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Tonsillectomy and UPPP and Coblation for base of Tongue
08-27-2015, 07:10 AM
No idea about the insurance coverage, but the procedure you describe is correct.
08-27-2015, 07:27 AM
Sounds to me that the surgeons are setting up to drain your wallet.
Heard too many horror stories of folks ending up with life long issues after this kind of fix and
almost nothing accomplished to actually solve the problem.
Your soft palate is there to prevent food from going up into your nasal cavity when you swallow.
If the soft palate is cut back then this natural safety barrier is compromised.
Then when you do get food jammed up there it's really hard to get out and it can't stay up there
because it will start to decompose.
You don't want garbage up your nose do you?
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton
08-27-2015, 09:37 AM
(08-27-2015, 07:03 AM)sleep_apnea Wrote: I am too rush for the surgery and will delay it, and think more about it. Thank you for the reply.
Here is a link to a study I previously posted on this site from 2011 showing that the adjustable rate appliances worked best for mostly mild to moderate apnea ranges in getting the AHI below 5. There were a few severity ranges that worked but I don't recall yours being one of them.
Anyway, a sleep medicine dentist I corresponded with from the now defunct apnea board said that the TAP appliance which I believe was used as the adjustable one in this study has a success rate of between 30 to 40% in getting people with severe apnea below 5.
He also said that optimizing nasal potency increases the chances of success. So if you have a problem with that, you might want to get that problem taken care of first before looking into dental appliances.
I don't know the long term success rate and I don't remember what this study showed about that if anything. Might be a good question to ask the provider if you decide to pursue this route.
You should look for a sleep medicine dentist who only works on dental appliances and isn't doing it to add extra money to his business. Of course, this isn't a guarantee but it increases your odds of getting someone who really will do a good job.
If insurance is going to cover it, it would be regular insurance. However, in your case, since they already paid for a cpap machine, they might balk at covering a dental device even if it is normally covered. Check with your policy.
But again, my question to you is if cpap is working, why mess with success? Dental devices obviously are alot more conservative than surgery but they aren't problem free. And I fear with you having severe sleep apnea, your chances of success wouldn't be as great.
Again, good luck to you.
I tried a boil and bite dental device and gave it a really good run. Actually I tried three different ones. My results were very promising as to reduction of AHI events. Most sessions gave complete relief if I set the device for 3 mm. projection. Any less displacement was only slightly effective. That would vary with the individual so YMMV is the appropriate term to apply.
You may also vary as to your tolerance of such a device. Initially your mouth decides it is something to eat and immediately produces lots of extra saliva, which is somewhat of a problem since swallowing with this thing in the mouth is let's say "different". That goes away after a few days and or else you learn to cope with it, not sure which.
Next comes the issue of whether you are a mouth breather or nasal breather. When I could manage to nose breathe, the device was more easily tolerated. When I had to mouth breathe due to a stuffed nose, the inability to produce saliva properly by normal means due to the device being in the way made my morning mouth be terribly clammy. That also caused some discomfort during the night and I often had to get up, take out the device and rinse out my mouth.
Next comes the problem of jaw aches. Depending on how much projection is required, jaw pain the following day can be an issue. At 3mm. I would give the discomfort a moderate rating and tolerable. It took about 30 minutes for my jaw to feel normal after taking the device out. When I tested it at a 2mm. setting, it was hardly any problem at all.
To summerize, I'll say if you are a nasal breather and can get by with 2 mm. projection, I'd say you will get good results with a mandibular displacement device. That's just me, you may find it easy to tolerate even higher settings. If your insurance doesn't cover it, consider getting one from an internet source like I did. It cost be $100 and is fully adjustable in 1mm. increments, which is absolutely necessary. Dentists get $1000 to $4000 for something I consider no better. I goofed up on the first boil and bite session and the company sent me out a second unit at no charge. Later I did some experimenting with the replacement unit and managed to make it less than great. I reported my misfortune to the manufacturer and was again sent a free replacement! It's the best customer service I have ever gotten from any company! SnoreRX
08-27-2015, 01:56 PM
Many people find that they develop jaw pain (TMD) eventually from using MAD. Insurance coverage is questionable. Also, you have no idea whether it works or how well it works unless you have another sleep test. You may find you need CPAP later anyway.
I will add that I tested my jaw breaker while wearing my apap (set as cpap and well below therapy level) and the Sleepyhead software validated the results that I reported earlier. I later tested without the apap and instead used an oximeter and a digital audio recorder. The results were very encouraging since no desats were flagged and listening to the audio proved that breathing was continuous, with no pauses or snoring. No restricted breathing was detected. Before getting my cpap machine, I used the audio recorder to justify getting a sleep test. At that time the recording gave many irregular breathing periods and several gasping sounds. I think my tests were accurate enough for my purposes but I don't mean to say a lab sleep test wouldn't be better. Alas, sometimes a lab sleep test can be less informative than something more user acceptable. If I ever have to get another one, it'll be a home test. My sleep lab test was totally meaningless since I never slept one wink Big waste of a couple grand, in my case. YMMV
Don't let anybody cut on you until you have exhausted all other methods of therapy in a full and complete fashion. Something as simple as sleeping on your side with a jaw advancement device set at a comfortable level may work. Keep in mind ENT doctors are surgeons. They are akin to the man with a hammer thinking everything looks like a nail.
08-27-2015, 05:26 PM
(08-27-2015, 05:28 AM)DocWils Wrote: Having your tonsils removed will not have a major effect, but admittedly, these days we tend to remove them anyway
I rather think you are wrong about that. In Canada tonsils are only removed when there is an immediate need to.
