Medical procedure that helped me tremendously

I would like to share my experience with something that made a great positive difference in my sleep troubles. Since I was a child, my breathing has been hampered by a deviated septum. ENT doctors have recommended anything from septoplasty to complete removal of the septum. However, I did not want to do it as this procedure has great risks: the latter can cause serious problems with the lining of your nose, while the former has the potential to reverse itself (as the septum has "memory"). What cemented my decision was also that I personally knew a few people who had had the procedures (both kinds) and they had negative experiences. Combined with the fact that my condition wasn't that dire - I could still breathe, albeit badly - I just did not want to go through a major surgery just to give it a try.
After I got on CPAP, it took care of the classic apneas but I would still regularly wake up at night because at times I simply could not get any air in my lungs. This lead to some horrible issues, such as an addiction to decongestants (which were probably the cause of my severely reduced sense of smell) but the constricted airways at night was the worst. A few years ago I underwent a procedure that seemed to help a bit - my ENT performed a lower turbinate reduction. The improvement was marginal (although it helped me get rid of Afrin once and for all – mostly willpower, though) but I would still get up at least a few nights a month, unable to breathe. Moving to the mountains (with the drier air) seemed to help a bit, too, but it wasn't enough. I was still using Vicks inhaler and pseudoephedrine. So I decided to give a new ENT a try and asked him to renew the turbinate reduction. I did not have much hope but I thought I'd give it a try. My previous ENT was great (he operated on my wife on something different) and I did not know much about the new one but he was at least quite thorough - for example, he ordered a CAT scan. On the scan I could see how my turbinates were pushing on the septum (a “nice”, round indentation), so it looked like there was room to reduce the turbinates and open the airways.
So, I went for the procedure last month, with my fingers crossed. It went quite similar to the last one. Although the new doctor called the technique "coblation" (cold ablation) as opposed to my old doctor calling it "radio-frequency", the only difference was that the old apparatus used a grounding plate behind my neck. For those who don’t know, you do this on local anesthesia (there are plenty of references on the Web, even some live videos on YouTube) and it is completely painless. My new ENT said he only does this now under general anesthesia but agreed to do it in the office for me (he’s now mostly doing plastic surgeries). The interesting part came when after he was done with the coblation, the doctor said “you are taking this surprisingly well, I am going to do now an outfracture” and explained that this was going to be a “breaking of some bones”. This might come as a surprise to any of you who have not suffered of this problem but this announcement not only did not scare me but I welcomed it – I can’t being to tell you how many nights I’d get up, unable to breath, and just wish I could take a screwdriver, stick it in my nose and start chiseling the blockage away... Well, the ENT did just that: using a flat steel instrument, he grabbed by head and started crushing the bones. I assure you, there was no pain – not at the time, not after the procedure. Just relief – immediate, blissful relief! I could immediately breathe better, even with the splints still in my nose. There were none of the bad consequences that the ENT warned about; in fact, the lining of my nose got so much better that I have not even had the regular bleeding that I have when I wash my nose every morning and night (I use Neil-Med).
I have waited before posting to see if there would be some receding or any bad effects but there are none. I am so much better now than before – in every way. I can breathe just fine now and my CPAP can finally do its job – and at a much lower pressure than before. At times, I used to have the IPAP at 20cm H2O (!) but now it is at 14cm and I feel I can go even lower. This is the best thing I have done for my condition and I highly recommend it to anyone who might have a similar problem.
McSleepy

McSleepy wrote:The interesting part came when after he was done with the coblation, the doctor said “you are taking this surprisingly well, I am going to do now an outfracture” and explained that this was going to be a “breaking of some bones”. This might come as a surprise to any of you who have not suffered of this problem but this announcement not only did not scare me but I welcomed it – I can’t being to tell you how many nights I’d get up, unable to breath, and just wish I could take a screwdriver, stick it in my nose and start chiseling the blockage away... Well, the ENT did just that: using a flat steel instrument, he grabbed by head and started crushing the bones.

OMG, you really were desperate -- and tough!
Wimp that I am about pain, I can't even imagine....

I know you said this:

McSleepy wrote:I assure you, there was no pain – not at the time, not after the procedure. Just relief – immediate, blissful relief! I could immediately breathe better, even with the splints still in my nose.

But the doctor himself had already expressed amazement at how you were enduring it

the doctor wrote:“you are taking this surprisingly well,

Ow, owwww, OWWWW! I'm still cringing.

