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kyhrsluvr
Unread post  Post subject: new robotic surgery  |  Posted: Mon Nov 28, 2011 7:18 am
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I just saw on NBC's the Today show, a new robotic surgery for sleep apnea sufferers. I think it is fairly new and of course, not for everyone, but it appears to be much more effective than the 'traditional' surgery for sleep apnea. I'm hoping sometime yet in my lifetime, hopefully sooner rather than later, that these techniques or others will become more available and more effective and will be another tool that can be used for the treatment of sleep apnea :)


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Mon Nov 28, 2011 9:56 am
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I need to take a look and see what that is. Do you remember if it is related to the hypoglossal nerve stimulation implants?

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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Mon Nov 28, 2011 2:51 pm
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No, It was performed using the DaVinci robot so apparently it is more precise than what any surgeon can do manually. The segment profiled a 30-something police officer and the surgery was performed somewhere in New Jersey. Googling it, I found other places that are offering it. Here is the link to the segment... http://today.msnbc.msn.com/id/26184891/ ... 0#45461490


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RobRens
Unread post  Post subject: Re: new robotic surgery  |  Posted: Mon Nov 28, 2011 5:41 pm

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The guy’s physical transformation in only 30 days was nothing short of phenomenal! Oddly enough, I had scheduled an appointment with my ENT a couple weeks ago for tomorrow afternoon. Guess what we'll be discussing. :)


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Mon Nov 28, 2011 11:26 pm
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I've been trying to watch this video for the last three hours. I think my internet connection is done for the day. I let it try to buffer for 2 hours and I got to watch 47 seconds of it. Arrrrgggghhhhhh!!! :evil:

I'll try again tomorrow. From what I read at a Penn Medicine website on the subject, it looks like it's the same surgeries (UPPP with tongue base reduction) that have been done for years, but with the precision of a robot. Also looks like they spend more time identifying the areas that are the root cause of the obstruction. If that's what is said in the video....which it looks like I'm destined to never see. :oops:

The 47 seconds of it looked very interesting though.....

I'll try again tomorrow.

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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 4:36 am
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Yes, that's what it sounds like.......the same surgery just made better because of the robot.
I don't know if I'm ready for anything like surgery yet, but it looks promising.
Rob, you'll have to let us know how your appt goes.
Jason, I just checked the link and it's ok. I believe it was the Univ of Pennsylvania that was the lead researcher in this procedure.


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 10:49 am
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Okay, my internet connection is finally healthy and I was able to watch it.

Was anyone else unimpressed with the medical corespondent? Matt asks a great question about how he lost so much weight in 30 days. 30 lbs in 30 days I believe is what it said.

The medical corespondent says that sleep apnea "causes you to crave the wrong kind of food." What??? So if someone has sleep apnea they all of a sudden develop a craving for Hostess products???

Sleep apnea slows your metabolism. It also just causes you to be tired because you have a string of nights in a row where you wake constantly. I know I don't feel like working out or exercising if I have a bad night. Multiply that by 10-100x and that is a sleep apnea patient. Her comment frustrates me since that is exactly what many patients hear.

Doctor: "Just start eating right."
Patient "All I eat is broccoli and pixie dust."
Doctor: "Well....then you should be eating MORE right."

I'll offer a better explanation. The surgery hurts like hell for several weeks so the police officer likely ate very little post surgery.

I really wished they said what his RDI and AHI were. Some people just have apnea while in REM and they can last a couple minutes, but then nothing else during the entire night in NREM. He also wasn't studies post surgery, so I'd love to know how much he improved his RDI and AHI numbers. It could be said that all this is irrelevant because he now feels great.

That said though, anything that is more precise than a doctor with a knife and a shaky hand is okay by me. I know that many patients who have had surgery still require CPAP, but they report that CPAP is more tolerable post surgery. The statistics show that traditional UPPP and tongue base reduction are more successful in mild to low moderate AHI patients. I'm very curious to see the data when this has been done for a couple years with the robot.

Thank you for posting this video. It was very interesting. I really wish Dateline or 20/20 would devote an hour to it since it effects so many people. Show several different possible outcomes with long term follow-up.

I am also very curious about what RobRens doctor has to say about this.

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RobRens
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 12:47 pm

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Being the good little cyber stalker that I am, I've been in contact with the police office profiled in the report.

He states that "they removed [his] uvula, tonsils, trimmed the upper pallet (ouch the most) and then removed a section of [his]tongue the size of a baseball (a little to graphic for morning television, so they said instead removed excess tissue)." He said that "[his] tongue was 90% of [his] obstruction" and attributes his dramatic weight loss to the fact that he was unable to swallow solid food for two weeks. Over all, he seems pretty pleased with his results.

