Sinus Surgery-Recovery [Final Thoughts]

Hey All:

Just arrived home from the hospital after hitting up the pharmacy.

Still on the morphine high from the 24 hour stint in the hospital.

I have the appropriate title topic and I shall post a little later the chain of events.

Thanks to all for the best wishes.viewtopic/t40757/viewtopic.php?f=1&t=40 ... 45#p356245

Hope it helps!!

Jerry

PROCEDURE:
Bilateral Intranasal Antrostomies
Ethmoidectomies and Polypectomies
Partial Turbinectomies
Septoplasty and Closure of Septal Perforation.

Yes a full slate of surgery!
Checked into Admissions at 12:00 pm,two hours before surgery.
Stripped down to a gown and blue paper slippers,hooked up to an I.V. and given an ounce of liquid anti-nausea drug.

Wheeled down the hall into the operating theatre where the Anaesthesiologist wryly said "I'm going to slip a Mickey into you"
No sooner said,then it was lights out.
An hour and a half later,I heard two nurses and the Anaesthesiologist hollering Breathe! Breathe! as they pulled a small plastic manual air pump from my mouth.
Sat up and the nurse said "how do you feel?" I replied "like I got hit with a frickin' freight train!"
"On a scale of one to ten,what is your pain level"she countered."Arggh '7' and climbing" I replied.
Anaestetist orders 10 mg of morphine into the I.V. and proceeds to recount how he had to add during surgery what is known as a PEEP to keep my oxygen levels up.

PEEP valves are designed to generate positive end-expiratory pressure when properly oriented in the expiratory limb of the breathing circuit. PEEP acts to improve ventilation by keeping the patient's airways from collapsing.

PEEP valves may be divided into two groups, depending on whether they allow gas to flow through them in one direction (unidirectional) or both directions (bidirectional). Both unidirectional and bidirectional flow PEEP valves will generate PEEP only with gas flowing through them in the correct direction of gas flow.

Of course this required extra vigilance on his part and is an extra step taken when breaths fall below 12 per minute and blood oxygen levels fall.
He attributed this to my "tummy with two untreated umbilical hernias pushing on the lower lungs"after asking if I had been a heavy smoker at one time.(Not)

With that,I was wheeled up to the Acute Surgery Unit for my overnight stay in a ward setting with six beds and two nurses to watch high risk surgery patients.
I was there because of my O.S.A. and had brought the CPAP machine with me.
Over to my right were the other two nasal surgery patients that the ENT had operated on before my turn arrived.(single procedure patients)
It was now 6:30pm and of course pain management becomes the focus.
Liquid Tylenol and codeine are the mainstays but I have found that combination ineffective in the past.So,I had the nurse call up the surgeon and request a steady course of morphine every three hours,first dose beginning at 9:00pm.He also ordered the packing to be removed from the left nostril,a momentarily unpleasant procedure,with little bleeding and what I would think be the norm for most people-no sweat.The right nostril,in my case,remained packed and a gauze with tape placed under it.
After the morphine started to kick in,I assembled my ResMed S8 Elite/H3i and Mirage Quattro FF Mask and dozed off.

Things went well until 3:00 am,when the night nurse saw some blood coming up the I.V. line that had to be flushed with saline injection.She flushed it with too much force and inadvertently moved the I.V. from the vein.Naturally from this point on the I.V. drip and any additional morphine injections were going straight into the tissue,not the vein,unknowingly rendering all I.V.fluids useless.
This issue wasn't discovered until the 7:00 am shift change,when the day nurse saw my left arm swollen where the I.V. was.By this time I was in great discomfort,not realizing at least 200ml of blood was building up in the still packed right sinus,creating an intense eye popping sensation,roots of hair and teeth aching soreness and of course,a smashing headache.
When I told her this,she removed the I.V. and gave a direct injection of 4ml morphine into the upper thigh.
At 9:00am the surgeon himself appeared (just as breakfast arrived-after a 33 hour fast!) and asked if I could lay on the bed.
What transpired next is beyond words.An exquisite pain as what seemed like a foot and a half of packing was drawn out.Like a live Egyptian mummification process,I felt as if my very brains would follow.
Then the levee broke,followed by a flow of blood that required a small bucket to contain.As I soldiered through this,the ENT Surgeon apologized and explained that there was more inflammation in the right sinus than had been revealed on the CT scan.Treating this area caused unusually profuse bleeding and required the extra packing.So,just my luck.At least I got another 2ml of morphine for my efforts.
Since I was a bleeder,discharge was delayed until 2:30 pm.vs.the first 9:00am visit.
So I was prescribed Ceftin Antibiotics,Polysporin,Nasonex Spray(after April 16) and-get this:Tylenol 1 with codeine.
There was great concern that due to the severe O.S.A.,no strong narcotics should be administered at home for pain management given that I can't get myself breathing again,unlike in a hospital setting.
So,this begs the question,how does one manage pain with severe O.S.A?
P.S.-Demerol use has been discontinued at this hospital for two years now due to its addictive properties!

