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Tuesday, November 20, 2007

Sinus Surgery:

Previously, I referred to the hectic three month period that has transpired since I last posted here. One of the reasons cited was because of sinus surgery.

Since I can remember, I have not been able to breathe completely through my nose. I've learned to live with it, but recently, I decided to have an ENT specialist look at it. Not only was I diagnosed with severe sleep apnea, which is now being treated with BIPAP use, but I was told that I was a definite candidate for sinus surgery. It turns out that a portion of my sinus area, called the inner turbinates, was too large and effectively had narrowed my nasal passage quite significantly. This was obvious when the doctor was unable to even insert the scope into my nose. It was also determined that I had a severely deviated septum. Surgery to correct the septum and to reduce the inner turbinates was recommended, and I agreed with the assessment. After all, any possibility that I might be able to breathe normally was worth the trouble.

Last week, I went to an outpatient clinic in the morning and was prepped for the procedure. The most annoying thing about the pre-op process was filling out redundant paperwork, and not being able to drink anything 12 hours prior to surgery. I was parched, and hungry, and not in a good mood due to lack of caffeine/liquid/food. My mood was further worsened when the medical tech spent 10 minutes looking for a vein, and finally settled for my knuckle, this while an unnamed R.N. asked me myriad questions that I had already answered.

(An aside here: why can't someone invent a standard process whereby medical consumers can collect this information, enter it into a system, and hand it off pre-op to those who may require it? It shouldn't be hard to have an encrypted database of medical information on a jump drive, should it? I mean, sheesh... I answered the same questions three times that day.)

Anyway, this attitude quickly subsided when the anesthesiologist brought a concoction that she called the "I-don't-care-juice" and injected it into the IV line. I recall events in this manner:
  • Ms. Anesthesiologist asked me several questions along the lines of "how are you feeling? do you have kids? are these the droids I'm looking for?"
  • An unrecognized individual came in and wheeled me away to the elevator.
  • Fade to Black...

Next thing I know, I awakened in a large holding area for folks with bleeding and lacerated sinuses. My mouth was painfully dry, and my calves were literally in a knot. Dehydration was much more evident than any nasal pain. Shortly, they wheeled me into another room where my wife met me. I was still groggy so I don't recall much conversation. I do recall the joy of drinking a Diet Coke just after she arrived.

Ami drove me home to rest (we stopped at DQ along the way for some much needed steak fingers). Home isn't particularly restful when you have three kids aged 4 and under, but I was glad to be there nonetheless.

As far as my condition after the surgery, I didn't really have much noticeable pain during the post-op period, other than my throat and my teeth. Apparently this is typical when a breathing tube is inserted during surgery. More bothersome to me was the fact that my nose was essentially useless. Inside the nose were inserted two splints made of plastic. They were rectangular with tapered corners, wound into a cylinder so that their tension would keep the nose in place during recovery. The remaining opening was completely insufficient for breathing, but just wide enough to allow bleeding to occur. This meant that I had to wear gauze on my upper lip, which was fine. However, I wish I had thought to shave beforehand. Ami ended up helping me shave my beard and moustache. The bleeding just wasn't cooperating with my facial hair.

Day two of the post-op period was very anxious for me because I just couldn't seem to clear out my nose or my throat, so it felt like I was being suffocated. I had slept very little and at a 45 degree angle no less. At this point, admittedly, I wondered if it was worth the effort. Ami took me to the ENT office to have a nurse suction out my sinuses. This was a tremendous relief. The nurse could detect my anxiety, and I admitted my aversion to being enclosed in any way. Not being able to breathe is definitely a feeling of enclosure.

Once cleaned up, I was able to more easily identify the opening into my sinuses and how best to irrigate and flush out the area. I found that irrigation on an hourly basis was necessary to both remove any blockage and to soothe the sinus area. With the feeling of suffocation no longer a problem, I was more able to notice the irritation around the nose itself, not pain so much as a dull feeling of discomfort. From watching my wife manage pain during three c-sections, I learned to try to get ahead of the pain instead of dealing with it after it arrived, so I took my prescribed Hydrocodone and left it at that.

On day three, the presence of the splints was much more noticeable. I had the inconsolable urge to yank them out and cast them away. This was akin to the madness of Poe's writings, echoing in my head -

"What is that? Oh, you damnable splints! You wreak havoc on my nose! Be gone, evil! The fury that rises within me! I can no longer live like this!"


When the morning of day four arrived, I was jubilant inside, but exhausted to the point that I could not demonstrate my happiness. Still, I went to the ENT knowing that soon, my nose would be free. The tech took me back to the exam room and promptly inserted some industrial-strength Afrin into my nasal passages. Several minutes later, she suctioned the area and used a weird-looking tool similar to those in the movie Dead Ringers to extract the splints. With a yank and a twist, they were removed, first one, then the other. What struck me initially was the size of these plastic beasts. How they fit into my nose is beyond me. Then the clots and tissue that emanated forth from my nose caught me by surprise. After a little cleanup though, I was pleasantly surprised by the presence of airflow into my nose, and by the clarity of my sense of smell. Suddenly, I was able to smell things that had long escaped me. To me, this was a pleasant unintended consequence, for the real joy I experienced was in my ability to breathe. Normally. Without my mouth. Astounding.

The doctor examined me before I left, expressed his pleasure in the outcome, and gave me a rinse kit to keep my sinuses flushed out. I went home pleased, all the while paying close attention to the smells around me. Flora. Restaurants emanating the odors of their foodstuffs. Nearby lakes. As I said before, astounding.

As for my present condition, I have found that the presence of tissue and congestion is still cause for breathing difficulty, especially at night. I still snore without my breathing machine. I still have swelling in the sinuses. And I still have enough pain to require me to take an occasional Hydrocodone. My nose is very sensitive to the touch, and to the air around it. Nose-blowing is required with more frequency. But this is part of my recovery, I am told.

It is encouraging that for the first time in my life, I can actually blow my nose. Smells are magnified. I can breathe with my mouth closed (when the sinuses aren't swollen, anyway). I realize many people take these things for granted. I certainly don't. I actually find myself stopping to "smell the roses".

I'm hopeful that I can eventually lose the BIPAP entirely, and that I can eliminate any reliance on pharmaceuticals to relieve sinus issues. This might be too optimistic, but then again, it's easy to be optimistic when you can now experience things for the first time that you never have before.

.: posted by Dave 8:27 AM

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