Monday, January 20, 2014

My septoplasty story (or, How I got the center of my nose removed and put back where it was meant to be)

If you know me, you know I can be a bit boisterous at times. As a child, I was a totally bouncy trouble factory whether at home or in the wilds. And I had grand ideas of how to amuse myself while my mother was doing the serious business of grocery shopping. One Saturday morning in 1973 (I think...the photos are long gone at this point), we were at the local grocery store (Radford Bros., North Main St., you might remember it) and I was marauding in the produce aisle. A produce clerk was filling up a center of the aisle bin with gourds. Stacks and stacks of decorative gourds all piled up inside this giant red and chrome Studebaker of a produce bin. I had been on a Richard Scary drawing kick and I saw animals in those gourds. Birds and monsters, and dinosaurs and Maurice Sendak wildebeasts. And I had to get a better look. So I hoisted myself up on the side of the bin to get a better view. Something felt wobbly and I froze in place. That is actually the last thing I remember for a while. I was wearing a short sleeved shirt and the chrome lip of the bin was cold on my arms. And then it tipped over on me, gourds bouncing everywhere, and I was pinned underneath. I don't remember that part at all. My next memory is of a fireman looking down at me in his big helmet and shaking his head, laughing a little, picking gourds off of my stomach. There may or may not have been commentary about what kind of trouble I had gotten myself into, but my mother had called my father and next thing I knew we were rushing to the county hospital emergency room in the station wagon.

My next memory is of a doctor wiggling my nose and saying, "Yes, that's broken all right." With all the luck of the universe, the bin didn't totally crush my skull, but it sure landed across my face, both cheekbones and my nose taking the brunt of gravity before the bin hit the stack of empty cardboard gourd boxes thankfully still sitting there in the aisle. In 1973-ish there was no such thing as mending a broken nose. I got an ice pack, some baby aspirin, and a lollipop. And then the next day I got to dress up in a ruffled white dress and tights and patent leather shoes and be baptized into the Methodist Church, looking for all intents and purposes as if my parents had beaten me within an inch of my life. There was a lot of explaining to do that day and I was promised both Jello and Jello Pudding so I was having none of that waiting around the church thing my mom was wanting to do.

Skip forward to age 12 when I was learning to swim. I could not breathe out of the right side of my nose. Every time the swimming instructor told us to go under the water and blow bubbles in the baby pool (ah, the indignities of learning to swim at an older age), I would end up snorting a nostrilful of water. There was none of the turning your head and breathing in through your mouth and out through your nose of swimming for me. It was breathe in through my mouth, go under the water, breathe out through my left nostril, come up and breathe in through my...nope, snort a nostrilful of chlorine that was not cleared out of the right side of my nose. I was miserable and never swam with my head underwater again. I became the ultimate Zen master of floating on my back in the pool for hours and hours.

Fast forward to college where I was out at a club with my (much younger) boyfriend who had never been slam dancing. We stood at the edge of the "pit" and watched, he surfed in and out a few times, and then just decided to stand there next to me. I was wearing glasses. I did not want to smash my glasses. So, instead, the drunken buffoons standing next to us picked up their even drunker friend and threw him at my face. Broken nose number two, no health insurance, full time college student, not even enough gas in the car to get me out to the hospital where I knew that nothing would be done anyway. Not even a lollipop this time around. And it made my nose much, much worse.

I have lived with this crooked and even more crooked prow for forty years, sleeping with my mouth open and waking up with woolen teeth, having a chronic drippy nose because I could not sniffle on my right side, biting a blood blister on my lip to force my cheek muscles to flare my nostril open. And those horrible up-the-nose selfies? One nostril was tiny and one was huge, with my septum doing a funky pokey-outey thing on the side I could actually breathe from. And one day, roughly 4 years ago, I ended up going to an ENT for a complicated ear infection and the doctor looked up my nose and said, "Wow, you know you have a completely blocked nostril, right?" and I affirmed his observation. But what was I to do, thinking that my health insurance would never cover rhinoplasty. Then, last summer I was poking around on the website of my latest insurance coverage and found a listing for "septoplasty, " as in the insurance would cover septoplasty but not cosmetic rhinoplasty. What was this septoplasty they speak of?!