McSleepy, I'm so glad you are breathing better now.

I'm still holding my breath from reading about it!

Whew.

Hello,
What a great story and so glad you are feeling better after this "painless proedure"....Please, it is so hard for me to undertaand how this could be painless...I have same problems as you were having and I am scared to death to have this done...I am a big chicken. I go to the ENT next week to talk to him after the fifth time. I am getting closer to making a decision on this procedure.
Thank-You for your wonderful story.
Wishing you continued wonderful breathing and good sleep.
Bren

Brenpbb11150 wrote:Please, it is so hard for me to undertaand how this could be painless...I have same problems as you were having and I am scared to death to have this done...I am a big chicken. I go to the ENT next week to talk to him after the fifth time. I am getting closer to making a decision on this procedure.

"Big chicken" doesn't even begin to describe how I'd be!
McSleepy is tough.

Thankfully, I don't have the problem, but if I did... general anesthesia for me!! And a LOT of it!

McSleepy wrote:you do this on local anesthesia
---
My new ENT said he only does this now under general anesthesia

Hope you get relief, Bren, whatever you choose to do.

Bren, I assure you - there is absolutely nothing to fear! I am not tough, in fact, as a child I was quite a handful when it came to the simplest medical procedures. I am still afraid of most medical interventions, and I am very healthy (thank God!), I've never had anything serious. I am terrified of not only general anesthesia but of any kind of sedation. I have had ulcer and I have GERD, so I've had endoscopy done 5 times - all without any sedation. It is not bad at all, there is no pain, either, and the gagging can be managed. With sedation you feel all there is to feel but 1) you are helpless to act on it, and 2) you don't remember anything afterwards. This scares me much more than feeling my bones being crushed.
My wife was in the room and she could hear the bones breaking, and she too felt it was frightening but as long as you can get over the scary thought, you will be alright. I can tolerate pain that was accidentally inflicted; I am quite athletic and have done all sorts of sports through my life. Just a couple of weeks ago I fell skiing and my shoulder is barely healed but I'm going skiing next weekend! But I do not tolerate pain that someone else is about to inflict. I still cringe when I have to have blood drawn from my vein or any injection. I'd hate any kind of pain that a doctor would cause me. But I assure you - this procedure had no pain associated with it, at all! Trust me, if there was, I'd say that there was small pain that you should tolerate for the great benefit it gives. But there was not - nothing at all. If someone had not told me I had had this procedure done, just minutes afterwards I would not have known I had it. As soon as the local anesthetic wore off (which was faster than after a visit to the dentist) and I regained feeling in my upper teeth (the only indication that anything was going on), I was feeling absolutely normal.
If I had to be perfectly accurate, I'd have to notice that there were a couple of instances of very brief pain but those were optional. I'll explain. My right turbinate was mostly bony (i.e., very little soft tissue) and when the doctor was injecting me with the anesthetic, the needle hit the bone. That was the first time I felt some pain but that one 1) does not have to happen if your turbinate tissue is soft, and 2) it was very brief and could be easily tolerated. By the way, the doctor will spray some Lidocaine in the beginning so the injection itself is painless, as well. Afterwards, as he was inserting the Coblator probe into my soft tissue, he again hit the bone and when he activated the apparatus I felt sharp pain that made me cringe and the doctor saw that and stopped it. That is when he said “your right turbinate is mostly bone, so I’m going to do outfracture”. If I have to describe this pain, it was like being touched with a sharp, hot needle but because it was so brief and the surrounding tissue was anesthetized, it was perfectly tolerable. I think my cringing (that my wife did notice) was mostly because of being surprised as there had been no feeling at all up to that time, rather than because of the pain. Think of how many times you’ve cut, burned, bruised yourself, etc., this one would be nothing in comparison.
I am not suggesting that other people having this procedure done by other doctors will necessarily have a painless experience. But I’ve had it done by two different doctors and it’s been painless. Furthermore, this procedure is advertised by health-care institutions as “painless” – I had a brochure for this procedure, the pediatric version, and it claimed it to be “painless”. Do you think in these litigation-happy times, the favorite target of lawyers will advertise something as painless if it had any chance not to be? Especially since they make more money by doing it all under general anesthesia? Yes, there might be a small risk of feeling brief pain during the procedure, yes some people might have different tissue that might crust, bleed, etc., but those are small nuisances in comparison with the ill-effects of anesthesia or even to sedation, in my humble opinion.
If you do decide to go with it, you should do some things to help you alleviate any side effects. Keep your nose-lining as clean and moisturized as possible. I used to use a nasal wash that had some small concentration of antibiotics (as prescribed by an allergologist) but have lately switched to regular (saline with soda) wash. I easily find NeilMed products and they are reasonably priced, so I use that every morning and evening. I use it differently than their instructions, though – I keep the solution in a bottle and instead of running it all at once through my nostrils, I pour about an ounce in a small cup and use a 10cc syringe to spray about 6-7ml twice deep in each nostril, after which I blow my nose hard. I also use Ayr saline nasal gel – in gel form (tube) and spray form (still gel-ly, so it does not run). The morning before the procedure, I did the regular wash but then I used a cotton swab to put Ayr gel deep into my nostrils, kept it there for a few minutes, and then did the wash again. Stuff comes out till the very end but you want your nose to be perfectly clean to avoid any infections (and it might be helping in other ways, too). Then I cleaned my nose again the night after the procedure, and even used my CPAP that same night. The doctor had advised against those two things but he also warned about bleeding and I had no bleeding at all – when he pulled the splints, minutes after the procedure, there was a little blood on them but that was it. And that’s given that before the procedure my nose was so sensitive it would bleed almost every time I did the washing (since I spray the liquid with high pressure). I’ve even had it bleed spontaneously at night into my CPAP mask’s nasal pillows!
Maybe I’m somehow “better” than most but this procedure went so unbelievably well with me, that I’m sure it will be perfectly tolerable for anyone else. Do ask for any details if you feel I can help you decide or prepare better.
McSleepy

