Is surgery the only option for treating sleep apnea or snoring
I do predominantly the line share of sleep apnea surgery in our department. I collaborate closely with the pulmonologists, who are the sleep medicine s. Those are the s that help diagnose and treat sleep apnea, as well. If those patients fail their, their medical or their conservative therapy, that's typically when they get sent to see me for surgical considerations to, to look at potential cures for their apnea. It's not uncommon for me to see a lot of patients for, who come in for snoring complaints and, you know, are wondering whether or not they have sleep apnea. So sleep apnea is condition where you actually stop breathing at night.
Snoring is somewhere on that spectrum, towards the more mild, you know, milder end of that spectrum. But, you know, really the only way to determine if you have sleep apnea, the gold standard of testing, is really getting a sleep study. And that's an overnight, monitored study where patients, you know, sleep in a room that's similar to a hotel room but they're being monitored and they're hooked up, you know, for sound so to speak with different monitors and cables on them. And that's really our best test to diagnose sleep apnea. The treatment for sleep apnea is typically a nonsurgical therapy; something called CPAP,
which stands for Continuous Positive Airway Pressure. And it's the patients that don't tolerate their CPAP who end up seeing me for surgical considerations. And there's a number of reasons why patients may not tolerate their CPAP. But there are some surgeries that can be helpful in patients who are not tolerant of their medical therapy. And I offer a variety of surgeries including nasal surgery, a variety of palatal surgeries for the kind of tonsil and soft pallet region and then also a variety of tonguebased procedures, as well. But we typically see a patient back after their procedure in about three weeks to recheck everything, make sure that they're healing okay.
After that, I normally recheck a sleep study in about three months after their surgery, just to give everything a chance to heal and to scar. And we, you know, make further recommendations based on the result of their followup sleep study after their surgery. We're exploring the, a new technology now which is actually a nerve stimulator for sleep apnea. It's an implantable device, very similar to a pacemaker that goes into the patient's chest. And there's an electrode that will actually stimulate the nerve that goes to the tongue to provide the tongue with a little bit of more tone when they're sleeping at night, and thereby eliminating their sleep apnea.
Compensation 101 How did I get this rating
If you've receiveda rating with multiple disabilitiesand wondered how VA got the combined percentage,the following information and example can help youunderstand. VA uses a concept calledthe quot;Whole Person Theoryquot; to determine Veteran'scombined disability rating. This method ensures thata disability rating can never be greater than 100,since a person cannot be
more than 100% able bodied. The disability isdetermined by using the quot;Combined Rating Tablequot;located at 38 CFR 4.25. To use the rating table,you need to start with the highest disabilitypercentage, and from there, arrange them in orderof severity, highest to lowest. For example, if there aretwo disabilities evaluated 50 and 30 percent disabling,the highest degree
or most severe disability in this example 50% will be foundin the left column. Then, the otherless severe disability in this example 30% will be found in the top row. The figures appearingin the space where the left columnand top row intersect will represent the combinedvalue of both disabilities. This combined value willthen be converted
to the nearest numberdivisible by 10. Remember, combined valuesending in 5 or higher, will be adjusted upward to the nearest number divisible by 10. Combined values endingin 4 or lower, will be rounded down to the nearest divisible by 10. The rounding is only doneat the very end after all the disabilitieshave been combined. Let's begin withJoe Veteran as an example.
Joe has been ratedfor the following disabilities in order of severity: 30% PostTraumatic Stress Disorder (PTSD), 20% Diabetes Mellitus,10% Peripheral Neuropathy. Joe has a combined rating of 50%. This combined rating wasderived by the following method. Start with the greatestdisability and then combine them using Table 1in 38 CFR 4.25.
First take the 30% ratingand find it in the left column. Then take the nexthighest disability which is 20% from the top row. The figures appearingin the space where the column and row intersect will represent the combined value of the two. The value is 44. Use this value for theleft row and then find
Complications after cosmetic surgery Houston Austin Dallas San Antonio
Hi, this is Hourglass, and welcome toanother tutorial in our channel Superhourglass. Today we are going to discuss obesity andpostoperative complications after cosmetic surgery. In this channel, we will discuss everything you need to know for you to get the hourglass shape you've always wanted. Welcome back. Obesity continues to climb in the United States. According to the CDC, more than 30% of the adult population is now considered obese based on the BMI. A body mass index of above 30 is considered obese.
Overweight is above 25, and morbidly obese is about 40. There is a continued debate and conflicting studies relating to non obese and obese patients when it relates to complications after surgery. Obesity has been related to postoperative complications including a 5 times higher rate of heart attack, 7.1 times higher rate of wound infection, and 1.5 times higher rate of urinary tract infection. In addition, obese patients are at a higher risk of pulmonary disorders like sleep apnea and hypoventilation syndrome (in other words, breathing slowly).
The problem with determining if obesity actuallycauses an increase in postoperative complications is that different studies have been designedusing different methodologies. Also, there is no strict definition of complications relative to the level of risk of the surgery. Some studies have related obesity to an increasedrisk of postoperative pulmonary infection, collapse of lungs, and pulmonary embolism. However, other studies have found no association between overweight, obesity, and postoperative respiratory complications. When it comes to cosmetic surgery, one of the main concerns with obese patients
and this has been shown in multiple studies is problems of wound dehiscence or wound opening after surgery, wound healing problems, and wound infection. There is no question that the more obese you are, the more likely you are to have wound healing issues and complications. Typically, we have the BMI to determine therisks of obesity and complications of surgery, but recently, as I discussed before, the amount of visceral fat, which is the fat around the internal organs, has been shown to have a major role in postoperative complications. Adipose tissue is now recognized to be morethan simply a lipid storage organ,
but a highly active metabolic organ with endocrine, paracrine, and immunological properties. In addition, excess adipose tissue, especially in the intraabdominal or visceral tissue, is considered a main metabolic syndrome where there is prothrombotic proinflammatory state associated with insulin resistance. The bottom line is that even if there areconflicting studies related to obesity and complications, it is generally accepted thatsomeone obese with a BMI above 30 is not going to be a good candidate for cosmetic surgery. Leaving the postoperative complications aside, an obese patient will have a less than satisfactory outcome
due to the fact that cosmetic surgery mainly involves contour procedures rather than weight loss procedures. Patients believe that they can come and have a tummy tuck and liposuction and all of a sudden their body will diminish from a size 10 to 12 to a size 3 or 4, but this is not the case. It is important that obese patients with a BMI above 30 reach a BMI that is within the healthier scale. In addition, it is important for the surgeon to assess the distribution of fat, including the visceral fat, because visceral fat has a significant role in proinflammatory conditions. It has been determined that it can actually increase the risk of prolonged recovery, poor wound healing, and blood clots.