Of course, the first thing I did was to go to YouTube and watch a septoplasty video. Please, don't ever, under any circumstances, go to YouTube and watch a septoplasty. You do not want to see someone's face being chiseled like a jack-o-lantern (unless you are into that kind of thing, and at this point I say, ewwww, Dexter, out!). The gist of the procedure is that the septum is either removed from the interior of the nose and shaped/replaced or partially detached, reshaped and re-anchored, all through the nostrils. I am a total wimp and I have no idea how I decided to go through with the surgery, but there gets to a point in your life when you are so tired of compensating for something physical that you just have to power through fixing it. This was my time to barrel through the construction barriers.

The rest of this post is the tell-all, describe-all, nitty-gritty of the surgery procedure and the recovery process and it is really not pretty, but I am hoping that it will give someone (anyone) a better idea of what to prepare for and what to watch out for in recovery. Some of these things are hints I wish I had beforehand, some are things I never would have thought of. But I hope that they are indeed helpful details.

First of all, I had to go to my regular physician to be cleared for surgery. This had to take place within 30 days of the actual procedure so think a little in advance. I needed blood work, an EKG, a basic physical, and to review all my medications for the surgeon. Both of my doctors' office staffs were very helpful in getting all of this paperwork filled out, triple-checked, and filed with my insurance company. There are no shortcuts, just be prepared to write a lot. I had already met with the surgeon for a consultation and he took a look at my nasal passages to confirm that I was a good candidate for the procedure. I didn't have any other procedure done so no MRI, no x-rays, not any other tests. It was an obvious break with an obvious deviation. If you have sinus polyps, need external or internal rhinoplasty, or have other issues with ears or nasal passages, this is where we will really differ. The cartilage of my nose was in the wrong place and it needed to be separated from the plane of my face, the area above my front teeth and the dividing line of my nostrils, reshaped and reattached with a scaffolding of sutures. So, here we go.

A month or so in advance, I arranged to take time off work over the Christmas into New Year holidays. I took 10 full days and I needed each and every one of them. More about that later, but please do not expect to go back to work and be functional in your life for at least those 10 days. If you are up and around and ready to move then you are getting the bonus plan. I stocked up on Ensure and V8 juice as well as things like soft granola bars, chicken pot pies, and pita chips. I wasn't planning on chewing being as painful as it was, so you might want to think about some nice soups and chunky stews. Do not plan on chewing unless you have to as a last resort, seriously.

The day of the surgery, I was allowed only 4-6 ounces of water to take morning medications with (and I was the last patient of the day on a Friday). No ice, no hard candy, no chewing gum, no cough drops. You will be very dry and very hungry going into pre-op but better that than have to reschedule. I had my procedure done at an outpatient surgery center and they were absolutely top-notch at the preparations and recovery plus you do not have to deal with normal hospital traffic. Highly recommend that route if you can do it! Prepare yourself to wear the most pajama-comfortable clothes and slip on shoes because, yes indeed, someone will have to help you dress afterwards. They are serious about the zero-jewelry, zero-makeup, zero-lotion, zero nail polish rules. It was not a problem for me, but why even bother pushing it. You undress and put on a gown and all of your clothes and shoes go in a big baggie that will follow you through the building from station to station. Dress lightly and don't bring a purse or wallet. I did, however, bring my Kindle with me and I am very glad I did. Ask in advance if your center has wifi and if they will let you bring a non-phone electronic device.

