When I was little — maybe three or four — Mom knocked me off the porch. She didn't mean to do it. It was a small porch, we were trying to leave for somewhere and had to run back into the house, she opened the door, I was in the wrong place... and I ended up face-down in the flower bed. I had a bloody nose, but there was no point in taking me to the doctor. So I got over it and years went by.
I noticed as a teenager that the inside of my nose was asymetrical. If I stick a finger into my left nostril, as sometimes I like to do, it will go up plenty far. But a finger put into my right nostril won't make it a half-inch before reaching a dead end. I can breathe through both nostrils, but the right one is almost completely blocked off by that wall of cartilage — the septum — that divides the nostrils. When my nose starts to plug up, the right side is always the first to get blocked and the hardest to get back open.
As a kid, especially when I was stuffy, I'd push on the septum, trying to open the passage a little bit. I didn't go to the doctor very often growing up, so it didn't cross my mind to ask a doctor why I was like that. I just figured it was the way I was built and I should live with it.
A couple of years ago, in 2001, I had a bad cold. My nose plugged up, the pressure built, and I couldn't keep my nose clear enough to breathe through it. That's always bugged me, and I used nose spray for several years growing up to keep unplugged, but this time was worse. After one night where I didn't sleep at all and experienced something the closest I ever had to a panic attack, I went to see the doctor. I was diagnosed with a sinus infection and put on antibiotics. He also asked me if I had broken my nose as a child, and told me I have a deviated septum.
I visited an ear, nose and throat specialist (ENT) who confirmed my septum was deviated and recommended surgery to correct it — something called septoplasty. At the time, my company was going through some financial struggles and I decided to focus on keeping my job instead of recovering from surgery. So I left septoplasty in the back of my mind and moved on.
I had another sinus infection in early 2002, but it didn't hit me as hard and antibiotics cleared it right up. I of course started with the nasal spray — Vicks Sinex is my drug of choice — and had to break the addiction again several weeks later. All was still well.
This year (2003), September 7, I sensed a cold coming on and picked up some Sudafed. The next day, I was blowing my nose a lot and started on the Sinex. I started having trouble sleeping. I did some web surfing and found out that Sudafed can trigger anxious feelings, so I stopped taking it. On September 10, I had a bad night of no sleep at all, and went to see my doctor on September 11. He prescibed amoxicillin and recommended Afrin (which didn't help at all). I had another rough night of not much sleep, so I called my doctor and he told me to tough it out. (He's no longer my doctor.) On Saturday the 13th, I tried napping and still couldn't sleep. I was sweating and cold to the touch. I went to the doctor's office, where they put me on a more powerful antibiotic, Augmentin, and added Allegra. I slept okay the next three nights. Then the symptoms, and the anxious feelings, were back and I didn't sleep the night of Tuesday the 16th. Back to the doctor, where Allegra was replaced with another antihistimine and an expectorant was added. I slept pretty well at my sister's place the next three nights.
On that Thursday, I went to see an ENT, who again diagnosed the deviated septum but ordered a CT scan of my sinuses for September 30. He didn't want to discuss the situation much until he had seen the pictures.
On Saturday, I flew to Chicago for a conference. Except for the first night, I slept well, but I was using Sinex every two hours or so. When I returned, I knew I needed to back off. On Thursday of the next week, I used Sinex at 1:00 PM and I haven't used it again since. I didn't sleep a wink that night. I've never been comfortable consciously breathing through my mouth. I didn't have the anxious feelings that had bothered me for over two weeks, so there might be a connection to the Sinex. The next night I knew I'd need to sleep, so I used 12-hour Afrin, which cleared me right up and I got my best night of sleep in weeks, even sleeping in on Saturday morning. I've taken a spritz of Afrin every night since, and I've slept well every night. I've backed off from three sprays in each nostril to one, and I hope to break that habit before I have surgery.
My CT scan was simple. I laid on a table, belly down, with my head facing forward. My chin sat in something that looked like a vise. My hands were tucked under my thighs to hold them still. The technician warned me not to swallow or move, then started the machine. The table moved back and forth in and out of a big white donut until they had pictures of every layer of the front of my head. They developed the film, handed it to me, and sent me on my way.