Also,DO NOT be discouraged from this procedure,I was a rare case.On a positive note I would like to add that the onboard data showed an overnight AHI index of 1.2 -no apneas,my lowest EVER and with only ONE nostril unpacked!I look forward to healing and getting stonger by the hour.

Oh MAN! I hope you heal soon and that it solves all your issues.

I originally opted for surgery. Mine was both nasal (broke a hole in base of my nose to add a drain--for sinus issues--oh yea I know that "Packing"), removed tonsils, cut off the uvula and throat trim for good measure) oohhhh does your account bring back the "black chilly willy" memories. XPAP is so much less pain. My surgery worked for a number of years but unfortunately, ultimately, I'm now on XPAP. Sleep Dr told me that next level of surgery would be complete jaw (upper and lower) re-configuration (breaking both upper and lower jaws, wire my mouth shut, knock out teeth (so I could drink my dinner for months) and tissue removal from the throat and back of tongue.) So, naturally, after my first experience I'm now a happy hose head!!!

I really hope you feel better soon.

Well Builta,these procedures were not meant to 'cure' my sleep apnea,only to help ease the use of the CPAP machine.
With the poor airflow in the sinuses,I was having multiple oxygen destaturation events and severe sleep fragmentation=fatigue.

First night at home and I was awakened three times from 10:00pm to 6:00am.Took two Tylenol 1.

Cotton swabs are my new best friend.

12:30am up to clear out nostril ends of blood clots with mineral oil.

3:30am up from nostril dryness/soreness.Took two Tylenol 1 and turned up humidity to '3'.

6:00 am up from congestion and soreness,another two Tylenol 1.

Guessing the first week will be pretty much like this but I used to get up around three times a night before surgery so nothing new there...

Playing the humidity game will be a challenge,I think.

Iced up every two hours for 20 mins all day Saturday and really felt rough.

Saturday night: was a repeat of Friday evening only more intense.
Sunday:I changed the Tylenol to 2X 500mg every 4 hours and I could feel more precisely where the instruments had been.
Monday:the pain has diminished but is still apparent.Very swollen and congested.
Cpap is intolerable,can only muster a few hours,with the AI throught the roof.

drmgrl wrote:Just read your post, 5aces. Hope all went well, today. I'll be praying that it was a success, and that you heal quickly. I had septoplasty and a sinusectomy several years ago. It took a little while for the swelling and inflammation inside my nose to go down (even though the outside began to look "normal" fairly quickly- so I was afraid it hadn't been sucessful. But don't get discouraged if that's your case, too. I learned that it's just the healing process, and once my nose healed completely, the change has been wonderful. (it has literally been years now since I've had a sinus infection or bronchitis, and I had them all the time)! Hang in there and hope you feel better soon!

Thanks for that post,drmgrl.I was beginning to think this congestion will never get better!

Hopefully,new treatments are intended to be less invasive than the current standard method, functional endoscopic sinus surgery, which involves removing bone and other tissue, and the use of nasal packing that has to be removed later.
"It's a painful, bloody procedure. Gauze needs to be pulled out after the fact, and the pain's been known to bring grown men to their knees." True.
I am calling it : "one of the most painful things I've ever gone through."

Well, you've certainly helped me make up my mind as to whether or not I wanted to go through that procedure. NOT!!!! Hope you feel better soon. My stomach was turning as you described your pain.

Bev

OutaSync,you should know that I was in a small category,about 5%,that have such difficulty.

Also,I opted to have all the procedures done at once.Most patients are only in line for only one or two.

Still,I can only recount my own experience,grim as it might sound.

Let's wait a while for things to heal and I put up some really good results!

Here are some crazy AI's from Saturday.Lucky,today I was able to book an appointment for Wednesday with the Respirology Doctor.
Halp!I can't breathe!

Wednesday the respirologist advised to take a few days off from cpap and let the sinuses continue to heal without pressurized air(even though I was using a FF mask).
Also I got a script that states:
"Severe OSA;as long as patient is using CPAP,pain medication and sedatives as appropriate are not a signifigant concern or contraindication"
Amen to that.
All that day it was like silicone caulking had been injected into both nostrils.First night I have slept right through(six hours).

Thursday the nose felt like concete had been poured in.Still gasping for air while eating(no choice there!) Slept through again(sleep remains a state of semi-awareness,at least I do not get right out of bed.)Ditched the Tylenol for the most part.Tire very easily,went out for groceries and a Mall stop with my caregiver(Mom FTW!) enough to wear me out.

Friday...ahh,some sign of relief.
Not so blocked up.No sense of smell yet.
Planning the Easter menu.I will slow Bar-B-Que a Whole Ham.Brushed with Bourbon Glaze,cooked over charcoal,apple and pecan wood chunks on Saturday.Things are looking up!

