Opting for Surgery

Thoughts? · Post by **Thoughts?** » Thu Jun 22, 2006 1:17 pm

I have severe OSA and have opted to have surgery.

CPAP is an absolute nigtmare and has caused me to sleep even less. I am 27 and refuse to spend the rest of my life trying to sleep with it.

I have read many of the posts on here and wanted to see if anyone has had the UPPP, Septoplasty, Somnoplasty, and Turbinates done at the same time?

My surgery is in July and would appreciate any feedback regarding past experiences and advice on pre/post sugery perparation/recovery.

Thanks

Guest · Post by **Guest** » Thu Jun 22, 2006 1:29 pm

Don't do the UPPP. Read up on it. Long term effectiveness is abysmal.

Some links for you:

UPPP Ohio Sleep Medicine Institue 10% success rate?

Jul 03 2005 subject: Mayo Clinic - Interesting article

Upper Airway Surgery Does Not Have a Major Role in the Treatment of Obstructive Sleep Apnea by Barbara Phillips MD

LINKS to surgery, turbinates, Pillar, TAP experiences Discussion topics about UPPP are on bottom third of page.

Billinseattle wrote:the nasal work (usually inferior turbinatectomy and septoplasty) is usually well tolerated, has a relatively short (1-2) week recovery period...and actually does what it is supposed to...help you use CPAP devices and lower the pressure required.

I wholly recommend the nasal surgery. You can't use CPAP without having a free nasal airway.

Tonsillectomy is probably a good deal...but this is a your-mileage-may-vary situation. It works very well in children who have OSA. However, as adults, it is less clear. Our airways morph as adults and the value of having tonsils out is less clear than in children. As adults, a tonsillectomy also is associated with more pain and is less well tolerated than in kids. The one thing that it will do is remove large obstructing tonsils as a variable...sooner or later they should be removed just to clarify the fact that you've done all you can to address the issue (at that point of potential obstruction).

So a tonsillectomy gets a qualified recommendation.

Now, there's the UPPP. That is a combination of a uvula removal or flap, trimming the palate , and tucking up the posterior walls of the pharynx.

The UPPP has many issues associated with it. First, in the vast majority of people, IT DOES NOT CURE OSA. The studies out there are old, not based on scientific method (using post-op subjective interviews instead of sleep lab data), and have at best a 30-50% "improvement" in post-op OSA symptoms.

Second, there is a high relapse rate in most people with a short period of time. If it did work in the first place, as you age your oro-pharynx becomes more lax (or if you gain weight, the neck compresses the airway)...and the few milimeters of new airway is re-collapsed.

Third, the UPPP is associated with pain and discomfort (that varies from person to person) for 1-3 weeks. Because of raw surgical sites in the back of the throat , swallowing anything (including your own saliva) is painful post-op.

Fourth, the UPPP has a few annoying side-effects that happen in a fair number of people. These are not "complications" (that may include bleeding, infection, etc...)...these are side-effects that commonly occur with the surgery. These may include a persistent foreign body sensation in the back of the throat, liquid nasal regurgitation, and an inability to seal some PAP devices to effictively use them.

So, with respect to the UPPP, my perspective is that the risk-benefit ratio is BAD. The risks (lack of a cure, relapse, pain, side-effects) do not justify the potential benefits (the low cure rate associated with this procedure).

to see the entire thread at TAS, click on this: Surgery

Guest · Post by **Guest** » Thu Jun 22, 2006 1:37 pm

I have heard mixed results. Some people love it, others hate it. I have had one friend and a close family member who had it done many years ago who have nothing but good things to say.

I am willing to take a 50/50 shot at it working, regardless of the pain, becuase using CPAP is not an option.

fujiinator · Post by **fujiinator** » Thu Jun 22, 2006 1:45 pm

I had both the nasal surgery and throat surgery when I was 26. I did the nasal surgery first and then after a little while did the throat. Both at once would seem like too much to me. I was able to breath through my nose for the first time in my life. It was a success for me up until 2-3 years ago and my Apnea came back.

Pros if successful you will not need a CPAP, you will be able to breath through your nose better if you cannot now.

