta. Congratulations Dr. Optid!

To Dr. Roser and all my friends at The Emory Clinic, thank you for the marvelous work you do. And know, you have had a profound influence on my life, and I will miss you all.

First, I am truly blessed to have such a wonderful family. When I had my surgery back in November of last year, they all rallied around me. I would never have gotten the help I needed for sleep apnea had it not been for my wife. Dr. Roser said it’s usually that way; the spouse brings in the patient more often than not.

Just about everyone on my side and Jeaneane’s side of the family was there at Crawford Long Hospital the day I had my surgery. It was a long day for them. Sitting around the hospital waiting on someone to come out of surgery is just not the most fun way to spend your day.

During the first week of my recovery, I was pretty much an invalid. Jeaneane was there for me around the clock preparing my special diet of liquidy foods and making sure I took my medications at the proper time. Jeaneane’s sister, Shelbie, helped out driving me to several of the doctor appointments Jeaneane could not attend. Amy’s husband, Philip, brought me some Brunswick stew one day when I started eating more solid foods. My brother Jeffry and my mother drove up from Adel to visit a couple of weeks after I came home, since Jeffry was sick the day of my surgery. My brother-in-law, Marty, called numerous times throughout my recovery to keep up with my progress and let me know I was in his prayers.

To my family, I love you all. There’s no need to list everyone by name — you know who you are. Also, to my friends, thank you for being there for me as well. I love you all too.

I am thankful to God that I am still here and for all the things mentioned in the paragraphs above. Without the mercy of God, I would surely not be alive today. I have had a number of close calls in my life time, brushes with catastrophe if you will, and I have always been delivered. With God, all things are possible.

A few bullet points.

• Chewing anything other than soft foods is still difficult and mildly painful.
• Voice has recovered completely, although I think it is slightly deeper now.
• Still doing jaw exercises to improve mobility of jaw.
• Sleeping well without sleep apnea by all accounts.
• Off all pain meds except very occasionally Advil regular strength. I had a difficult time coming off Lortab. Several restless nights. Withdrawals are not fun, but it had to be done.
• Starting to get back on exercise routine. Weak after doing hardly anything for 2 months.
• Thankful for Dr. Roser and his team at The Emory Clinic.
   

Dr. Optid was first assistant to Dr. Roser during my surgery, and Dr. Cho was second assistant. They have been really great doctors, but more importantly, they are very warm hearted people, whom I now consider friends. I will miss not seeing them. I highly recommend Dr. Roser and his team for this type of surgery.

• Healing progressing well
• Voice returning to normal. Still a little scratchy and weak but improving
• Feeling returning to nose and chin
• Some feeling returning to front gums, more feeling near the back
• Sleep apnea alleviated completely by all accounts. Will probably do another sleep study in the Spring to confirm
• Afternoon sleepiness alleviated
• Still some pain in the gums usually after eating or at night but controllable
• Still on soft food, such as pasta, fish, soft veggies, etc.
• Still using Afrin at bedtime to help with nasal congestion but need to start weaning off
• Ok to start with orthodontic treatment to fine tune my bite
• Have appointment next week with my orthodontist, Dr. Moody Williams.

My voice is much stronger and almost back to normal sound. If you could have seen the little video the ENT doctor did of my vocal cords, you would understand how miraculous this is. There was no movement of the left cord—paralysis due to injury from the intubation tube during my MMA surgery.

I was really bummed out after that visit, but Jeaneane got me back in line spiritually when she got home that afternoon. Thank God for Jeaneane!

Photo from 12/02/07. If you’ve been following the blog, you know we’ve been taking photos to document my progress. I don’t think I’ve had this many photos taken of me in my entire life. I’m usually the one taking the pictures. You can see the photos in chronological order on the MMA Photos tab.

Pain continues and is severe at times. Prescription written for refill of Roxicet. Lortab does not help much.

I’m still not very active due to low energy levels. Still mostly resting. Walking to get the mail is about the extent of my exercise. I can’t wait to get back on the tread mill and get my energy back.

Voice Loss

Dr. Steed said there is a good chance my voice will return. In his experience, full recovery occurs about 85% of the time.

Diagnosis: Left Vocal Cord Paralysis probably due to intubation tube laying on the left cord during my MMA surgery.

Prognosis: Voice often returns sometimes in a few days or a few months. Sometimes damage is permanent. If doesn’t return by 9 months, probably won’t return.

Well, I certainly did not see that coming. Just praying for healing. It’s like the worst laryngitis you can imagine. Normally, the vocal cords vibrate in a lateral motion to make sounds. In the case of vocal cord paralysis, the paralyzed cord just lays over to the side leaving a gap, which the air flows through unmodified except for the little effect the good cord makes. Thank God for that good vocal cord!

In case you haven’t figured it out, I believe in the power of prayer. So, if you do too, please remember me when you pray.

Healing is going well. Stitches on the outside removed. Prescribed Lortab 7.5 for pain as needed. I’m still taking the Roxicet, which is stronger than Lortab. I’ll start trying to back off to Lortab depending on how the pain subsides. Roxicet is great for pain, but it makes me sleepy. Right now, I prefer to sleep.

Regarding pain, it’s still quite strong. It’s a persistent ache with sporadic sharp pain in the gums, particularly the lower jaw.

Day 1 Post-op

Right after surgery, Drs. Optid and Cho came in to check on me. They kept a close watch on me, but I think everything progressed rather well, and they were pleased with the surgical outcome. Dr. Roser said my occlusion was good enough not to require my jaw wired shut. Thank God for that.

The after effects of anesthesia, the morphine and other meds kept me in what I would describe as a semi-awake dream state. I had about a 1 second span of attention, which made it difficult for the hospital staff to get x-rays.

My son-in-law, Josh, complimented me on how cool my Halloween costume looked. Too bad it was a day late. I’m planning on getting it trademarked and on the shelves by next Halloween. It’s going to be called Orthognathic Man. How cool is that!

Day 2 Recovering

Woke up with a terrible headache. Morphine had ran out. It is was quickly refilled. They gave me a setup where I could click a button, and the morphine would dispense automatically. Thankfully, it has a failsafe mechanism on it to prevent overdose, because I think I was hitting that puppy at night on autopilot.

My voice is shot due to the intubation tubes, which have to go in through your nose. Normally these go in through the mouth, except here they’re operating inside the mouth and can’t have the tubes in the way. I’m very hoarse and hard to understand when I speak.

Day 3 Going Home Today

Woke with head and mouth hurting again. Hit the button for near instant relief. Truly amazing. Ice chips felt great in my mouth, and water was good. I don’t recall eating anything they brought me during my stay.  We requested non-dairy, but the just kept bringing it right on schedule. I asked a nurse for some soy milk, which they brought.

I love Silk Soy products, especially the yogurt. We get them at our local Publix supermarket. Dairy gums you up inside, so I don’t eat it at all. Prior to and during recovery, you especially don’t need anything that gums up your sinuses.

Dr. Roser came in and installed rubber bands on my front braces to help position my jaw. They aren’t too tight, and I am able to eat any soft food that does not require chewing.

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