septoplasty and turbinate surgery

per-turbed in san jose wrote:Hey Boston...how are you feeling these days? Breathing better, I hope?

Hi, Sanjose. It has been more than 3 weeks now. I guess I am improving. My nose is definitely not as congested as before, sometimes both of the nostrils are just wide open. However, its still not very comfortable. I cant quite describe the uncomfort, its like a kind of imbalance between two nostrils, not smooth breath and I might caught a cold last week, making me coughing now, this might also contribute to the uncomfort. I went back to my surgeon on 3 week mark and he said everything looks fine. He also told me that patients after surgery tend to more sensitive the the cycle between two nostrils which is the problem bothering me and after several months I will return to normal again. I am wondering do you still notice the uncomfort from your nose frequently 8 months from the surgery?

Hey Boston...after 8 months, I don't really notice any issues. Sometimes, my nose is a little more clogged than others, but so much better than before surgery (and I think the clogging is due to year-round allergies). I can tell you that I definitely had a noticeable nasal cycle AFTER surgery, and it was interesting getting used to it. I was so relieved to actually have a nasal cycle however, that I soon got used to it and was just so happy to actually be able to breathe through my nose. Because my nose was so closed before surgery, actually seeing it wide open takes away my anxiety because I know I am getting air through my nose and can breathe no matter what. I don't know if that makes much sense to you, but for me, there was a huge psychological aspect before surgery...seeing how closed my nose was and feeling like I was unable to breathe.

Brooks...best wishes for a great surgery and speedy recovery.

Sanjose, good to hear you are doing fine in the long run. I am gonna hang in there and report the progress later.

I thought I would add my experience to the list - FWIW.

Last Friday I had what the surgeon called "major sinus surgery" including turbinate resection w/tissue removal, septoplasty (surgeon described things as "pretty twisted around up there"), ethmoid, sphenoid, and maxillary sinus resection with tissue removal, and polypectomy.

The surgery took between 3 and 4 hours.

Unlike others posting in this topic, my post-operative period has been far from easy. I am not able to use CPAP for "at least a month", and was told to NOT blow my nose and to NOT sneeze. The latter apparently is not dangerous, but it can result in a person's face "blowing up like a pufferfish."

The splints in my nose are extraordinarily uncomfortable - and they remain in for 6 days post-op. The bleeding is continuous and the clotting has been ... well, just downright grotesque. I am using nasal lavage (like a NETIpot) every few hours, per doctor's suggestions, but there is no possibility of the nasal passages being opened long enough to breathe for more than a few minutes. That, in combination with no CPAP means I have gotten virtually no sleep since the surgery. I manage to nod off from time to time, but am roughly awakened by the lack of air. The constant draining of blood results in constant queasiness/nausea.

AND - this is not the worst of it. I have tried repeatedly to train myself to breathe through my mouth. I'd like to have some kind of appliance I might be able to bite on that would allow my mouth to remain open at night, but even then I am not sure I would be able to train my air passages to open to breathe. As a consequence, there are times I have this overwhelming feeling of being just unable to get any air. If I am alert enough to remind myself consciously to just open my mouth, the anxiety that results is controllable - but if I am half-awake (as I am often), there is a distinct period of anxiety and near panic as I feel unable to get a breath.

This has a distinct psychological impact and has resulted in severe depressive episodes.

The meds the doc put me on include an antibiotic and a pain reliever. I am also using an anti-inflammatory and because of the anxiety, decided to use some anti-anxiety medication (doubles as a skeletal relaxant) that I had from my previous surgery.

The surgeon tells me he is certain I will be "dramatically" improved when I get through this - but it sure is not an easy process.

I hope to be able to report significant improvement in upcoming days.

That anti-anxiety medication may very well be relaxing your muscles in your airway and causing your apnea to be much worse.

roster wrote:That anti-anxiety medication may very well be relaxing your muscles in your airway and causing your apnea to be much worse.

That is a good point - and one I had not considered. The first night (or two, I am losing track), I did not take the anti-anxiety medication and did not sleep more than minutes at a time. The occasional bouts with panic were NOT a good thing at all. Since taking the anti-anxiety meds, I've been able to manage a bit more sleep - a couple of hours last night.

Am not measuring the apneas since no CPAP, but I'll hook up the pulse oximeter tonight and see what it tells me.

Thanks!

DHC wrote: I did not take the anti-anxiety medication and did not sleep more than minutes at a time. The occasional bouts with panic were NOT a good thing at all. Since taking the anti-anxiety meds, I've been able to manage a bit more sleep - a couple of hours last night.