Not sure how much more of his emails I should post without his permission, so I'll just leave it at that. There may be light at the end of the tunnel after all. :)

I'll post again after my appointment this afternoon.


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 1:51 pm
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Were you playing "Google Me Elmo" again? :lol:

You seriously need to be a private investigator. By the way....stop driving by my house. ;)

A baseball sized piece of tissue is pretty significant.

I am REALLY curious what his AHI and RDI was pre and post surgery. Hmmm.....if only there was someone on this forum that is adept at digging up information. :)

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RobRens
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 2:40 pm

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Of course I was. BTW... I like what you've done to the front of your house. Just wish you hadn't cut the bushes back so far!! :)

I'll touch base with him again and see if I can get more info. Even better, maybe I can get him to join the forum. Unfortunately, I'm stalker #36 on his list so it may take him a while to get back to me.

I'm off to see my ENT. Stay tuned.


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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 5:05 pm
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Good job guys........you nailed that one Jason about his weight loss. I hadn't thought of that, just figured he was feeling that much better but it was an awful lot.

I'm not very impressed with Dr Nancy Snyderman on NBC in general. She once called the bacteria that causes whooping cough a virus.....NOT. I wrote to her on that one. I kept it nice :roll: but never had a return response. She probably had many people write to her on that one. I agree...it would be nice for another program to profile sleep apnea. Between you both, you should be able to contact someone via Rob's cyber stalker :geek: abilities and Jason's expertise to sell the story (and help write it) and help make the program happen.


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 5:38 pm
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kyhrsluvr wrote:
Good job guys........you nailed that one Jason about his weight loss. I hadn't thought of that, just figured he was feeling that much better but it was an awful lot.


I'd like to say that it was from brilliance, but that's not the case. :cry: Every single patient (no hyperbole there) who has had the UPPP (that I've seen in my sleep lab) has said that it was the most painful thing they have ever experienced and they didn't eat for a month.

I'd really just like a longer and more comprehensive story on sleep apnea and all the options available and realistic expectations for each. Then a bunch of personal stories following people in all the situations. Maybe a heartfelt musical montage and there we have it. ;) We had a local NBC affiliate do a story and they seem to want to go for the cheap laugh instead of really spending the time educating people about apnea and treatments.

RobRens...you are way too funny!

RobRens is the one with Hollywood connections. He's known as the "Juggling Accountant to the Stars." I look forward to the appointment details.

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RobRens
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 8:39 pm

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Well, I met with my ENT this afternoon and, to be honest, I'm a little underwhelmed. He numbed my nose, looked up each nostril and down my throat, pulled my tongue out, then to the left and right. He then ran a scope up my nose and down my throat and showed me on the monitor what was what. All pretty standard stuff.

He seemed to think that everything looked pretty much normal. He did say that my tongue was a little large, but that it was hard to tell from a sitting position what it looked like when I was laying down (Ya think?) and said that my throat was pretty narrow.

He mentioned that there is a TORS machine at the hospital across the street from his office, but that he had no business using it. (Good to know!)

He gave me the standard options:

• Sleep on my side (I already do)
• Avoid alcohol (I really don't drink much anymore)
• lose weight (forgot his magic wand)
• exercise (if I only had the energy)
• use Astepro 0.15% Nasal Spray to help with my morning congestion (We'll see)
• use a CPAP (DUH! The first thing I said was that I had apnea and had been on a CPAP for a little over a year!)
• try an oral device (which he said wouldn't work in my case)
• have the same surgeries I've already had. (That ship has already sailed)
• or have the robot surgery

He didn’t really offer an opinion on the TORS either way, just that it was a newer version of an old procedure. He did give me a referral to a doctor at USC who specializes in this procedure.

That was a fast $100 out of my pocket as my ENT is out of my network.

I guess it’s time for a second opinion and another $100 medical bill.

I guess one of the problems inherent in those “let’s cram everything we can into this one hour of news” reports is that you have 30 to 90 seconds to tell the whole story. Therefore, many of the details get left out. Sure he lost weight. He had 3rd degree burns in his throat and couldn’t swallow for a month. Yes, there are benefits for those who are viable candidates, but there is also the down side of all the pain and suffering along the way.

I’ve already had ¾ of the work done and it wasn’t fun. But neither is going through life deprived of sleep. Oy!

Your Google Me Elmo Juggling Accountant to the Stars,

RobRens


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Tue Nov 29, 2011 9:11 pm
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Yeah.....that sounds like the meeting left something to be desired. I'm sorry to hear that.

