Surgical solution (?)

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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49er
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Re: Surgical solution (?)

Post by 49er » Wed May 20, 2015 12:50 pm

msla wrote:And the letter to the editor from a Md. http://missoulian.com/news/opinion/mail ... 7394c.html
I find the rebuttal of the original article accurate and agree with Dr. Holle's conclusion.
Thanks for providing this link.
A recent “meta-analysis” of multiple studies found that a “surgical cure” (less than 10 apneas/hour) was attained by MMA in only 43 percent, and with less than adequate post-operative studies and long-term results
I wish Dr. Holle would have provided a link to what he was talking about because I have seen a higher success rate quoted. Of course, the folks who have quoted the higher success rates haven't provided links either which makes it frustrating. As I mentioned before, anyone considering surgery, has to really press their doctor hard for this information.

Anyway, I am not really sure what the point of his rebuttal was. No one is arguing that cpap shouldn't be the first choice of treatment for everyone to try. But when folks have exhausted all conservative options and not treating apnea is more risky than having surgery, then a person needs as much information as possible such as learning about how the MMA can be done in a less painful manner.

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robysue
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Re: Surgical solution (?)

Post by robysue » Wed May 20, 2015 5:09 pm

49er wrote:
msla wrote:And the letter to the editor from a Md. http://missoulian.com/news/opinion/mail ... 7394c.html
I find the rebuttal of the original article accurate and agree with Dr. Holle's conclusion.
Thanks for providing this link.
A recent “meta-analysis” of multiple studies found that a “surgical cure” (less than 10 apneas/hour) was attained by MMA in only 43 percent, and with less than adequate post-operative studies and long-term results
I wish Dr. Holle would have provided a link to what he was talking about because I have seen a higher success rate quoted. Of course, the folks who have quoted the higher success rates haven't provided links either which makes it frustrating. As I mentioned before, anyone considering surgery, has to really press their doctor hard for this information.

Anyway, I am not really sure what the point of his rebuttal was. No one is arguing that cpap shouldn't be the first choice of treatment for everyone to try. But when folks have exhausted all conservative options and not treating apnea is more risky than having surgery, then a person needs as much information as possible such as learning about how the MMA can be done in a less painful manner.

49er
49er,

The original article includes the following passage:
The Missoulian wrote:Taylor, who has been performing his method of maxillomandibular advancement for 11 years, likens the surgery to an “internal face lift.” In 600 operations since he started using the method, Taylor said none of his patients have retuned to CPAP.

“This model has not been duplicated anywhere else in the world,” he said.

Taylor also has a second practice in Palm Desert, California. He said his method provides patients with an affordable and accessible treatment for their condition, with about 80 percent of them having insurance coverage for the procedure.

“They have realized that over a lifetime the patient savings are astronomical,” Taylor said.

About 20 million Americans have some form of symptomatic sleep apnea. Taylor said he’s working to help doctors and surgeons across the country use his method, and has made presentations on it at conferences around the world.

“The biggest hurdle is just embracing the concept,” he said. “My legacy would be to train as many people as possible to do this surgery this way to help those people.”
(http://missoulian.com/lifestyles/health ... c85fa.html)
This language certainly leaves me with the impression that the doctor who is performing the surgery believes that
  • (a) it has a 100% cure rate (when he's doing the surgery),
    (b) the surgery is "cost" effective when looked at over the patient's life time,
    (c) his approach should be much more commonly used
And I suspect that Dr. Holle, who wrote the rebuttal quoted earlier may have had much the same impression that I had.

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49er
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Re: Surgical solution (?)

Post by 49er » Thu May 21, 2015 4:07 am

“The biggest hurdle is just embracing the concept,” he said. “My legacy would be to train as many people as possible to do this surgery this way to help those people.”
(http://missoulian.com/lifestyles/health ... c85fa.html)[/quote]

This language certainly leaves me with the impression that the doctor who is performing the surgery believes that
  • (a) it has a 100% cure rate (when he's doing the surgery),
    (b) the surgery is "cost" effective when looked at over the patient's life time,
    (c) his approach should be much more commonly used
And I suspect that Dr. Holle, who wrote the rebuttal quoted earlier may have had much the same impression that I had.[/quote]

Regarding the cure rate, here is what Dr. Kasey Li has on his website, who many consider the top surgeon for doing this procedure:

http://www.sleepapneasurgery.com/overview_adult.html
Maxillomandibular advancement is the most effective sleep apnea surgical procedure currently available. The success rate is usually between 75% and 100% 27,28,35,36 with a long-term success rate approaching 90%
Now in all fairness, he does say that success is based on this:
Improvement in quality of life with reduction of sleep apnea symptoms
Achieving RDI to less than 20 and reducing RDI by greater than 50%
Improvement of oxygen nadir to 90% with few desaturations to below 90%
Still, my question stands as to where Dr. Holle is getting his statistics regarding a 43% cure rate if Dr. Taylor and Dr. Li are quoting higher success rates. And what is the Dr. Taylor and Dr. Holle basing the success rate on?

When Dr. Taylor was saying is surgery was cost effective, what I inferred he meant was that for people who chose to have the surgery, it would be cheaper for the hospital to pay for the surgery vs. letting them develop apnea and develop more costly complications from diabetes and stroke. Of course, this is based on how effective the surgery truly is which I think no on really still knows for sure.

When Dr. Taylor said his approach should be more commonly used, he was referring to the fact that if someone choses to have MMA surgery, the procedure he has developed would promote an easier recovery from the surgery. Whether it is as effective as the standard procedure is another issue. I didn't infer he was advocating this should be used instead of cpap.

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Re: Surgical solution (?)

Post by jlaw3x7 » Tue May 26, 2015 9:07 pm

I just hope somebody can learn from my mistake. It's so hard because you trust doctors to give you help but many don't care about helping unless you mean helping themselves to your pockets.

Don't trust a doctor. Do your own research. Find independent verification. If it is too good to be true, it is.

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Re: Surgical solution (?)

Post by 49er » Wed May 27, 2015 2:49 am

jlaw3x7 wrote:I just hope somebody can learn from my mistake. It's so hard because you trust doctors to give you help but many don't care about helping unless you mean helping themselves to your pockets.

Don't trust a doctor. Do your own research. Find independent verification. If it is too good to be true, it is.
Again, I am so sorry for what you experienced jlaw. As I previously mentioned in posts, I saw several ENTs regarding the possibility of having a septoplasty and none of them made any grandiose promises with the exception of one who said it would cure my apnea which I knew was a bunch of BS. Another one did mention cpap alternatives but that was due to my faulty communication that I feel led to him thinking I wanted to explore that area. Finally, several of them made sure I had tried conservative measures like nasal steroids and rinsing before they talked about the surgery.