If the pain relievers are opiate based then they can very well be keeping you awake. On some people opiates tend to make them very wired. Morphine less so, oxycodone more. It all depends.

jonquiljo wrote:

DHC wrote: I did not take the anti-anxiety medication and did not sleep more than minutes at a time. The occasional bouts with panic were NOT a good thing at all. Since taking the anti-anxiety meds, I've been able to manage a bit more sleep - a couple of hours last night.

If the pain relievers are opiate based then they can very well be keeping you awake. On some people opiates tend to make them very wired. Morphine less so, oxycodone more. It all depends.

The one prescribed and I am using is Percoset. The anti-anxiety medication was Valium.

Doc had me change some things today and will be replacing the Valium with Ativan as well as Ambien to help with sleep.

Hopefully I can keep focused on removal of the splints tomorrow and expect things to be much improved thereafter.

DHC wrote: The one prescribed and I am using is Percoset. The anti-anxiety medication was Valium.

Doc had me change some things today and will be replacing the Valium with Ativan as well as Ambien to help with sleep.

Hopefully I can keep focused on removal of the splints tomorrow and expect things to be much improved thereafter.

Sorry DHC to hear of your misery. Percoset contains oxycodone and tends to be more energizing than Vicodin (hydrocodone) or Morphine - morphine is the most sedating, though you need a CII script (in person, not phoned in) because it does not contain Acetominophen to make it less restricted. Valium, IMO, is a better benzo sedative to take as it is longer acting and therefore you will not constantly be taking it every 6-8 hours. Frankly you are lucky to have a Dr. that is bold enough to prescribe any of those meds these days!

Ambien is a good idea! You will fall asleep (or think you have) and it will be invaluable during the miserable nights. Good luck with it.

I have problems (nasal) like you - and since my UPPP 14 years ago - I have been hesitant to go under the knife at all (laser or not). I am tempted to get RF ablation for turbinates - as the problems seem to be minimal. I am needed to take care of things around here as my wife is disabled with a bad spinal problem - so being out of commission from surgery is not a good option for me. But I will keep track of how you feel and are doing - for your sake and my future decisions.

Again, good luck. I hardly doubt that any benzo like Ativan or Valium in moderate doses will exacerbate your apnea enough to be a problem - certainly not while you are miserable with other post-surgical issues. I will tell you also (after a miserable UPPP recovery 14 years ago) that things do get better. There will be a day fairly soon where it isn't so bad and it will improve steadily from there. Keep the faith!

DHC, Are you familiar with positional sleep apnea (PSA)? PSA means your apnea is most severe when backsleeping and less severe when sleeping on the sides or tummy.

Recently we lost electrical power overnight and having no CPAP, I tried to stay up most of the night. I took some short naps during the night and always made sure to avoid backsleeping because of PSA. About 50% of all OSA patients have PSA according to parameters set by sleep professionals.

If your surgery allows it, you might try to avoid backsleeping.

roster wrote:DHC, Are you familiar with positional sleep apnea (PSA)? PSA means your apnea is most severe when backsleeping and less severe when sleeping on the sides or tummy.

Recently we lost electrical power overnight and having no CPAP, I tried to stay up most of the night. I took some short naps during the night and always made sure to avoid backsleeping because of PSA. About 50% of all OSA patients have PSA according to parameters set by sleep professionals.

If your surgery allows it, you might try to avoid backsleeping.

Hi Roster,

Yes - thanks to the good folks here I *am* aware of PSA and it makes sense. The ENT who performed the surgery told me to sleep at a 30 degree angle (that is, head elevated 30 degrees above laying flat) - like in a recliner. I have not even tried to lay in bed since the surgery. Prior to last July, my predominant sleeping position was on my stomach. The ACDF (cervical spine fusion) surgery in July now prevents that altogether. For now it is the recliner and I am able to turn on my side(s) at least a little.

Thanks for the suggestions.

The splints came out today. Wow! What a relief!

I can breathe easily and with the ability to breathe through my nose, no more anxiety/panic attacks.

I was surprised at the size of the splints - much smaller than I expected. There were 4 altogether - two that were relatively easy to reach and remove - and two that required use of a scope and a bit more tugging. They are flexible plastic splints that do not entirely occlude the airway. I also learned that the surgeon used a dissolving gel to splint the deeper sinuses - ones he would have difficulty reaching for later removal. Some amount of the gel remains and should soon come out now that I am continuing with nasal lavage and the splints are no longer in the way of the rinse reaching those deeper sinuses.

