RE: Tracheostomy anyone?
I am very sorry to hear that your spouse had stage 4 cancer. At this stage there is little hope of recovery, and, depending on the type of cancer, there are different treatment procedures (excision first, then radiation, radiation first, then excision, aggressive chemo first, then excision, etc). That your spouse has achieved remission is a remarkable feat at this stage. The determination of in which order to do things, established by your oncologist, is based largely on precedent, which is measured in mean 5 year survival rates, meaning that the statistics are constantly evolving and as such the recommended approach is constantly being tweaked and adjusted for the best chance of long term survival. Trends tend to show up very fast, and the given method would have been considered the best chance for an extended survival period. I certainly know that the recovery period is hellish either way, and you and your spouse have my sympathy and my best wishes for continued recovery and a long and happy life.
Returning to the topic, I have made myself pretty clear as to my views of surgical intervention of any type when using or readjusting PAP usage will suffice. MMA is a wildly inconsistent procedure with results that can only be described as iffy - it may work, it may not, most often it reduces symptoms but does not cure them, meaning that you would still need the PAP, so why do it anyway if the PAP works? A tracheotomy will often deal with the symptoms, if it is an upper trachea or above problem, but the life style afterwards is so bloody difficult, I can't imagine anyone choosing it over a mask.
The best way to avoid your condition worsening is to lose weight and get fit. I makes a heckuva difference in almost every case except CSA events or events caused by nasal and soft palate problems, which are not affected by weight gain or loss. For the latter, if the problem is ballooning or softening, and not extensive length, a simple insertion of plastic rods helps, although that method is now being replaced by "scarring" of the region, either being a method of making the region less flexible. For some a mouth insert does the trick, particularly if the problem is the shape or direction of the jaw, for others a nose clip is sufficient if the main cause is the collapse of nasal wall, but such cases rarely have AHIs that rise above a 10. All of these would fall under conservative therapy methods, and non or minimal invasive approaches.
I know that we live in a society that wants quick and permanent fixes, but medicine rarely offers them, and when it does, like magic, it comes at a huge cost. So before undergoing the knife for anything, and I DO mean anything, get a second opinion and a third and read up on the procedure and the post op long term results and effects (these are published online for almost every type of procedure). If there is really a good reason to then abandon conservative therapy, such as CPAP, then do so, but "I want it fixed!" or " I hate having to wear a mask the rest of my life!" isn't sufficient cause. The end results may be far worse than just learning to accept and love your mask. In those cases, see a head shrinker and get cognitive behavioural training. It has proven results, especially with PAP compliance where mask wearing was unbearable to the patient, almost always for psychological reasons that may have manifested themselves in physical reactions to the mask.
And one more thing - no surgery is trivial, even something as fast and relatively easy as a tracheotomy. So think carefully before doing it. Some surgeons and some doctors are very enthusiastic about cut and stitch, others, like me, tend to realise it is a necessary thing, but neither a picnic nor desirable if at all avoidable. Every surgery is fraught with perils, even minor ones, and you do it advisedly. Sometimes the perils are minor (infection, scarring, etc) but sometimes, like long term tracheostomies, the perils are quite major and can even be life threatening. So think before you cut. Think hard, and then take a walk, and think hard again. Yes, you OSA may be "cured" (it isn't, it is bypassed but still there), but at what cost, especially compared to not having a permanent physical change to your body and lifestyle?
(This post was last modified: 10-07-2013 04:27 AM by DocWils.)