u/Expensive_Umpire_975

Warning: Doom and Gloom post

Dear accountants,

We are entering a dystopian era. 2/3 of my accounting department is now offshored to India. AI will soon be displacing more jobs. Data centers are burning through our clean water. Inflation is high and raises aren’t keeping up with the cost of living. Microplastics are accumulating in mass quantities in our balls. Private equity is buying out all our domestic CPA firms. Massive layoffs and boomers pulling up the ladder. Housing and having kids is unaffordable. 40 trillion in our national debt.

What will things look like in 10 years from now? Will we have AI staff that we get into fights with and have to do remediation through HR? What’s the game plan? How do we survive this era?

Sincerely,
Friendly Neighborhood CPA Mogger

Hi all,

I am currently 6 months post-op from MMA/DJS + genio. For the first time in 6–7 years of battling UARS, I’m actually waking up some mornings feeling refreshed and energized — a very foreign feeling for me. It’s not every morning, but generally, if I’m able to get my sinus congestion under control, my sleep quality is pretty good.

Overall, I would say my symptoms have improved by roughly 70%. I went from being a complete vegetable to being fairly functional in life again. I’m hoping that as I continue to heal and the inflammation/congestion improves, the results will become more consistent.

I had a 9.5 mm upper/lower advancement with a 5 mm genio. Before surgery, my sleep test showed:

• Non-REM RDI: 10, AHI: 4
• REM RDI: 26, AHI: 9

Things I tried before surgery:

• Extensive sinus surgery to remove large cysts and polyps, along with septoplasty, turbinate reduction, and FESS. This significantly improved my nasal breathing but probably only improved my UARS symptoms by around 20%. I had this done almost a year prior to MMA.
• CPAP — this worked decently for several years. I never woke up feeling refreshed, but it at least kept me functional.
• Custom MAD — this actually worked great for about 8 months. I had full remission of symptoms, but I developed severe TMJ issues and had to discontinue treatment.
• ExciteOSA — this improved symptoms somewhat, but in my opinion, it wasn’t worth the price. I would recommend myofunctional therapy or other cheaper tongue-training options instead.
• Positional therapy — helped to some extent, but I struggled to find a comfortable way to consistently apply it.
• Cognitive Behavioral Therapy — this actually helped a lot, and I would recommend it.

What has changed 6 months post-MMA:

• Waking up feeling refreshed some mornings
• Overall better energy levels — I’m able to spend time with friends and family without feeling crippling fatigue 24/7
• Better sex drive
• Improvements in depression and anxiety
• Less brain fog and better cognitive function

Recommendations:

• Nasal breathing is incredibly important and needs to be addressed, either through expansion and/or sinus work. The nights I sleep well now are usually the nights when my congestion is minimal.
• Get as many opinions from OMFS surgeons, orthodontists, ENTs, and sleep doctors as possible. Had I not done this, I could have easily gone down the wrong path with surgery or treatment. Every doctor will try to sell you a procedure or treatment, whether or not you actually need it.
• If you end up having MMA, make sure you prepare thoroughly. Have your meals and medical equipment ready beforehand, and have family or friends available to help during the first few weeks. Recovery is no joke.
• Don’t give up. Getting relief from UARS takes a massive amount of resilience, both physically and mentally.

I’ve noticed that a lot of PE firms that acquire CPA firms, have rules that bar accountants from displaying their CPA certification on things like email signatures. Seems like an odd and disrespectful rule to the profession.