Today is Thursday, October 2. I met with my ENT again this afternoon. He showed me the CT pictures and assured me all was well with my sinuses, but the deviated septum should be corrected to relieve congestion and help prevent sinus infections in the future. He's also going to remove some of my turbinates. I don't want to go through another sinus infection like this last one, so I'm going ahead with surgery later this month. I'm hoping for Wednesday, October 22, but I'm waiting for a call from the scheduler.
I asked some questions during my appointment, and here are some of the answers, paraphrased and subject to my interpretation:
Should I be taking any vitamins or avoiding any? A daily vitamin is fine, but stay away from big doses of vitamins, including E, and stay away from aspirin or other blood-thinners before the surgery.
What should I expect when I wake up? You'll be packed tight with a sponge about the size of my finger in each nostril. You won't be able to breathe. You'll have 24 hours of misery. You won't be able to eat much, drink much, or sleep much. There will be a gauze pad taped under your nose that will need to be changed every two hours or so. After 24 hours, the packing will be removed and you should immediately breathe better than you have.
How much and what kind of pain should I expect? For how long? Most people don't have much lingering pain. Just discomfort. The inside of the front of the nose will be sore, because that's where I'll make my incision.
How long should I plan to be away from work? Depending on your drive to get back and your tolerance for pain, maybe in a week, maybe a bit longer. Some people go back after a few days. Nosebleeds are likely.
What restrictions will I have for the next days and weeks? You'll have a splint stiched into your nose for a week or so. You won't be able to blow your nose or exercise for at least a week. I don't recommend flying for a couple of weeks, because of the risk of nosebleeds. You're going to scab up gradually because of the amount of exposed raw tissue in your nose. You'll come in and see me after a week, I'll numb you and clean it out. Then we'll do that again in a couple of weeks. The recovery will take 6-8 weeks.
If I have to breathe through my mouth, can I get help to keep my mouth from drying out? Use a humidifier. Put it right next to your bed and point it at your head.
Will I lose sensitivity in any part of my nose? You shouldn't have any long-term loss. But when a nerve is bruised, it takes a long time to heal. The tip of your nose will probably feel funny, and your front teeth may feel odd. It may take months for all of the feeling to return.
That's where things stand today. I'll add updates as I go through the surgery and recovery.
Wednesday, October 8 — Last night, I noticed a voicemail from Vicki, the scheduler for my surgeon. She said they'd scheduled my surgery for Friday, October 24. One problem, though: Holly and Caleb are leaving for vacation that day, at Mom and Dad's. So if I had surgery then, I'd be all by myself. I decided to reschedule for November 14. Everyone will be in town anyway, since my nephew's birthday is that weekend. So my surgery is now at 9:00 AM on November 14 at Shawnee Mission Medical Center. I was warned not to take any blood-thinners (aspirin, herbal tea, vitamins, etc.) for two weeks before the surgery.
Thursday, October 9 — I talked to my surgeon's nurse today, and found out that if I have the surgery on Friday, November 14, I have to leave the packing in over the weekend until Monday. Risking the wrath of his scheduler, I left her a message today asking to reschedule my surgery for another day. I also talked with the billing department to ask for an estimate of the cost of my surgery.
Wednesday, October 15 — The scheduler called me back today. She argued with me for a minute about whether I'll have the packing in for one day or three, but we finally agreed to try to reschedule for November 18 or 19.
Monday, October 20 — I called the scheduler today and she confirmed that my surgery is at 7:30 AM on Tuesday, November 18. I have to check in at 6:00 AM. (She also "distinctly remembered" talking to me about the new date and some paperwork related to it, and I didn't argue, but we haven't talked since last Wednesday. I've been waiting patiently for her call.)
Friday, October 24 — I called United Healthcare today with the surgery code (30520) and talked to Gary. He checked and told me it's a covered item. Both Dr. Thornton and Shawnee Mission Surgery Center have contracts with UHC, so they'll pay 90% and I'll have to pay 10%. He wouldn't give me any hints about how much it will be, so I called Angie and asked her for an estimate. I also left a message for Katrina asking to schedule my follow-up visits for the day after and the week after — just before Thanksgiving.
Monday, November 3 — I called and left another message with Angie to get an estimate of how much my surgery will cost. Katrina called last week and told me I'd have to schedule my follow-up visits at Dr. Thornton's other office. I called today and the person who talked with me was very rude, asserting that it's all "post-op information" that I can't have until after the surgery. For someone who's about to spend many thousands of dollars having a structural change made to my body, I ought to be able to expect some respect from the hired help, shouldn't I?
