Should I have surgery?

[ChicagoGranny]

If I may sum up all the warnings posted here, that surgery will cause MS, fibro, Lou Gehrig's, psoriatic arthritis, leukemia, cholera, AIDS, soggy ravings, a future second-round draft choice and some other things that will be posted later.



Edited to include "soggy ravings".

[chunkyfrog]

Granny, I have a hard time believing all that. Please put down the brandy and step away.
Empty nose is a real thing; those things you mention are unrelated to apnea and butchery masquerading as a cure.
(((You were being sarcastic, but please do not confuse real outcomes with soggy ravings of denial queens.)))

[Greg Riddle]

Empty nose syndrome was the reason the ent was conservative when he did my turbinate reduction

[Cereal Killer]

Google "empty nose syndrome".
(Sorry, folks, somebody had to mention it.)

Why do you even bring that up, if not for drama? The OP's ENT never mentioned nasal surgery:

I have been diagnosed with sleep apnea with 65 episodes an hour and I am on a cpap now, I was referred to a ear, nose and throat specialist and he recommended that I have surgery. He wants to remove my tonsils, shrink my uvula, and stretch my soft pallet. He said that it may not cure the apnea but that I would snore less and sleep better. Should I have this surgery? Have any of you had this done? What should I expect from it and what's recovery like if you've had it? Couldn't find too much on the internet so I was hoping to get help here. Thank you!

[Nick Danger]

I have been diagnosed with sleep apnea with 65 episodes an hour and I am on a cpap now, I was referred to a ear, nose and throat specialist and he recommended that I have surgery. He wants to remove my tonsils, shrink my uvula, and stretch my soft pallet. He said that it may not cure the apnea but that I would snore less and sleep better. Should I have this surgery? Have any of you had this done? What should I expect from it and what's recovery like if you've had it? Couldn't find too much on the internet so I was hoping to get help here. Thank you!

This is referred to as the UPPP (I call it the roto-rooter job). It has a low success rate (this article discusses the ways that the success rate can be manipulated by changing the criteria: http://www.ncbi.nlm.nih.gov/pubmed/22565855). I had the surgery and it reduced my AHI from around 90 to around 70 - the surgeon considered that a success. I wouldn't have had this surgery if I had it to do over again. The recovery was the most painful thing I have ever been through - 2 weeks of hell.

YMMV

Keep in mind that people who are posting to the forum (including me) who have had the surgery are probably on this forum because they still ended up using CPAP's. So you probably aren't going to read many (any?) success stories (if you define success as not needing CPAP). With that said, success rates are low and even those with initial success tend to get worse over time.

[palerider]

Granny, I have a hard time believing all that.

granny's been 'celebrating' a bit much lately, methinks.

[Sheriff Buford]

I have never thought that surgery is always the last resort. If a doctor is definitely sure he can cure your apnea issues with surgery, then go for it. I wouldn't wish this treatment on anybody... except ISIS.

Sheriff

[archangle]

I have never thought that surgery is always the last resort. If a doctor is definitely sure he can cure your apnea issues with surgery, then go for it. I wouldn't wish this treatment on anybody... except ISIS.

Sheriff

I agree that some surgery is sometimes a good option for some people.

However, doctor confidence is not a good indicator of the probability of success. Actually, a confident doctor may be a bad sign. I think a lot of surgeons suffer from delusions of grandeur.

[49er]

I have never thought that surgery is always the last resort. If a doctor is definitely sure he can cure your apnea issues with surgery, then go for it. I wouldn't wish this treatment on anybody... except ISIS.

Sheriff

I agree that some surgery is sometimes a good option for some people.

However, doctor confidence is not a good indicator of the probability of success. Actually, a confident doctor may be a bad sign. I think a lot of surgeons suffer from delusions of grandeur.

All of the ENTs I saw definitely did not make any promises or had delusions of grandeur. They were definitely confident in their abilities which was a good thing but I felt they were honest regarding my septoplasty/turbinate reduction and what was reasonable to expect.

[kteague]

I worked in the pathology department way back when these surgeries were considered the latest and greatest. The skill and perspective of the surgeon are key. We could tell when we got the specimen cups when certain doctors had performed the procedure. One surgeon routinely removed not only the fleshy material from each turbinate but a ridge of the underlying cartilage, a chunk sometimes as big as my pinky finger. Imagine when they did this at more than one level on each side. Knowing your doctor is conservative and understands your concerns is so important.

