Thanks to stable insurance coverage that allowed me to catch up with old dental issues, and to more attentive self-care, I was ready to listen when two different sources suggested a few years ago that I might consider exploring ways to address my improperly developed facial structure. First, a dentist friend commented (most gently and diplomatically) that it might be possible for orthodontia and surgery to improve my “mid-face deficiency”, which I’ll describe in my layman’s terms as a lack of proper growth in the bony structures between my mouth and nose.
Around that time, I began working with a new and very excellent dentist, who soon informed me that without orthodontia, I was at great risk of losing my teeth in the next decade or so. Without further ado, I consulted an orthodontist about a treatment plan. My dentist also sent me to an endodontist for a root canal, and to a periodontist for a look at recession of my gums.
My new periodontist recommended two minor surgeries in preparation for the orthodontia and surgery, and for the health of my gums. First, in a frenectomy the periodontist cut a bit of tissue connecting my lower lip to the gums below my lower front teeth. Next, in an allograft, he sutured some graft tissue (I can’t recall what it was, but it looked like cooked pasta!) into place along those same lower gums below my front teeth. After a period of healing my gum recession was less pronounced in that area, though it may require another procedure after the rest of the surgery and orthodontia is complete.
At my first appointment with my new orthodontist, he took one look at me and strongly recommended that I schedule an appointment at a sleep clinic. In his words, I had the classic profile of a person who suffers from sleep apnea, or disrupted breathing during sleep. In discussing his plans for my orthodontic treatment, he also suggested that orthognathic (jaw) surgery was likely to be necessary as part of the treatment, and referred me to an orthognathic surgeon. Ultimately it took me two years and a couple of changes before I settled on a final choice for an orthognathic surgeon.
Following my orthodontist’s advice, I did consult a sleep doctor, underwent a sleep study, and was diagnosed with “severe” sleep apnea. Somewhere I came across a very helpful explanation of terms involved in sleep apnea, that drew upon the Latin roots of the words involved.
- “pnea” is related to air, breathing or breath (think about pneumatic lifts, using air to support something)
- “a” as a prefix meaning not
- “hypo” as a prefix meaning under or low
So, “a-pnea” means not breathing, and “hypo-pnea” means taking in a low or insufficient amount of air. (Pronounced APP-nee-a and hi-POP-nee-a, I believe.)
One important metric when one takes a sleep study is the Apnea-Hypopnea Index, or AHI. This is an average of the number of times per hour that one’s sleep is interrupted by either “apnea” (no breath) or “hypopnea” (insufficient breath). My AHI from my sleep study was 37 – which means that my sleep was interrupted an average of 37 times per hour in that study. On average, I never slept more than 2 minutes without interruption! This figure is well into the range considered "severe" sleep apnea.
Once I was diagnosed with Sleep Apnea, I was prescribed a CPAP (Continuous Positive Airway Pressure) device which helps me breathe more regularly as I sleep. In my particular case I must wear a “full-face mask” (which does great things for my facial skin). I’ll hope to share more on that particular aspect of the story, and my struggle to learn to “tolerate” the CPAP, which is thankfully mostly in the past. But, the happy result is that my AHI is down to around 6 or so, which is an acceptable level, and my sleep is much improved.
Returning to Orthodontia: In the fall of 2014, not long after I began using the CPAP for my sleep apnea, my orthodontist fitted me with orthodontia (braces). Certainly many people have experienced braces, and my experiences with that aren’t groundbreaking or unusual, though I do have the perspective of having braces both in the 1980s and in the 2010s. There have certainly been some improvements! As someone used to journaling, I’ve made a few recordings and journal entries along the way as I encountered new struggles and phases, such as the struggle with lingual buttons. These were poky attachments on the inner side of the lower teeth, that my tongue could not leave alone.
My tongue’s inner dialogue, when confronted with the new buttons: “What’s that? Ow! What’s that? Ow! What’s that? Ow! What’s that?…”
And, my typical dialogue with my tongue around that time. Tongue: "What's that? Ow!" Me: "OK, how about we avoid that spot?" Tongue: "What's that? Ow!". Etc.
