My Septoplasty Surgery Experience from Hell

[FJB]

Hi All:

I had my septoplasty last Thursday Aug 24. The ENT said my nose was one of the worst obstructed he’d seen.

This sounds odd to me, but tell me what you think I should do next.

The procedure was to be performed at Local Community Hospital, which I had agreed to during prior visits. On late Aug 23, I was informed via phone that the procedure was to be performed at Big Medical Clinic’s in-house surgery center instead and not at the hospital. Since the procedure was critical, I agreed to the new location. They provided no description of a disparity in facilities or services. Paperwork was rushed through the morning of the procedure by several individuals. I was not allowed to read the paperwork, so I signed it as “unread” so the procedure was performed. (As I suspected, the staff did not notice.)

The operation went routinely, and I was released the same afternoon. I complained of what I believed was unusual nose pain, but the recovery nurse informed me that she had administered all drugs that she could and that I should leave. Since I had secured dilaudid the day before via Rx, I complied. I was scheduled to see the ENT the next morning at 8:00 AM to have nasal packing removed.

Substantial nasal pain continued the remainder of the day and worsened during the night. Dilaudid is a powerful narcotic, and I selected that one because surgical pain can be unpredictable and severe. From around 2:00 PM until 6:00 AM the following morning, I consumed NINE 4 mg tablets, which is approaching the maximum daily dosage of the drug.

Around 6:30 AM, I awakened my wife to drive me to Big Med Clinic. It maintains an urgent care facility and the surgery center. It seemed logical to return to where the procedure was performed to receive the most efficient treatment. Furthermore, the attending was a staff physician there. He told me to return or phone him were anything wrong, I could no longer tolerate the pain, and my condition was worsening rapidly.

While in route, I began violently vomiting from the pain alone. We arrived at about 7:00 AM. The sign on urgent care stated that opening hours were 8:00 AM. We knocked on the door and a friendly guard showed us to where we could enter the building and he retrieved a wheel chair. There was desk staff at the urgent care center, but they stated emphatically that no doctor was in the building. They stated that there were unable to help us. We then went to the surgery center in another building, and the nursing staff there was not only unhelpful, they were actually rude and hostile.

We explained the situation and had to insist on them taking some action, and begrudgingly, one agreed; however, I don’t believe she made any calls. We tried Dr. ENT’s office directly and only received VM. I asked the nurse had she paged him 911, and she made no reply at all. I asked if she knew his cell number, and again no reply. The nurse asked me to wait in the waiting room full of people, and I told her that I would likely vomit in there. With a sigh and worse, she said we could wait by the bathrooms but offered no chair or anything. We retrieved our own chairs and waited. Some other nurses happened by and we explained that we had an emergency, and they tried to intervene.

Another nurse asked us into a back storage-type room and asked me to sit in a plastic chair. I told her that I was on the verge of losing consciousness and wanted to lie on a bed there. I had to direct her to check my vitals. She stated that since my BP was low, my pain was probably not too bad. I suffer high BP, and low BP can also mean one is about to feint.

Eventually, the anesthesiologist who performed by prior day’s procedure arrived, and I was relieved since he knew my situation and could likely administer a pain shot. He informed me that Big Medical Clinic’s Surgery Ctr had “no procedure” in place for contending with my situation. (A post-op patient arriving in acute distress.) He had informed me the day before that the nasal packing could be very painful. That was the source of the pain, and I told him that.

After giving-up on the surgery center at 7:45, after the 2nd rude nurse told us all we could do is head for an ER, we returned to the main building and the urgent care facility. We were again denied treatment. From there, we traveled down the hall to ENT’s office, and lo and behold, he had been there treating patients in his office since 7:00 AM. We approached the counter and addressed him directly, explained the situation, and he said he would be glad to help but it would be another 20-30 minutes. There were other patients in the waiting room, none in acute post-op distress.

We again returned to urgent care and were denied treatment again since they “did not wish to interfere in another doctor’s case.” We returned to ENT’s office and after not leaving the counter, we were taken back to a treatment room. ENT assured us that the packing was the cause of the distress, and he quickly removed them and sprayed some numbing agent in my nose. It did not help much. I was amazed at the size of the nasal packing. It was huge, and I could not see how it would even fit in my nose. ENT stated that it was the smallest size available, and since I wanted the breathing tubes, they would hurt even worse. This is the first I’d been advised of that fact.

ENT had no pain medication on hand, but stated he would send an order to urgent care. We headed there, went through triage, and then saw the staff doc. The doc had received no order from ENT, but said that he was familiar with the procedure, had it himself and it was miserable, and would give me something “strong.” I heard him discussing Nubain but he later told us that it was Demerol. He stated that he gave me the max dose allowed. I return home, and after another dilaudid tablet, fell to a fitful, exhausted sleep for around 3 hrs.