Some topics here have mentioned neti-pots. The nasal lavage I used was slightly different called 'Sinus Rinse' by NeilMed. You can see it here -- http://www.neilmed.com/usa/sinusrinse.php.

The doc had told me to rinse at least 5 times each day after the surgery. It turned out I rinsed much more often than that. The NeilMed bottle holds 8 ounces of water, and I was going through more than a gallon of distilled water each day for rinsing. I was told to continue rinsing that frequently for at least a month - and then to plan to rinse the sinuses at least once daily for the rest of my life.

I asked again about using CPAP. The doc had previously told me to cease its use for 30 days post-op. Today I asked if I could start using it at a very low setting and he agreed to my using it in a few days - at 10 days post-op, but at a very low setting of 4 or 5cmH2O. With the IntelliPAP, those low pressure settings have worked OK for me in the past, and with more open upper airways, I am hopeful this will allow me to FINALLY get some restful sleep.

I had planned to strap on the pulse oximeter last night, but forgot - so will try to get it on tonight and see how things go sans CPAP for a few days, and then slowly ease back into it.

Except for a headache, the removal of those foreign objects from my sinuses has made such a huge difference in how I feel at the moment, I am ready to declare the surgery a raging success - but of course, that is highly premature. It is just such a relief to have those things GONE!

Well I am glad to hear you are feeling better and feeling good about the surgery. It is likely after healing that you will be even more appreciative of the surgery.

So you had about seven tough days post-op and then the splints came out and you got great relief.

I will repeat my experience just to let other candidates for surgery know it is not always so difficult. I had a badly deviated septum corrected and turbinate resectioning and reduction. The surgery was on a Monday morning and the splints were taken out on Thursday of that same week. The surgery was outpatient and I was home by mid afternoon.

I used my full face mask (F&P 431) every minute I slept from Monday on despite being told by the doc it would be thirty days before I would feel like using it.

On Tuesday and Wednesday I lay around most of the day watching old DVDs I had collected for post-op. Thursday morning the doc took the splints out and my wife and I went mall shopping and had a nice lunch. After that it was back to pretty much normal activities except for being careful not to bend to do heavy lifting for about two weeks.

Very easy surgery compared to the big benefit of having a very nice clear nasal airway for the first time in my life!

Just had the surgery yesterday. Deviated septum, bone spur, polyps, turbinate reduction and some exploratory work in the other frontal sinus cavity. The Dr. reminded me on several occastions that my sinuses/nasal cavity was a disaster. Thx Doc, for the confidence you inspired. Anyway, the surgery was longer than expected, nearly 3 hours and when I work up in recovery, I was in the sitting up position with my asthma nebulizer attached to my face. Apparently I'd had difficulty breathing. That was a bit of a scary feeling, gasping for breath when you first wake up.

I was not nauseous (had been given a patch behind the ear), however I was wheezing and coughing up blood that had trickled into my lungs. The pain was minimal at that time. I was coughing alot to expel mucus, etc....and by the evening, it felt like a truck had rolled over my body. I was taking pain medication every 4 hours due to the splints and packing in my nose.

I slept maybe 2 hours that first night. My mouth was so dry and my throat so sore that I was sipping wate or hot tea every few minutes. I was using a small syringe to squirt warm water laced with hydrogen peroxide, up into my nostrils. By the end of surgery day, most of the blood had stopped flowing but now the splints were clogged with the infected mucus that had been living in my sinuses for years. By bedtime, my teeth were hurting along with my entire face because of the congestion. At this point, I was asking myself why I'd had this surgery. Still coughing bloody phlegm out of the lungs.

I took a sleeping pill before bedtime and fortunately slept throught the night. On the morning of the second day, I could hardly move out of my bed. Maybe it was surgery trauma that made me sore all over. Started in with the pain pills and coughing up more phelgm and blood which had collected in my lungs over night. Can't believe that the packing won't be removed until the third day after surgery. I'm in major pain and am tempted to call the dr. to have him remove the packing early. The soreness in my throat has not subsided (where the breating tube was placed during surgery). My meds say not to have any alcohol while taking pain pills but forget that. I'm thinking of a nice sip or two of brandy to put me out of misery.

I'm sure that the end result will be worth all this pain and aggravation of dripping blood and snot.......... I would definitely say that this is the worst surgery I've ever had (and I've had appendectomy, cataract, knee surgery). This unending pressure and pain just makes me want to scratch my eyes out. I've taken off work all this week and more than likely will take off next week as well. Everyone is different and I had ALOT fixed so I'm sure that is why my recovery is so much worse than other recoveries I"ve read about.

del