That's the second time that you've heard your throat is narrow...right? You may want to research hyoid advancement surgery. The idea is that it pulls the hyoid forward and the anterior wall of the throat comes with it. This, in effect, makes the throat bigger. Research it well...it doesn't look pretty at all, but it gets at the root of the problem you seem to be having.

The thing is that it is 99% likely that CPAP will still be needed even if the surgery is successful. But think of your airway as one of those skinny coffee straws that are really only good for stirring. You need one of those McDonalds straws that allow you to finish off a 64 oz soda in three gulps. Your narrow airway is the limiting factor to how much air can move through it. CPAP would likely be more effective with a normal sized airway.

I'm certainly not a proponent of surgery, but there comes a time where it's the option that just makes sense. I would just want to make sure that the surgery is going to address the root of your apnea.

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RobRens
Unread post  Post subject: Re: new robotic surgery  |  Posted: Wed Dec 21, 2011 10:43 am

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Ok, so I saw the ENT at USC regarding TORS (wow, that's a lot of acronyms!). He didn’t rush me toward surgery, which is both good and bad. I hoped he’d say “Yes, you’re a perfect candidate and TORS will make your life wonderful.” Instead, he wants to do some further investigation. He’s going to send me for a CT scan to see what’s going on with my throat while in a reclined position. The saga continues...

Happy Holidays everyone!

Rob (aka Stalker to the Stars) ;)


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TheLankyLefty
Unread post  Post subject: Re: new robotic surgery  |  Posted: Wed Dec 21, 2011 12:38 pm
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That was a lot of acronyms BTW....oops... ;)

That's good that he's not in a rush, "Hey, my 2:30pm surgery just cancelled so let's just squeeze you in."

It's fantastic that he wants to actually investigate where the obstruction is while you are laying down to see if the TORS will even work, and if so, where to cut.

The statistics on some of those surgeries isn't great, but it makes me wonder. If done properly (like how your doctor is approaching it) can the success rate and effectiveness of apnea surgery become a more realistic option? I would think so.

I would love to see AHI improvement statistics of Baseline vs. TORS, Baseline vs. "standard" UPPP/LAUP, and Baseline vs. CPAP and how they all compare to each other.

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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Wed Dec 21, 2011 5:08 pm
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I had an appt with my dr today and mentioned this robotic surgery. She said she is not a fan of surgery but if that I truly want to pursue it, she would get me connected with a real good surgeon. She also mentioned that a surgeon would further evaluate me to see if I was a good candiate. She wants me to wait a bit yet though and see how things go and see if I start to feel less tired consistently. I told her I have some days that I have felt great and my energy level was, as I described it to a friend, "like the energizer bunny". Other days I still feel tired even after getting a consistent good nights sleep with <1 AHI. By the way, she gave me an "A" on my summary report from the cpap's SD card 8-)
She also says to continue taking 5 to 10 mg of melatonin nightly. I was taking it probably about 3 times a week on average. She highly recommends it to get to a consistent deep stage of sleep.
I'll be very curious to watch and learn from what Rob learns. He can be a sort of guinea pig (along with his 'Stalker' title) for the rest of us ;)


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karroo
Unread post  Post subject: Re: new robotic surgery  |  Posted: Thu Dec 22, 2011 5:13 pm
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Hi Kyhrsluvr - can you tell me about the rationale for taking melatonin. hard to get in AUstralia ie not in every drugstore but i have a lot saved from trips to US 9my dad likes it). I only just started CPAP. thanks

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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Thu Dec 22, 2011 5:51 pm
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Hi Karroo, melatonin is a hormone that is naturally made by your body and apparently functions to regulate sleep. I had real awful insomnia :evil: for my first two weeks of cpap use and it even caused my blood pressure, which has been normal, to go up due to my lack of sleep and I was thinking of quitting cpap. Jason and then my dr suggested taking melatonin. I don't know if it was completely due to it or the fact I was slowly getting used to the cpap, but I started sleeping better almost immediately. I did get some mild headaches for the first couple of days of taking it, but nothing I couldn't handle and they have since stopped.

I am having no problems sleeping 7 - 8 hrs a night now but still feel tired although not so bad as before. I had since been taking usually 5 but sometimes 10 mg of melatonin, inconsistently and my dr has suggested I continue taking it on a consistent basis to improve my deep sleep periods. I have been about 2 months now on cpap. I do have days when I feel real good with tons of energy but those aren't the norm at least not yet. I will probably drive my husband crazy if I get to that level all the time :lol: .

I saw your posts on your mask issues. Are you going to be able to try something different? Jason is such a big help in sorting this all out :) .


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kyhrsluvr
Unread post  Post subject: Re: new robotic surgery  |  Posted: Thu Dec 22, 2011 5:57 pm
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Never mind my question Karroo....I just read your follow-up posts :)


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