Conclusion: Had these problems occurred in a hospital, it would have been easy to obtain Morphine and wait the process out in relative comfort. My nose has been in ghastly pain all weekend, and I wish to consult with another physician ASAP. I think that my nose will be Ok, but it has been swollen shut since the packing was removed Friday morning. This is not a good condition for a person suffering from severe sleep apnea. I’ve had 8 hrs of fitful sleep in the last 3 days.

Suggestions on how I should proceed are welcomed. Why did they change locations? Why were there no "procedures" in place for dealing with a post-op patient in distress? This sounds just dumb at my expense.

[tater pie]

Wow! It sounds you went through hell! I had a septoplasty 2 years ago for an extremely deviated nasal septum and didn't have any problems at all. The packing is huge and all I can say is that I'm sure glad I was out while they were putting it in. I didn't have breathing tubes though and it was only slightly uncomfortable and a nuisance since I could only breathe through my mouth. When I had my surgery, I was supposed to have it at an ambulatory surgical center but when they found out I had sleep apnea, they said I had to go to the main hospital. My ENT did the surgery there (he would have done it at either place but because of the sleep apnea, I had to go to the hospital which was across the street from the ambulatory surgical center) and he did a great job. He's known as one of the best ENT's in our part of the state. The staff was very kind and attentive and the doctor met me at his office early the next morning which was Saturday morning (he's normally closed on Saturdays but met me there because I needed the packing out). He did advise me to keep cold compresses on my nose for about 24 hours. He told me to fill up a surgical glove (which he gave me a box of) with water and freeze it and after it was frozen, to break the fingers apart and put it on my face with the fingers over the sinus area. It sounds crazy but it helped a lot. I had very little pain or discomfort and healed quickly. I only had to take pain pills the night after the surgery and it was only a low dose of vicodin. I only had some nasal drainage for about 3 weeks after the surgery but after that, I was fine.

It sounds like you were really treated terribly. It will be tough to get another doctor to take over your case but I think I would try. I know "ENT's have a reputation for being butchers and a little slap happy with surgical knives. I certainly hope you can get some relief and satisfactory care. I guess you could always do what my husband does in situations like this, go to the top of their structure and talk to the head hancho and don't take no for an answer. I remember once we were having trouble with our car insurance claim and my husband finally kept pushing until he got in touch with the vice president of the company (and it was a national company). Well, we got the check Fed-Exed to us that day.

Hope things get better for you soon. It sounds like you could really use some relief.

[FJB]

Hmmm, you had sleep apnea and had to go to the hospital as a result....
I'm contacting my insurance co and asking them why the location was changed at the late date.

This septoplasty is the first in several surgeries designed to cure my apnea. What a start! Maybe I'll keep the apnea instead...

What happened is the result of bureaucratic fuster-clucks and the "it's not my job" types. I have an injury accident lawyer involved in another matter, and I'll have him menace them, and threaten state and ins. co action. (They can play hell with large clinics; it's almost hospital sized by itself.)

Thanks for the info. I've heard that often..."Mine was no big deal..."

My luck is just special. That's why I got dilaudid first.

[wabmorgan]

I had septo-rhinoplasty done only about 2 months ago. They did use the breathing tubes "splints" you refer to. They came out quite easy when it was time to have them pulled.

My worse side effect was a headache that just wouldn't go away.

Dr said it was due to sinus presure following the nasal proceedure. It was bad but not unbearable. I kept putting ice on my nose and I also put afrin in at the advice of the dr. That actually seemed to do more for my headache than anything else did.


Also, I had packing in for several days. 4, I think.

It may be that the more swelling you have, the worse it is.

I think the dr has a lot to do with how well this proceedue turns out. I heard horror stories pior to surgery, for the most part anyway. Friend of mine said it wasn't that bad and I went for it base on his experance.

Sorry, you had a bad experance. I would do mine again if I had to.

[Snoredog]

I had that surgery done a long time ago and I don't recall it being all that painful. I took Vicodine for pain. Only time it was painful was when my 18 month old daughter went to give me a kiss and bonged it, then it hurt.

One thing I learned, never schedule a medical procedure later in the week past Wednesday, if you have a problem doctors are gone on Friday and the weekend.

I would have just went to the ER.

[wabmorgan]

I learned the hard way about the not past Wednesday issue.

My nose never did hurt... but by Saturday I was on the phone with the on- call ENT for my headache. That when he told me to try the afrin... and that must have took some of the sinus presure away... because it helped more than the pain meds they gave me.

[FJB]

Well, I saw another ENT at Big Med Clinic Clinic covering for mine who ran for vacation right after my procedure. (Another lesson: Don't get surgery from a guy going on vacation the next day...they never said anything about that either.)

The pain in my nose is probably caused by something not rare or common in the procedures. The splints sewn inside the nose probably got into a nerve in there. (oh boy! I'm lucky that way.) The packing just made it more obvious and worse.