In pre-op, you get an IV right away. You will be a little dehydrated so if you are anything like me, you will have a couple of bags of IV solution before you even hit the operating room. Your nurse will go over medical history, drug allergies, and confirm your name and procedure at every single step along the line. This is how they gauge your alertness as well as confirming your charts are following you. The most important step for me was planning in advance to ask for an anti-emetic patch. Ask your doctor's office beforehand so it is in your notes, ask your nurse in pre-op to confirm, and when your anesthesiologist does the pre-surgical interview, he or she will confirm what medication you will receive in the patch and how to care for it. General anesthesia causes many, many people to become nauseous upon waking and to remain incredibly nauseous for days afterward. If you have ever gotten motion sickness, you absolutely want to go over getting that patch with all of your medical staff. It was a life saver for me as I can get a good motion sickness going on an escalator. You absolutely do not want to vomit after any kind of facial surgery. Besides the fact that it will be incredibly messy and painful, it can cause severe infection and the pressure can actually undo the work your surgeon just did. It is no joke.

To this point, the IV needle was the worst part of the day. Once I got my patch installed, I was much happier and less queasy and I had a nice repetitive game set up on the Kindle to play while I was waiting to meet my surgeon for the pre-op pep talk. At some point your assistant anesthesiologist will bring you a relaxing preparation for your IV. If you are very, very anxious, you can also ask for something to make you drowsy and you can sleep through until the end from there on out. This is the final stretch. After meeting with the surgeon, I closed up the Kindle, took off the glasses (that stuff got put into my clothing bag) and I got wheeled down to the operating room. Everyone introduced themselves and then I got the mask, whereas counting down from 100 only makes it to 98. Then, tahdah, someone is calling your name and asking you to wake up.

My recovery nurse had a huge cup of water and some Teddy Grahams waiting for me. You get the snack of your choice and all the water you can drink. Again, if you get the anti-emetic, you will be all ready to eat some food and drink some nice cool water! This is a surgery that requires intubation so your throat and esophagus will be tender and scratchy. I wish I had brought some hard candy with me for the ride home. The next half an hour to an hour will be all about making sure you are ready to get up and move around. I had a serious gauze packing up into my sinuses and the nurses were instructed to remove it as soon as possible. I am so glad they did that while I was still pain-free from the surgery because it feels very, very odd like an Egyptian mummifier is taking your brains out through your nose. It is a huge sense of pressure and then a rush of a very empty relief behind your cheekbones and eyes. Be prepared for weirdness. Then I got the "moustache bandage" which is literally a big piece of gauze taped across the nostrils to catch any remaining blood seepage. The first day and night, prepare for a small flood of heinous liquids. Your nurse will give you dressings and instructions on when and how to change them properly. Here is another caveat for you. The tape is horrendous on your face. I broke out in a crazy rash and changing my dressings was like tearing off a couple layers of skin from my cheekbones. I have since heard that you can ask for a first piece of tape to be put down before the dressings so you will be removing the tape from tape, not from skin. Other people say ask for a bandage before the tape. Just beware that the tape can irritate the holy living crap out of you.

All this is still in recovery. You still have to deal with going to the restroom and getting dressed. And, yes, you will absolutely need a nurse or someone else with you. It took me at least an hour to get control over my knees and I could not even lace up my own crosstrainers. I had some fun conversations with a couple of the nurses, and my friend who drove me was nice enough to deal with taking care of my prescriptions. If you can get them filled there, do it. You do not want to be sitting around waiting in a pharmacy in the condition you are in. You will not be sure what planet you are on for at least the next 8 hours. Do not plan on doing anything critical in your life. Just making it back and forth to the toilet in one piece will be all the decision-making you should be allowed until at least the next day. Plan to sleep sitting up for a few days and nights (I bought a Wondawedge pillow and it was perfect but you can also sleep in a recliner chair). And you will be thirsty like the desert for the first three or four days. I also bought a warm steam humidifier for my bedroom. The moist air was heavenly!

