One week from surgery

About four years ago, I sat across from a doctor in Santa Barbara, Calif., conducting the usual first-visit interview. I'd just moved back to Santa Barbara after a couple of years away and had a new primary care physician. Dr. Sim looked like he hadn't been out of medical school more than a year or so, a factor that probably worked in my favor. Thinking back, I probably am very lucky to have met with him. During the interview, we touched on the fact that I always seemed tired and that I grew more tired as the day wore on.

In fact, in recent years I'd taken to scheduling important meetings in the morning because I knew that I definitely wouldn't be at my best after about 1 o'clock in the afternoon.

"Might be sleep apnea," Dr. Sim said. Back in 2003 I'd never heard the term. Three sleep studies, two different CPAP machines, a TAP machine, various ways of trying to sleep and countless visits to about a dozen doctors and dental specialists later, I'm exactly seven days away from having major surgery -- maxillomandibular advancement with genioglossus advancement, if you want to know the details -- and, I hope, a chance at getting my life back.

Me? I'm a 44-year-old man, in pretty good shape (5-10, 165lbs) -- not exactly your typical apnea patient ... though, the more I read, the more I see that there really isn't one anymore. I live in Wilmington, North Carolina, though I'm hardly a native. Heck, they just got a Trader Joe's in this state and I actually have to drive 140 miles to get there! The horror!

I'm pretty sure I've had apnea for several years. Up until that visit with Dr. Sims four years ago, always felt dog tired, but I just thought that's the way it was for everyone. So, keep in mind that I've been giving you a handicap all this time. Just you wait!

Like I said, I've had three sleep studies, tried CPAP and BiPAP, but couldn't find a mask to fit because of the shape of my face. Tried the TAP appliance, which for those who don't know, looks a little like a medieval torture device. Essentially, it allows you to ratchet your jaw forward ... and then sleep ... and drool ... a lot. It actually worked a little, but not really enough.
Turns out, my unusually small chin -- retrognathia, if you want to get technical -- is the chief culprit. Which led me to the oral surgeon and the BIG DECISION. I've been in braces since January 2006. My teeth are certainly much straighter, though my overbite has increased significantly. I'm not a pretty eater.

In March, my most excellent orthodontist told my oral surgeon I was ready to go.

I'm scheduled to check into the hospital at UNC-Chapel Hill on Tuesday, April 10. There, a very talented (so I'm told) doctor will perform a maxillomandibular advancement (MMA) and a genioglossus advancement. In short, they'll move my lower jaw forward about a centimeter, my upper jaw forward enough to compensate and fiddle with my chin to move my hydoid bone (that tough part around your Adam's apple) up. All this to give me a bigger airway. And, as a bonus, make me an even more handsome devil.

They say I'll be in the hospital for one or two nights, then, if all goes well, go home. Likely, I'll be banded, rather than wired shut. I guess that means I'll be able to talk. I've heard or read about other MMA patients feeding themselves with syringes. My doctors said they want me to start spooning in anything I can puree in the blender ASAP. No syringes. The sooner I get used to my newly aligned bite and numb chin the better, they say. Fine by me.

Am I worried? More and more as the date approaches. Am I excited? Yes, but the worry tends to cloud it. Do I know what to expect? I think so, but who ever really knows? Do I know what I'll look like afterward? Not really, but I have suggested to my doctors that, since they'll be in there busting it all up anyway, why not put it back together looking like Tom Cruise or George Clooney? No, I say, really, I mean it.

Actually, I'll settle for the ending my apnea. After all, that's what this is all about.