.

I've done 2 root canals with no anesthetic to numb it. It's surprising what we can do that we don't think we can do. By the way everyone at my dentist office thinks I'm nuts.

If I have this problem I would do this in a heartbeat.

OMG, this just totally freaks me out! I can't even read about it without cringing! Y'all have my deepest respect for having such an incredible tolerance for pain.

Muse-Inc wrote:OMG, this just totally freaks me out! I can't even read about it without cringing! Y'all have my deepest respect for having such an incredible tolerance for pain.

While I can agree that having a root canal involves some serious levels of pain (albeit, tolerable - in my youth dentists where I'm from did not use any anesthesia), I must restate that in my case (the turbinate reduction) there was none. I am not a doctor and I don't know why that is but I suspect the bone has no nerves. The turbinate bone is porous and it does not have bone marrow, so it is not as if someone was breaking any solid bone, like your thigh bone or something (sorry if I made it sound too graphic!) And the soft tissue is completely anesthetized, although I have no idea why there just wasn't any pain after the anesthesia wore out. Maybe in my case that tissue was less sensitive than in most people but, like I said, the medical profession thinks it should not hurt, so maybe there aren't that many nerve endings in there. The fact is that for me, other than the thought of what was going on - someone sticking a fat needle in my soft tissue and turning on microwaves, then flattening the bony structure underneath - was a completely painless experience.
General anesthesia has its risks and they are quite serious (just read the paperwork they make you sign before you go in). And I believe it also has some negative consequences that are guaranteed (not potential risks but actually happening to you). I should also mention that if you do not have insurance, my procedure is perfectly affordable while the full septoplasty is not. The purpose of my writing is to give some confidence to those who might be facing this question, especially those like me who were not going to accept a full septoplasty (it wasn't really necessary) but were not aware that this alternative can be risk-free yet very effective. I should also mention that I had been on Nasacort (a steroid) for many years and two days ago I started phasing it out, and it is going very well so far. It's been a month since the procedure and I'm breathing better than ever, and I'm about to get rid of all nasty medications that I had been taking. Yes, I'm still on CPAP but that's not so bad and I might be breathing better than many people, who think they're perfectly healthy. Not bad, I think!
McSleepy

McSleepy wrote:This is the best thing I have done for my condition and I highly recommend it to anyone who might have a similar problem.
McSleepy

Very interesting story. If I was going to do it for myself I would then seek a knowledgeable Plastic Surgeon who does "face lifting" and "nose reduction" instead of an ENT.

Example of specialty :

Surgery / Plastic, Maxillofacial and Oral Surgery

Clinical Interests:

Cosmetic and reconstructive procedures involving the face including rhinoplasty (cosmetic and functional), cleft lip and palate repair, surgery to treat facial paralysis, craniosynostosis, and other craniofacial conditions.