[yaconsult]

I diagnosed my own sleep apnea using a voice-operated pocket dictating voice recorder. At the first meeting with the ENT doctor, she said that my breathing tube was very narrow and that I should probably have a plastic valve installed in my throat! She explained how I would open the valve at night so that I could breathe unobstructed and then close the valve during the day so I could talk, drink, etc.

Or, she said, we could try CPAP.... YES, PLEASE!!! Luckily, the CPAP works very well for me. Clearly, the valve in the throat would also work but has its own risks, requirements, and complications.

In January, I told this story to my new CPAP doctor in the Sleep Medicine department, which didn't exist back eight years ago, and thought the suggestion was premature, but there have been a lot of advances and things learned since then.

For most people, unless they have certain structural problems, CPAP is the safest and most effective treatment available.

[archangle]

I diagnosed my own sleep apnea using a voice-operated pocket dictating voice recorder. At the first meeting with the ENT doctor, she said that my breathing tube was very narrow and that I should probably have a plastic valve installed in my throat! She explained how I would open the valve at night so that I could breathe unobstructed and then close the valve during the day so I could talk, drink, etc.

EEK, Was she suggesting a tracheotomy, where you have a hole in your throat to the outside world?

Unless you had something really unusual, that's really scary. A tracheotomy is a lifesaving procedure for some, but there are a LOT of drawbacks.

[Uncle Flapp]

The recovery was the most painful thing I have ever been through - 2 weeks of hell.

+1. I would rather have an appendectomy (again), root canal, and colonoscopy all in the same day. My ENT sold me some magic beans. Wish I didn't buy them.

- Flappy

[yaconsult]

I diagnosed my own sleep apnea using a voice-operated pocket dictating voice recorder. At the first meeting with the ENT doctor, she said that my breathing tube was very narrow and that I should probably have a plastic valve installed in my throat! She explained how I would open the valve at night so that I could breathe unobstructed and then close the valve during the day so I could talk, drink, etc.

EEK, Was she suggesting a tracheotomy, where you have a hole in your throat to the outside world?

Unless you had something really unusual, that's really scary. A tracheotomy is a lifesaving procedure for some, but there are a LOT of drawbacks.

Unfortunately, I know all about tracheotomies and was on a respirator for 6 weeks due to complications after heart surgery. This was years before having an apnea diagnosis. Overcoming physical addiction to a respirator is the hardest thing you can imagine - your breathing muscles lose all their tone and no longer want to work. They call it "weaning" you off the respirator. I call it "extreme torture".

I don't think that was a factor in her recommendation, though. I wonder if I would have needed the respirator if I was on CPAP all those years ago...

[49er]

I diagnosed my own sleep apnea using a voice-operated pocket dictating voice recorder. At the first meeting with the ENT doctor, she said that my breathing tube was very narrow and that I should probably have a plastic valve installed in my throat! She explained how I would open the valve at night so that I could breathe unobstructed and then close the valve during the day so I could talk, drink, etc.

EEK, Was she suggesting a tracheotomy, where you have a hole in your throat to the outside world?

Unless you had something really unusual, that's really scary. A tracheotomy is a lifesaving procedure for some, but there are a LOT of drawbacks.

Unfortunately, I know all about tracheotomies and was on a respirator for 6 weeks due to complications after heart surgery. This was years before having an apnea diagnosis. Overcoming physical addiction to a respirator is the hardest thing you can imagine - your breathing muscles lose all their tone and no longer want to work. They call it "weaning" you off the respirator. I call it "extreme torture".

I don't think that was a factor in her recommendation, though. I wonder if I would have needed the respirator if I was on CPAP all those years ago...

yaconsult,

I watched a relative go through the ventilator issue when she was alive several years ago. So I definitely empathize with with your situation and can't imagine what that was like for you.

By the way, my cardiologist routinely refers people for sleep studies and specifically has two sleep doctors she works with. For various reasons, I preferred to go elsewhere but obviously, she realized the definite link between sleep apnea and heart disease and has done something about it.