Tuesday, November 4 — Angie called me back. My surgeon's part of the surgery will be $642. That's obviously not very closely tied to the total cost, which I'm expecting to be $10-15,000. So I think I'm going to give up on finding out how much it will cost and Just Do It.
Thursday, November 13 — Mary from the Shawnee Mission Medical Center Surgery Center called me this afternoon to brief me on preparing for the big day. My surgery's at 7:30, so I need to be there by 6:15. I need to bring my health insurance card and clothing that's comfortable and easy to slip over my head. I can't eat or drink after midnight, not even mints or water. And my goatee has to go.
Tuesday, November 18 — Mom, Dad and I were at Shawnee Mission Surgery Center by 6:00 this morning. I signed in and waited. My pastor and another man from the church came to read scripture and pray. My name was called. I changed into a gown, got an IV, talked with the anesthesiologist, took some medicines and got ready to go. They wheeled me into the operating room and I was out. Soon I woke up in the recovery room. I was plugged by the packing and couldn't wait to get on my feet instead of laying there. Mom and Dad came back to see me, then they left to get the car and I got dressed. The nurse walked me to the car and we left. I picked up my prescriptions and got a milkshake. I'm miserable this afternoon. The packing means I can't breathe comfortably, my mouth is drying out, I can't swallow... overall I feel bad and can hardly wait for 9:00 tomorrow when the packing will be removed. Holly made me up a couple of ziplock bags with frozen peas to apply to my nose. The peas shape to my nose better than ice cubes. I can use one bag while the other is re-freezing.
Update, 8:15 PM: According to Mom and Dad, Dr. Thornton said my deviated septum was worse than he had thought, and I have two splints sewn into my nose. That's actually good news, I think, since it hopefully means I'll notice even better results tomorrow when the packing comes out. I left the hospital with gauze taped under my nose, but that was soon ripped off and I've just caught drips of blood with a kleenex all day. My pain reliever isn't giving me a buzz, so once these sponges are removed, I should be able to sleep without much trouble. Tonight I went to the grocery store and bought all kinds of comfort/junk food, then remembered once I was home that I can't taste anything. I don't think I'm going to sleep tonight, so I rented Gods and Generals on DVD. If I happen to fall asleep, that's great. If I don't, then I've finally found room for a four-hour movie.
Wednesday, November 19 — I had a rough night. I didn't sleep for more than a minute or two at a time. Every time I'd start to fall asleep, I'd snore through my mouth and wake myself up. Then I'd need a sip of water or a shot of sore throat spray, and everything would start over. By sunlight, I was exhausted and eager for the sponges to go.
We got to Dr. Thornton's office at 9:00 this morning and they sent me straight to an exam room. Dr. Thornton came in and asked about my night. I told him it was good except for not sleeping, and he agreed that it must have been rough. He cleaned the inside of the tip of my nose, then gripped one of the sponges with a pair of angled needle-nose pliars. The sponge — about six inches long with rounded ends and soaked in blood — slipped right out with a tickling sensation near the back of my throat. Then the second sponge came out... and I could breathe! Better than ever before! It was the moment I was hoping for and it was as good as I had imagined. He suctioned inside my nose and sent me on my way with instructions to see him again next Wednesday afternoon to have my splints removed and scabbing cleaned out. I'm supposed to use Afrin twice each day for the next week, plus saline nasal spray several times per day for moisture. And I can't blow my nose for a week because of the potential for nosebleeds.
I slept for several hours this afternoon and I'm looking forward to a good night of sleep.
Thursday, November 20 — I slept on and off last night. My nose is congested. I'm using Afrin and saline solution, but since I can't blow my nose, I can't breathe freely. I'm so tired. I hope I can sleep tonight.
Friday, November 21 — I slept well sitting up on the couch last night. I'm still tired this morning, though; I have a lot of sleep to make up. My nose is really stuffed today.