All kidding (and cringing) aside, you've written a great firsthand account in all your posts in this thread, McSleepy. Very helpful to anyone thinking about having that procedure.

McSleepy wrote: I have GERD, so I've had endoscopy done 5 times - all without any sedation. It is not bad at all, there is no pain, either, and the gagging can be managed.

I had that done once. I elected to have it done cold turkey - as you did. Without any sedation at all. I managed easily to keep from gagging during the first minutes. As time ticked by, it got more and more difficult.

During the last couple of minutes tears from sheer will power effort were rolling down my cheeks. A nurse was dabbing them away gently, and in a calm, quiet, soothing voice -- yup, she was very good at her job! -- was assuring me, "You're doing great...just a little bit longer. Alllllllmost finished." It seemed like I heard her say that at least ten times. In the meantime, the increasingly louder voice in my head was saying, "Don't do it, Laura... don't gag; hang on, don't do it, don't gag, relax, don't do it, stay still, stay still..."

I managed. Barely. Results were nothing found.

As you said, McSleepy, there was no pain to that at all, but I clearly remember thinking as I walked out -- "It seemed like a good idea, but no way will I EVER have THAT done again without sedation. Never, never, EVER."

You're smart and know what works for you, McSleepy. And omg - root canals cold turkey! - jazzer, too!!

You're both smart -- and, I still say... tough!

Thank you for the kind words, Laura! I think you were just being nice when you said I was smart but, come to think of it, I do know my body quite well and I try to be as educated as possible about my conditions, and medicine in general. I think that is very important as medical professionals today have no time to pay much attention to their patients and you need to exercise a great deal of caution when making decisions. Which, coincidentally, is why this forum exists - people want to be educated about OSA and CPAP treatment and since they are not getting anywhere near adequate attention from their sleep professionals, they come here for help from their peers.
Let me take a quick break from the topic to thank the few medical professionals who are the exception and have come to this forum to offer their expertise - thank you, you know who you are!
Doctors today feel compelled to do something when they have no idea what needs to be done or know there is nothing they could do (common example: viral infections). In other cases, they have no sufficient knowledge of the condition but are quick to offer what they've specialized in. Unfortunately, quite often they will be driven by costs, e.g., if the best course of treatment would not be supported by the insurance company, the doctor will avoid it. Conversely, if they know the insurance would pay, they might tend to offer a procedure that would bring them the highest financial gain. I'm sure all of you would have your own examples to add but the point is: we need to know our bodies and be as educated as possible so when we seek help we know what to expect and ask of the doctors. I have been fortunate enough to have worked in a cardiovascular surgery hospital and have some insight on how the medical profession operates. But nowadays, with the advent of the Internet, we call have access to vast resources and obtaining the desired information is juts a matter of desire. Your health is in your hands!
McSleepy

McSleepy wrote:I think you were just being nice when you said I was smart

I've been reading your posts. I think you're just being modest.

McSleepy wrote: but, come to think of it, I do know my body quite well and I try to be as educated as possible about my conditions, and medicine in general. I think that is very important as medical professionals today have no time to pay much attention to their patients and you need to exercise a great deal of caution when making decisions.

See? You're smart.

On a humorous note...some years ago, I came across this funny description of nasal surgery.
A starving wolverine, no less!! ROTFL!!!

___________________________

Blogging Under The Influence

Today I am whacked out on pain killers because yesterday I had surgery to correct my deviated septum. I didn’t ask a lot of questions about the procedure but I can deduce most of the details based on the way I feel today. Apparently doctors shove a starving wolverine into one nostril, where it scratches and eats until it hits brain. Then they pull him out by his tail. Nurses stop the bleeding by packing each nostril with a queen size mattress that is carefully wrapped around a wino.

Prior to the surgery, I wasn’t worried, at least until I had an unfortunate nose-related dream. In my dream, the surgery was finished and I was admiring my highly functional nose in the mirror. It processed air perfectly but it looked somehow different. At first I couldn’t put my finger on it. Eventually I noticed: I had one huge nostril where before I had two smaller ones. Call it a uni-nostril if you must.

Now I sit here, my brain half functional, my lower ganglia stinking of wolverine breath, wondering if beneath the bandages I have one nostril or two. In my dream, the uni-nostril looked sleek and modern. The only downside I could think of is that this is exactly the sort of thing that can earn you a nickname for life, such as Nostrildamus or Snout Adams.