Cons surgery is not a guarantee that it will work(you may still need a cpap), You may have the Apnea come back in ten years or so

The specialist I went to was not too surprised that it had come back. It seems like the data on how long it will last you is starting to come out.

For myself I decided it was not worth doing the throat surgery again, especially if I would have to do it again in ten years. I am 37 now and adjusting to the Cpap machine. I have a supportive family and friends. There are also the people at this site to ask. I would still do the nose surgery if you cannot breath through your nose properly.

In the end is is your choice on whether to do it.

Please feel free to ask me any other questions if you have them.

nomad · Post by **nomad** » Thu Jun 22, 2006 1:51 pm

I'm going in for a pre-op visit to talk to my doctor about the surgery. What should I look out for... what questions should I ask? I really don't favor the idea of someone cutting away at my throat, but I HAVE GOT TO get my snoring in check. And no, I have no illusions that this surgery will stop my sleep apnea. It may reduce it at best. Like I said, this is all about the snoring.

The doc said that roughly 2 months after the surgery you generally do another sleep study to see what has changed.

Guest · Post by **Guest** » Thu Jun 22, 2006 2:04 pm

Anonymous wrote:I am willing to take a 50/50 shot at it working, regardless of the pain, becuase using CPAP is not an option.

It's not a 50/50 shot of it working. Read all the research. UPPP doesn't cure OSA. It might improve your OSA so your pressure requirement goes down. You might stop snoring, initially. But, according to all the studies, in the majority of cases the snoring returns after a few months. Even in the absence of snoring, OSA can still be present.

If you want surgery that actually been proven to be successful, you might consider the MMA/GA surgery that you can read about in the above provided links. It has a proven 85% success rate.

Knowing the facts, it is hard to understand how anyone would consider UPPP. Most reputable ENTs no longer even suggest it as a viable option. I urge you to click on all those links in the above post and read all the material. When you have read all those and searched the internet for all current studies on the efficacy of UPPP and are well-informed you will undoubtedly change your mind.

fujiinator · Post by **fujiinator** » Thu Jun 22, 2006 2:06 pm

Well if your pressure is right on the machine I did not think a person would snore. I ended up using a Mirage FF mask and that seems to be working well for me. If I have a large leak then I do snore though.

If I were you I would ask if you would still be supposed to use your cpap after surgery or what they recommend. I was fairly lucky in that I did not have a lot of pain. I did get that scratchy feeling in the back of my throat for a while at first and then it went away.. I also had my nose packed with gauze which was not very fun and I felt weird going out in public like that. I was fortunate that I had a very good doctor who put my mind at ease about the surgery and gave me a lot of information on what would happen and what they were going to do.

I would also ask how long your recovery time will take and length of hospital stay, etc.

Guest · Post by **Guest** » Thu Jun 22, 2006 2:38 pm

"Guest:"

Having undoubtedly both read quite a bit of literature on the topic, as well as speaking to people I trust first hand, I have decided to do the surgery. Undoubtedly, my ENT is one of the best in the Mid-atlantic and has suggested this surgery. 2 second opions have yeilded the same response, but you undoubtedly are far more well informed then every Dr. I have seen, or anyone I have talked to with positive tings to say about these surgeries.

I have found a ton of good info. on this site and others, both pro- and con- and have made the decision to do the surgery. I am not looking for opinions on whether or not to do the surgery (I ask my Doctors for those), I am requesting information on preparing/recovering from the surgery.

After reading through this forum, I have to ask why you so adamently argue the worthlessness of these suregeries, and the stupdity of those who try them.? Do you sell CPAP machines?

yardbird · Post by **yardbird** » Thu Jun 22, 2006 2:42 pm

advice for post surgery preparation:

prepare to go back on cpap

Not trying to be a jerk, but the statistics are against you. Heavily against you.
Oh... and I'm not a doctor... but I did sleep at a ..... nevermind....

ufo13 · Post by **ufo13** » Thu Jun 22, 2006 3:24 pm

Guest:

I agree with all the advice NOT TO HAVE THE SURGERY! Yardbird is right on in IMO! I have been on cpap for 12 years, and way back when-They were pushing surgery so after I had my sleep study, it was suggested I have it done by the Plum (sleep Dr). I called my surgeon who I grew up with and he always told it straight even if it cost him! Now retired, He also was Highly Respected on the EAST COAST! He told me forget-a-bout-it! Just as the very knowledgable Yardbird has said, my surgeon said, It won't last very long and will require it to be done again and eventually you will be on CPAP anyway! They told my brother the same thing on the west coast a few years earlier! I am NO DOCTOR also but you asked for an opinion and I am giving the best info I have, as the other forum members have done. I hope it helps with YOUR decesion!

All the best,

Steve,
ufo13

Guest · Post by **Guest** » Thu Jun 22, 2006 6:14 pm

snork1 wrote:My friend who swore by UPPP and had his done by one of the best surgeons around, now has his apnea back full bore, after less than a decade, AND has all the swallowing issues associated with UPPP.
I am sticking with reversible and less drastic approaches until they get a real CURE figured out via surgery or whatever.

bluesky · Post by **bluesky** » Thu Jun 22, 2006 6:24 pm

I explored surgery with my Dr. when I discovered I had OSA. He said absolutely not. Didn't like his answer so I went to a surgeon to discuss it. He said the same thing - absolutely not. They both said that even with the surgery I would still ultimately be using the CPAP. One said 50/50 chance of success at best. The other said he wouldn't give the odds. I decided that if I am going to have surgery I want a much better chance of success than 50/50 at best. This is only my experience with it. I do know a couple of other people with OSA - One's dr. recommended the surgery - They had it done, and are still using a CPAP. The other one's dr. said the same mine did - No surgery because the chance of success is too small - He has been using a CPAP for about a year less than I have.

Guest · Post by **Guest** » Thu Jun 22, 2006 6:34 pm

Anonymous wrote:After reading through this forum, I have to ask why you so adamently argue the worthlessness of these suregeries, and the stupdity of those who try them.? Do you sell CPAP machines?

I do not adamantly argue anything. I thought you should know the facts. I don't imply stupidity of those who consider UPPP, only ignorance.

LOL! No, I don't sell CPAP machines. I don't think yardbird or ufo13 or snork1 or bluesky sell CPAP machines either.

The quantifiable and verifiable research and medical studies have proven the worthlessness of UPPP. The best surgeon in the world cannot change the facts. I was simply relaying that information to you, because you obviously weren't aware of it. Don't shoot the messenger.

vonniebelle · Post by **vonniebelle** » Thu Jun 22, 2006 7:08 pm

I think you are very brave to have this surgery. I personally avoid the knife as much as possible. I do, however, understand how you feel about being "hooked up" for the rest of your life. The alternative, though, is scary. I will be interested to know how you do. Please keep us updated on your progress. If this solves your problems, I will be so pleased!
I am considerably older than you, and can remember a time when many of the ailments we can now treat were "untreatable", so I am extremely grateful for my CPAP machine. I think I probably would have died by now if I had not had that option -- that's how bad my apnea is. But I have had worse problems, and have learned that we can adjust to a lot of things if we approach them with the right frame of mind. Every morning when I wake up, I am very thankful for the sleep I got, because before my CPAP, I wasn't getting any, and it was causing me many other problems. I had some trouble adjusting to the machine, but my therapist helped me by having me try different types and sizes of masks. When we found one that fit me right, it made quite a bit of difference, and I don't resent my hookup any more. I had to make some other adjustments (like when I do my hair! ), but hey, life is about change anyway!
I have not met anyone yet who has opted for the surgery, but if I do hear of anyone, I will gladly come in and report what they had done and how it worked for them. I do hope this will do it for you! GOOD LUCK !!

Guest · Post by **Guest** » Thu Jun 22, 2006 7:23 pm

Barb (Seattle) wrote:I also had the UP3 (uvula removed) and my numbers went from 70/hr untreated to 64/hour, not a very good improvement for all that pain I experienced. Wishing I wouldn't have done it...what a waste of time it was for me...

Opting for Surgery

Opting for Surgery

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