Sunday, November 23 — This recovery is turning out to be about as rough as I thought it would be. On Friday morning, I called Dr. Thornton's office and was able to get in for a little bit of cleaning. That helped me breathe better the rest of the day. Friday evening, I went with Joni to her parents' farm in Iowa. I slept most of the way up. That night, I slept sitting up in bed for hour-long increments most of the night, then in a recliner from about 6:00-8:00 AM. I was stuffy Saturday morning but feeling pretty clear Saturday night until I had a bit of a nose bleed. I paced the floor until about midnight Saturday night, then I slept on the carpet in the living room until 4:00 AM. When I woke up, I paced for 20 minutes or so, then fell asleep on the couch until a little bit after 8:00 — my best night's sleep yet. Today, though, my nose got really congested. The left nostril is almost completely blocked. Either a splint bent or it got covered in so much crud that it's hard to breath around it. Tomorrow I'll see if I can get in for another clearning to help with the two nights between then and when my splints come out. Tonight has the potential to be a rough one, maybe almost as bad as the night with the packings. My mouth is already dry from breathing through it. I keep trying to remember these verses:
And He has said to me, "My grace is sufficient for you, for power is perfected in weakness." Most gladly, therefore, I will rather boast about my weaknesses, so that the power of Christ may dwell in me. (2 Corinthians 12:9)
...but in everything commending ourselves as servants of God, in much endurance, in afflictions, in hardships, in distresses, in beatings, in imprisonments, in tumults, in labors, in sleeplessness, in hunger, in purity, in knowledge, in patience, in kindness, in the Holy Spirit, in genuine love, in the word of truth, in the power of God; by the weapons of righteousness for the right hand and the left, by glory and dishonor, by evil report and good report; regarded as deceivers and yet true; as unknown yet well-known, as dying yet behold, we live; as punished yet not put to death, as sorrowful yet always rejoicing, as poor yet making many rich, as having nothing yet possessing all things. (2 Corinthians 6:4-10)
Both of these quotes are from a letter Paul wrote. Paul had a "thorn in the flesh," some unidentified physical ailment that never went away, despite his prayers that God would relieve him. At least I know my "thorn" is being removed on Wednesday!
Tuesday, November 25 — I struggled through most of Sunday night, sleeping in fits on a recliner and finally getting a couple of hours of sleep on the couch. Then, an answer to prayer and turn for the better: I went to see Dr. Thornton for cleaning at 3:10, and he decided to take the splints out! He clipped the stitches, then pulled them out. They were bigger than I expected, roughly the size of two quarters each. I asked if I could blow my nose now, and was sternly warned to wait for four to six weeks for that. I need to use saline nasal spray a lot — he said I can't over-use it. I have an appointment with him next Thursday to get cleaned up.
I was worried that the bleeding would cause congestion again, but by 11:00 last night, I was still clear. I cleaned up a little bit with a Q-Tip soaked in saline and went to bed. I slept great! I woke up once and realized I was still clear and went back to sleep. This morning I'm breathing okay, too. I had a nosebleed a little while ago, so I need to use a Q-Tip again to feel really clear. But I'm over another big hurdle and very happy about it!
Thursday, December 4 — I've slept well (or at least as well as usual) since the splints came out. I've gotten congested from time to time, but some light blowing, dabbing with a kleenex or gentle application of a Q-Tip has always done the trick. Today I visited my doctor for a follow-up. He used the vacuum on me briefly and said I'm healing up nicely. He did say I might have a slight (1/8") perforation in the septum near the tip of my nose (though it's still possible it will heal). A perforation could mean I whistle ever so slightly when I breathe. He said it's no big deal, except it's annoying for him, because he didn't want it to happen. I have an appointment to see him again in three weeks.
Overall, I'm feeling great. I can breathe a lot more through my nose, and when it's not congested, it's a wonderful feeling.
Update, 10:33 PM: According to my insurance company's web site, my surgery cost $16,381. That's about what I expected. Also, I'm expecting some insurance hassles, because they think their network discount brings the total down to just over $1,500. Someone forgot a zero.
Monday, December 29 — I visited my surgeon again last Monday, and he said everything is healing as it should. He's more certain I'll have a perforation. He wants me to keep using saline nasal spray for another month or so, and visit him for a checkup in a year.
Personally, even though I've felt better and better since the splints were removed, the most noticable improvement was right before the four-week mark. I can breathe so much better than ever before, and I've been sleeping great. Looking back on the last month or so, even though I was miserable for a while, I'm glad I had this surgery done and I wouldn't want to go back.
Tuesday, July 27, 2004 — Someone emailed me today asking for an update. It's been a while, so here's the latest: I feel great and I'm so happy with the way everything turned out. I saw my surgeon a couple of weeks ago for a six-month checkup, and everything is fine. I do have a permanent perforation, but it doesn't affect me. Almost every day, I take a breath and appreciate how well I can breathe now.