And if anyone ever used the phrase “I need that like I need a hole in the head,” I would just tilt up my head, flare my huge nostril and say, “You got that right.” Then I would laugh at my own joke until I snorted an entire sandwich and a bag of chips out of my nose hole.

I really shouldn’t be operating a keyboard. (November 16, 2005)

Thanks for the post McSleepy.

My nose has been completely congested (but drips constantly) due to allergies for two months (allergies seem to be worse than ever; global warming or is it Bush number 2's fault?), and thus no CPAP as I don't have a full-face mask. This after I had very good CPAP results in the previous three months that changed my life for the better. I'm on the full range of allergy meds: antihistamines, decongestants, steroid spray for years (which had provided relief to some extent until now) and tried steroid pills and antibiotics these last two months with no relief at all. On Monday I went to an ENT for evaluation. He could not get the scope in my nose farther than about 1/3 inch, if that. It was really painful in the right nostril even after numbing. He said that my septum is S-shaped and blocking both nostrils. This might explain why saline nasal sprays tend to block my nose for about 30 minutes after squirting. Scheduled septoplasty and turbinate reduction surgery for May 5th. Just had the CT scan today to rule out any other issues that could not be visualized with the scope. I'm going under general anesthesia so would think I'm going under the knife (and hammer?) rather than coblation or RF. I'll have to ask him about outfracture when he calls about the CT results.

You would think that after 40 years of getting treatment for allergies, including allergy shots twice a week for 8 years, that someone would have looked up my nose to see the deviated septum sooner than now.

Sydney

Just to post an update: yesterday I had the same procedure done again, by the same doctor. I went to see him in December (I thought I needed a prescription for a CPAP mask, but in the end didn't need to) and he brought it up and suggested we do it again. I had some effects that indicated the turbinates had swollen a bit, but not to a point where the obstruction would be bothering me too much. Since the last procedure, I had never had to get up at night to try and figure out how to open up my nasal passages like before, but I had occasionally woken up and had to snort up some mucous to clear it up. He said he had some new Olympus equipment that the could request (the representative brought it for my procedure) and, indeed, it was very quick - one insertion, fire it up, and it was good. I think he also used the probe to make some holes in the bone so that he could flatten it further during the outfracture. It was fun this time - I was communicating with him, telling him when he would enter the bone (as the impedance of the bone is higher and the device would fault). I also was giving some feedback to the Olympus representatives (one was a trainee from another state).

It is amazing how there is no pain during this procedure. I was very calm, so I can't say that the adrenaline was masking any pain. After the nurse administered the Lidocaine (spraying into the nostrils), I felt my larynx go numb, so that when the surgeon injected the local anesthesia, I didn't even feel the needle piercing the lining. Dentists do something similar (they swipe a Lidocaine patch) but you can not only feel the needle enter your gums, but the penetration is actually a bit painful. Not this one. Then, after it was all numb, I could not feel any pain, although I could feel the probe (thicker in girth than a syringe needle) enter the turbinate (a stretching) and then enter the bone (tiny crushing feel).

It was very educational as it makes you aware of the location of the various parts of your anatomy. It was also productive as I could help the surgeon better perform the procedure. I can imagine that if he's doing it in the blind, he could not hit the right spots as well, and it is certain that if the patient is freaking out, he won't be comfortable and calm to carry on effectively.

As last time, I never had any pain after the anesthesia wore out - not immediately, not the night after. In fact, if I didn't know what was done to me, I would have never known it. There was no swelling, I could breathe through my nose just fine, even when I had the splints in. When I took them out, there was barely any blood on them. No bleeding sine then, at all (it's almost 24 hours now).

I should mention that in between the last time and today, I had my first real surgery (an ACL reconstruction) and I can tell you that the general anesthesia (mostly the fear form it) and the effects of the analgesics (Oxycodone) were much worse than anything else I've ever experienced. The orthopedic surgeon wasn't comfortable with local (epidural) but, in retrospect, I would have at least taken it way down on the analgesics (maybe sone Tylenol).

In other words, I recommend this procedure to anyone who has enlarged turbinates and can benefit from it. Talk to your ENT, but make sure he or she is a good one as some damage can be done, too. This is the third time I've had it done in 7 years and it is getting better each time (so far, I'll give it a few days to confirm). I think I won't need to have another one done for a long time, if ever. One things is certain - do not fear this procedure if it ever comes up for you.

McSleepy