If I can give you any advice at this point, for the sake of all that is holy, please stay on top of your pain meds! I got both a Tylenol/Vicodin combo and a horsepill of an antibiotic. Take those pain meds exactly when they tell you to take them. Do not try to tough it out and see how badly it hurts. It is going to hurt like ungodly hell. You do not want to know that kind of hurt. Just take them, stay still and keep your mind occupied on other things. I watched a lot of television online that I do not remember. Rewatch all your favorite movies on Netflix. Veronica Mars and Buffy the Vampire Slayer? You always wanted to watch those again, right? And you still have that anti-emetic patch behind your ear. Leave it there for as long as your doctor said you could. I left mine for three days. Perfect.

Now here is the gory part. The first time you change your bandages, you will be horrified. Your nose is going to be completely clotted up with blood and sutures. Leave them alone. Do not touch them, do not even try to look at them funny. They are directly connected to pain receptors you did not know you even had. Neosporin with pain reliever will be your best friend for the next couple of weeks and be very, very, very delicate in the application process. The tiniest bit of pressure will make you see stars and tweeting birds like Roger Rabbit. Total knockout of yourself. Also try to avoid any clothes that go on over your head. If you biff your nose by accident in the next couple of weeks, you will swear words you didn't even know you knew. I know I was the victim of two self-biffings and I will never forget the pain as long as I live. Your face will hurt, your teeth will hurt, your eyes will feel as if they are out on stalks like a snail. Taking those pain killers like clockwork? You betcha!

And you say at this point, "OK, but was it worth it?" Oh, heck yeah, it was worth it! At the end of my painkiller script, I was pretty much fine. I did switch down to Tylenol for the funky feeling I had above my front teeth (but after all, they had a chisel up there). I could breathe out of both nostrils for the first time in 40 years. Now, the fact that it is the most bitter winter in Michigan since I have lived here? That is unfortunate. The cold air hitting those previously-protected sinus cavities is like someone shoving a sharp, frozen chopstick up my nose even today, a month to the day after the surgery. The strangest thing is that I have two pretty much symmetrical nostrils now. I wasn't expecting that! My face looks different! My voice is also a little different and I have a muscular pain in my jaw because it is changing my bite. I do not have to grind my teeth sideways in my sleep any longer to be able to breathe. I would say to expect some of the unexpected, not all of it bad, but some of it really, really unusual.

And here is what you have been waiting for...the downside of it all. My only real drawback to the whole procedure to date (one month in) is that my sutures did not dissolve. The first three weeks I felt as if I had barbed wire in my nostrils. It was a tender, crying pain. Imagine grabbing all of your nose hairs and yanking them out...that sting constantly for hours and hours. That Neosporin with pain reliever literally kept me from ripping my own face off. Just be prepared in case you are suture-resistant like I was. In fact, this afternoon, *TMI ALERT* I blew my nose and sutures came out. They were sutures I did not even know I had from way up in the bridge of my nose. My cartilage was quilted back into my face like a finely laced doily. And I rushed into doing some things I should not have done. Shoveling snow? Don't do it. Carrying heavy laundry up and down the stairs? Don't be an idiot. Thinking of going to the gym? Do you really want your nose to go flying off your face and across the room when you overexert yourself (a hyperbole, but still...)? Just think a LOT more about what you are doing and how much pressure you are putting on that little chicken breastbone in your face. You will be thankful later.

I think that is more than you would ever want to know about septoplasty if you are thinking about having it and perhaps more about me than you ever wanted to read if you didn't. Everyone is different, but I can already see this as a game-changer in how I exercise, how I sleep, how I deal with asthma, colds, and allergies, and how my facial structure holds up in the upcoming saggy years of my life. For all of the getting used to and all of the minor discomforts, I am very thankful to have had a great outcome and a smooth recovery (albeit one I should have lengthened a few days). And to all you labored-breathers, talk to your ENT. I should have done this a decade ago! A hearty, and well-oxygenated, cheer!

No comments:

Post a Comment