There have also been the days when my orthodontist adjusts the tension in the braces to get the teeth moving. This results in pain that all braces-wearers know well. On the plus side of that experience, I’ve often taken the opportunity when I have mouth pain to do some exploring of how to eat when you can’t chew or swallow easily, thinking ahead to recovery from surgery. I used to think that having to squirt liquid food from a packet into one’s mouth, like an astronaut or a science fiction character, would feel unnatural or even disturbingly dystopian. Now I appreciate the convenience and ease of that kind of eating. Oh, I don’t think I’ll ever stop appreciating many foods in their best presentation, with flavor, scent, texture, and general yummy goodness that I am thankful to take in. But it’s nice to have an alternative that’s fast, doesn’t hurt, feeds me well, and leaves me satisfied. It also helps greatly having Lorraine’s expertise and exploratory spirit absorbing recipes and modifying them into more healthy – but still tasty – new versions, good for both of us.
For additional exploration of issues related to my speech pre- and post-surgery, I have also consulted with the department of Speech and Hearing Sciences at the University of Washington. We’ve taken video and various computer measurements of my speech. After my surgery, we’ll take another set of measurements, and I hope we’ll learn something interesting there. Later, I will work with a speech therapist assigned through that office. I hope to learn a lot in that process and perhaps improve my skills even beyond current levels. After all, we are hopeful that this surgery will improve my ability to breathe freely, so perhaps, eventually, I'll be able to speak more easily as well.
Along that line of thought, I have also consulted two of my teachers in the area of the Alexander Technique, asking their insights into the best Use of my Self in this process. We have discussed how I can carefully consider the steps (“means-whereby”) I’ll need to learn in self-care (such as feeding myself with a syringe and catheter), so that I can do those necessary steps with as much ease and comfort as possible. We’ve also talked about the post-surgical speech therapy I’ll be doing, and how to incorporate my study and experience with AT and body-mapping into my cooperative work with the speech therapist.
We’ve also talked about how to address one of my largest fears associated with the surgery. My surgeon is planning that I will be intubated during the surgery and overnight, mostly because of my history with sleep apnea. That is, to ensure that I breathe properly, a tube will be inserted through my nose, down my throat, between my vocal cords, and into my trachea. This is an area that makes me most nervous, both for how I will do when I wake up, and for any long-term effects on my voice. I am fearful that I will have a great impulse to talk – to phonate, making sound with my vocal cords, which will have the tube running between them – and that will in some way damage my voice. I’ve spoken to my surgeon about this concern, and feel reasonably well assured that all will be well. I'll also be speaking about this to my anesthesiologist, whom I haven't met yet, before surgery.
My Alexander Technique teachers have described this as a great opportunity to work at the AT practice of inhibition, the conscious choice not to do a certain action. In my case, as I expect to be awake for some hours while still intubated, I will practice the inhibition of all the typical actions I do that affect my vocal mechanism, including speaking, humming, clearing my throat, and others. Will those impulses to act be irresistible? What actions will I discover that I haven’t thought about now? What is swallowing going to feel like, as the larynx closes off the trachea to prevent food or liquid from going down the windpipe (but now with a tube in the way)? How patient can I remain in my wish to communicate, confined to a pen and pad? (A little too late to take up ASL.) I'll notice what I can, and report back on my experience.
This post has covered many of the different angles of study I have taken, with the help of professionals in medicine and other practices, to help me prepare for this surgery and for the recovery to follow. In my next post, I’ll talk in more detail about the surgery itself.
Next: The upcoming surgery: Maxillary osteotomy, Mandibular osteotomy, Genioplasty (chin), Septoplasty & Inferior turbinectomy (nose).
Dr. Adam Burdick has been a professional musician for over two decades. Teaching, conducting, and performing in various music genres, he is also a perpetual student with interest in a wide range of topics. He loves to ponder and share his discoveries with anyone interested!