It wasn't always so. I had mine yanked when I was 5 and back then they did it to pretty well everyone. I got sleep apnea anyway.
Quote:because at some point they WILL turn on you
I don't believe there is any evidence that this is so.
Tonsils are part of your immune system and yanking them without good reasons surely must handicap that system. We have them because our ancestors survived better than those without them. No human is born without them.
Any organ can "turn on you" but these days the heart and lungs seem to be the main culprit, not the Tonsils.
I am neither a Doctor, nor any other kind of medical professional.
Actually you know, it is what it isn't.
08-27-2015, 06:49 PM
(08-27-2015, 05:26 PM)eseedhouse Wrote:Quote:because at some point they WILL turn on you
The theory these days seems to be that tonsils help your immune system learn as you're growing up, but they don't have much benefit as an adult.
(08-27-2015, 05:28 AM)DocWils Wrote: these days we tend to remove them anyway, because at some point they WILL turn on you, and better younger than older (say, 70) for this very minor op.
Interesting. I thought that once you reached mid 20's or so, major tonsillitis was rare. Is it just that most of us get at least a minor flare up or two, or does it tend to become a problem in older people? Or is there some sort of long term cumulative problem from minor tonsil infections?
08-27-2015, 07:58 PM
Tonsils can become enlarged or inflamed in adults and may require surgical removal, just as in children, but other problems show up over the years due to accumulation. In older patients, for instance, asymmetric tonsil hypertrophy may be an indicator of virally infected tonsils, or tumours such as lymphoma or squamous cell carcinoma. In addition, you can develop as an adult a tonsillolith, material that accumulates on the tonsil because tonsils are filled with wee nooks and crannies where bacteria and other materials, including dead cells and mucous, can become trapped. These can grow up to a cm, sometimes (rarely) more. The main substance is mostly calcium, but they have a strong unpleasant odour because of hydrogen sulphide and other chemicals and can be the primary cause of halitosis in some people, as well as an infection bomb waiting to go off. In addition, smoking and regularly drinking a lot of alcohol can bring on tonsil cancer. And then there is peritonsillar abscess, an accumulation of pus behind the tonsils. So lots of stuff in an adult with tonsils. Grossed out enough already? For our purposes here, tonsil size may have a significant impact on upper airway obstruction for overweight people, obviating the impact of CPAP, so repeatedly inflamed or enlarged tonsils usually must come out. However, normal sized tonsils will have no impact on your AHI.
As for function, yes, they are thought to act as a first line of defence in the throat, but most ORL(ENT) experts agree that the tonsils often do not perform their job well - in fact, they are extraordinarily bad at it. More often than not, they become more of a hindrance than a help. One theory is that tonsils evolved in an environment where humans were not exposed to as many germs as we encounter today as a result of living in areas with relatively high populations - another is that because of their structure, they are not equipped to handle modern pollutants, and thus will turn. All evidence suggests that people who have had their tonsils removed are no more likely to suffer from bacterial or viral infections than people with intact tonsils. There is no statistical difference of any significance in any validated meta-study. In short, there is no reason not to yank them, just as, if there is no infection, no compelling reason TO yank them, save that healing and trauma is less in younger than in older people, and it costs less in younger people (a lot of complex maths concerning drugs and a care and days of recovery, etc).
The reason that Canada stopped yanking them as a matter of course (but even then only upon onset of infection, BTWl, although back in the 50's and 60's it was still the habit of paediatric docs to offer it to parents once the child was old enough, even if asymptomatic, a practice which was stopped) was the cost on an already over extended medical health system. It was deemed to be not cost effective, and had nothing to do with any thoughts of immune system development. The social medical system that Canada had instituted was never designed to work against a heavily rising population and massive drains on the system due to chronic and fatal long term diseases not yet discovered when the system was designed, like AIDS and the massive rise in cancer and lifestyle diseases. And I know this because one of the people who made the recommendation to the Feds, which was then passed on to all the provinces to do or not do as they saw fit, was a govt. doc in Ottawa, who was also my god-father and who delivered me. Alas, he is no more, but lived to a ripe old age of 91, and died of lung cancer, which pissed him off, as he had given up smoking 40 years prior. He was a great and wonderful man, a gifted physician, a talented violinist, and a great mentor. And I miss him to this day.
eseedhouse, I AM a doctor, and while I certainly appreciate your input, it is an incomplete picture. I hope this has filled in a few parts of the page a bit.
08-27-2015, 08:50 PM
(08-27-2015, 07:58 PM)DocWils Wrote: The reason that Canada stopped yanking them as a matter of course (but even then only upon onset of infection, BTWl, although back in the 50's and 60's it was still the habit of paediatric docs to offer it to parents once the child was old enough, even if asymptomatic, a practice which was stopped) was the cost on an already over extended medical health system.
Well I was five at the time, so that would be 1949.
Medicare did not become nation wide until 1966.
As for cost, Canada spends a lot smaller share of GDP for health care than the U.S.A. does, and overall gets better results. Sure you can get better care in the U.S. if you have lots of money or really good insurance. But if you happen to be poor, well...
Here the really well off can go to the U.S.A. and get the platinum treatment, but everyone who stays in Canada gets the same standard of care, rich or poor. And it's a pretty good standard as statistics and my own personal experience confirm. Yes, we could do a whole lot better but not by "privatizing" which is what the current Government would like but won't admit in public...
I am neither a Doctor, nor any other kind of medical professional.
Actually you know, it is what it isn't.
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