The nose is improving, and I got in 6 hrs of mask time last night, so I am ok. As for removing the splints, ENT 2 said to call ENT 1's office and see when my follow-ups were scheduled. He is reluctant to second-guess ENT 1 as to what he did.

So even had I gone to the hospital, they would have done nothing but give me a pain shot. Which I would have gotten. I am mostly mad at the clinic for having "no procedure" in place for dealing with these issues. Surgery handouts only stated to "call your doctor" should any of a list of items happen. We went one better; we showed up where my doc works. Then couldn't get anything done without him, and he was in his office the whole time, and everyone said he wasn't. My My PCP and a litany of other doctors were there too.

Couldn't anyone just ask were there a doctor with a syringe in the house?

[Guest]

After my preceedure I had "no mask time" for about a week:(

[hornplayer]

I had a lingering headache from my surgery as well. I ended up going to a therapist for a couple weeks to try and rid myself of it. The therapist said that surgeons really crank your head backwards during the surgery and that often will put a good crimp in the nerves back there that take a while to heal.

[FJB]

These types of things seem to happen to me with med types for some reason. The upside is that I now have a huge stash of powerful narcotics. Dunno why I would use them, but they are there.


I also got the skinny from the surgical nurse. Apparently they took my nose apart like Humpty-Dumpty and did it up custom on the table. It would be more interesting were it not me. And yes, surgery is not always a delicate process. It's more like beating.

The nose is better; the sinuses cleared out a little today. So hope remains. I will be glad when the constant nose-hair-yanking feeling and stinging is gone. The meds help a little with that but not much. They will let me take almost as much codeine as I wanna. The splints don't come out until 9-8-06. That's how much work they did in there.

Just think, if the easy Septoplasty is this way, how hard is the jaw advancement procedure going to be? (Probably easier than this.)

I want my apnea cured.

[Pirate]

If you want to cure your sleep apnea, I wouldn't rely too much on the surgeries. I had them all except for the newer tongue tightening procedure and I was still snoring and having problems with sleep apnea. I finally gave in and started on cpap. I had resisted it for many years by having surgeries. In hindsight, I could have prevented all the pain and discomfort of the surgeries by just going on cpap from the beginning. While the surgeries didn't cure my sleep apnea, they did have some unexpected benefits. I rarely get sinus infections any more, since my airways are more open and less likely to get clogged up and I no longer get sore throats since my tonsils were removed during on of the surgeries.

[FJB]

I wanted to go on CPAP therapy; I'd been feeling so terrible for so long, anything sounded good.

The greatest problem was that CPAP didn't work as advertised. After months of messin with it, the surgeons started looking more likely.

I am prepped to stay on CPAP forever. I am hoping that surgery will correct mine, which some are fixed that way. I hope to be one of the few, the proud, and the lucky.

I have CSA too, which never was a big problem. My severe problems with OSA became obvious through a drop in activity just about 18 months ago.

I hope to get my life back. I miss it.

[snork1]

All I can say is that sounds like a TERRIBLE ENT and a TERRIBLE hospital.

I had 3 hourss of intensive nasal surgery as outpatient surgery.
Pain was NOT a big deal. I had discomfort for quite awhile.....but the ENT did a LOT of work in there.
I was using CPAP the same night, albeit a bit roughly due to blood clotting.
I lost a fair amount of blood over the next couple of weeks during the regular saline flushes, but it was not "pain".

I did not get the sinus surgery to eliminate Apnea, my ENT did not say it would eliminate Apnea, nor have I EVER heard of anyone being CURED of Apnea with NOSE surgery.

The idea of sinus/nose surgery is to make it so the various therauputic approaches CAN WORK.

My theory is that you have to have your nose working for ANY apnea treatment to work.

PS: NEVER EVER go back to that doc and hospital.

[FJB]

It's 4:00 AM on day 7 post surgery, and I was awakened by the need to feed my nose drugs. My mask time has been on and off, and tonight is one of the off nights. I yanked it about an hour into it.

There is still considerable residual congestion, which is interferring with the CPAP. I have the full-face type, and it really does not work as well without the nose being in the mix.

I was excited by the nose procedure because of what the ENT did. He treated is with steroid injections as a stop-gap until the surgery and within a few days of the injections, my energy level skyrocketed. It was so cool. I got more done and had more fun in two weeks than in months previously.
CPAP was working as designed.

So I hope to finally put this tough part, or potential complication, of the surgery behind me. I did get to blow my nose productively tonight, and it hurt, which may be contributing.

The ENT is a nice guy who gets off on helping. I saw it in his eyes. The nose procedure alone will not fix my OSA. You're right in that it will help the CPAP therapy work. He said that I was an excellent candidate for potential cure, or being off CPAP therapy, for reasons other than my nose and would need procedures he does not perform.

So he has a great reputation. It's the best I can do. No on else will touch me either. I am like a leper.