5aces wrote:Friday...ahh,some sign of relief.
Not so blocked up.No sense of smell yet.
Planning the Easter menu.I will slow Bar-B-Que a Whole Ham.Brushed with Bourbon Glaze,cooked over charcoal,apple and pecan wood chunks on Saturday.Things are looking up!

So glad to hear you turned that first corner. Did your doctor give an estimate of how many weeks or even months before all healing and all swelling is complete? Following your thread with great interest.

Happy Easter and Happy Easter Glazed Ham! Life's simple, wonderful pleasures are once again on the horizon!

SWS,I asked the ENT Surgeon during the discharge consultation:
"How much healing time for the sinuses before I take the Maintenance of Wakefulness Test?"

His response:
"With what you had done,minimum four weeks.Stretch it to six weeks if you can"

The Respirology Doctor at the Sleep Clinic had this to add:
"When you feel ready to restart your CPAP,slowly build up your usage hours each day.After you have two full weeks on your CPAP,call us to book your MWT test"

My high hopes are that my newly refurbished sinus airways will act like a Supercharger on a V-8 engine and I will be able to "squeal the wheels" once again!
Happy Easter To All! Will post a pic of our BBQ Glazed Ham.I do it a day early and heat it up on Easter Sunday.

5aces wrote:Will post a pic of our BBQ Glazed Ham.I do it a day early and heat it up on Easter Sunday.

Double incentive to follow your thread, 5aces...

Funny you should mention cooking your holiday masterpiece a day early. When my wife cooked our very first post-wedding Thanksgiving bird years ago, she pre-baked it perhaps 90% through the previous day. I almost couldn't believe my eyes... What sacrilege! Traditionally those holiday-ritual meals entailed a middle-of-the-night wake up time for the holiday chef on my side of the family. That kind of sleep deprivation was both traditional and necessary, to ensure that our elaborate holiday meal was ready on time. But after not being able to discern any taste difference whatsoever in that first holiday meal, I was an instant convert to my wife's holiday-meal sanity. Naturally we've been doing it that way ever since.

5aces wrote:SWS,I asked the ENT Surgeon during the discharge consultation:
"How much healing time for the sinuses before I take the Maintenance of Wakefulness Test?"
His response:
"With what you had done,minimum four weeks.Stretch it to six weeks if you can"
The Respirology Doctor at the Sleep Clinic had this to add:
"When you feel ready to restart your CPAP,slowly build up your usage hours each day.After you have two full weeks on your CPAP,call us to book your MWT test"

Well I'm not a health professional. But I wonder if this can be an unrealistically short cycle between surgery and your Maintenance of Wakefulness Test. I'm thinking there should be some significantly impaired sleep architecture after that surgery---as well as before the surgery if CPAP treatment was poor. That impaired sleep architecture essentially amounts to some sleep debt that often needs to be paid back (at far less than a one-hour-deprived to one-hour-paid-back correspondence rate, thank goodness). None the less that sleep debt can be more significant for some of us, and less significant for others. So depending on just how long your body decides to take as it repays sleep debt, you may not be completely refreshed for that Maintenance of Wakefulness Test in only four or six weeks after surgery.

Still, if reporting in for multiple Maintenance of Wakefulness Tests is not a problem, then I think I'd definitely report in for that first test at the four or six week mark. However, if you are allotted only one or two Maintenance of Wakefulness Tests per year, then you just might want to give your body even more time to heal the effects of long-term "broken sleep" before taking that test.

Good luck!

A most insightful reply,-SWS and I thank you for that.

Correct,I have already used up the 'two' overnight sleep studies per calendar year our Canadian Ministry of Health allows.

Approval for my third overnight study(MWT) arrived last week from Ministry of Health.

I am pushing for the test so I can get a Medical Waiver signed off by the Sleep Institute,for Commercial Driving Insurance.

Until I pass the MWT,I cannot report for work.

I wore the CMS-50F pulse oximeter last night.Only had 18 sp02 events but had one low of 74% at 2:00am! Baseline was just above 95%.


Hoping I feel ready at the end of the sixth week but only my data will reveal that.(thanks to this site,I am more than prepared to furnish any required data)
I see another thread in the works...

Easter Ham Updates:[Double Smoked Whiskey Glazed Ham]
Bar-B-Qued from 4:15pm-10:45pm last night!(Lump charcoal,Apple and Pecan wood chunks)



Half Ham Bone-In.Covered with dry pork rub and pinapple rings.
Glaze:Bourbon,Turbinado Sugar,Tamari Soy Sauce,Cosby Molasses,Apricot Marmelade,Serrano Peppers.

Well Easter Dinner is complete and the family has returned to their homes.Now I get to enjoy leftovers!

As promised -SWS:

Creamy Scalloped Potatoes,Roasted Yams,Steamed Asparagus and BBQ Ham.
Lemon Merangue Pie,Sweet Egg Bread(look for the whole hard boiled eggs in the bread) and Milk Chocolate for dessert!
My head hurts but I am so very happy with the dinner.

And you've made me hungry all over again, 5Aces. It all looks soooo ... YUMMY!!!!