April 2009 – spew

D-DAY +7 :: Wednesday

Certainly one of those moments in life where a week has certainly not gone by. But the calendar doesn’t usually lie.

I’ve spent more than enough time lying down and resting and not exerting myself. This is getting really old. But I understand why it’s necessary. For just when I think I’m well enough to pop out to the store or to run an errand, I’m slowly washed over in this dull ache of lethargy and apathy. All I want to do is lie down. Is this the lingering anesthesia? Is this just my body sacking reserves and resources as it performs whatever internal repairs?

A week on, I can cite some evolutions in my symptoms.

Alternating moments of spunkiness which beget lethargy
As noted above, I get these winds of normalcy, where I simply must get out of bed & pull weeds or filter Jude’s room of toys greater than X months old. And just as quickly, my knees are taken out from under me.

Alternating conditions of wet sinuses followed by dry sinuses
Imagine for a moment that we don’t live in a humid climate up here in Marin County. My sinuses are behaving like a dish sponge. Soaking wet after my rinsing, followed by a slow drying up over the next 5-6 hours till the next rinse. But just like that sponge, I can literally feel my tissues and cavities shrinking and hardening over those hours. Where the septum stitches are, this is at times painful, especially when I smile or open wide. But mostly it’s just a general feeling of contraction. I can feel it when I press my tongue hard to the roof of the mouth. As well as when I look hard-right or hard-left. Hard to explain any more than that.

These moments follow the nasal rinses, which I must say, save for the tampon removal, have been the most satisfying of my recovery. Even a full calendar week on, I am getting significant debris flushed out of each nostril. Black jellyfish the size and probable weight of silver dollars, which only seconds before were, or were attached to, the very dryness and crustiness mentioned above.

Headaches
Prior to the surgery, I used to 2 and only 2 different kinds of headaches: {A} the hangover brand, which seemed to nest itself around the base of my skull in the back, and {B} the eyeball kind, which I would get if I spent too much time in bright light without sunglasses, or after long days with contacts. But since the surgery, I am getting a different kind, one that seems to be a mix of the eyeball headache, but centered high and forward on the skull. It’s as if the pain is a focused core just on the other side of my forehead. I’ve had 3x of these in the week since, 1x of which was severe enough to prevent me from walking upright and seriously considering mainlining one of those Vicodins.

Boredom
I hate TV. There are simply loads of crap on, regardless of time of day. The later the day progresses into night, the worse it gets. Nothing but mind-numbing, spirit-crushing crap that people I love are by every definition hooked on. Perhaps I should have temporarily upped the number of Netflix discs I could have out at any one time. But there have been days where all 3x discs are in the mail, and I’m left only with the telly in the bedroom, which was Anna’s childhood TV. I can spend 30-45 minutes at a time sitting at the computer with a comfy pillow under my ass, before the waves of fatigue wash up me. Reading has helped pass the time, but I’ve so far been unable to focus on the development of plot. And I haven’t the energy to get behind my workstation such that I can string a network cable all the way into the bedroom (why can I not make a VPN connection over wireless again?).

Grumpiness, Irritability
Ok, those two terms described me fairly accurately before the surgery. But since, I’ve been more so then usual. I have less patience for many of the same types of situations around the house. Be it Jude perpetually forgetting that Charlotte is asleep, or simple things like inanimate objects not doing as they’re told, I feel myself getting close to the snapping point. Which may all well be the lack of regular medications I’ve been suspending whilst I recover, which I take for some wicked ADD. It’s called Concerta and I must include the lack of this medication as a likely culprit.

I’m writing all this down in with so much detail because this is the kind of post-op account I wish I would have found beforehand. I only found one blog that provided the level of detail I needed on the special kind of surgery for which I was scheduled. If any of that guys’ account was going to be true for mine, I was in a better headspace after reading it. Turned out that his recovery, save for some pain involved with septum splints as well as some GI issues, and has tracked fairly closely with how mine has. Again, certainly NOTHING like the blogs & comments on others’, where pain and severe discomfort and warnings of such were all that I could find. Hope my details and description of the passing of post-op time helps you should you find yourself staring down the business end of endoscopic sinus surgery.

D-DAY +2 :: Friday

Today I feel like shit, but not really because of the nose. I have those achy bones funny feeling in the back of my throat that seems to always preceed either a cold or sinus infection. And here I am with what I am sure amounts to open wounds up in my sinuses. Insane to think about getting an infection up there so immediately following surgery. But I am on antibiotics, so there’s hope.

The numbness of my general nose region is starting to wane. Or, at least change. Prior to today, I literally couldn’t feel my nose unless I was touching it. Certainly no pain. But now, I am acutely aware of a few things:

An increased volume or capacity of airflow.
I was told this would be an immediate effect. When you think about how the surgery removed so much foreign matter from the middle sinuses, the pipes are 75% wider. We’re talking bandwidth here. Even though only the right side seems to be free-flowing, overall I can take deeper breaths faster thru the nose then before.

An increase in resonance
Without having Dr Rust confirm this specifically, it feels as though there’s more space for my voice to bounce around. It hasn’t changed so much as simply feels like its coming from a larger resonance chamber. When I first noticed it, I was speaking whilst looking closely into a big mirror. So I just assumed it was the echo from that surface I was hearing. But I’m hearing it again & again, at rest and whilst vertical.

Stitches
When Dr Rust did the septoplasty, he basically cut into the cartelage separating my nose, removed some of that, realigned the septum true, then stitched the new structure in place. Odd at first, the deviation was to the right, but the stitches are on the left. Makes sense now. As my nose de-numbs, I am totally aware of these stitches. They’re down in the crook of my nose, right above the lip of the left nostril. Which makes anything close to a smile or a wide-mouth some of the first real elements of pain thus far.

Blood in my spit
At will I can tounge-scrape the back of my throat and spit a half-and-half mix of saliva & blood. Sometimes, this will occur when I involuntarily do a swift nose inhale (sniffle?). We all do this. We get a bit of something, mucus, debris, boogs, and we either swallow or spit. Yes you do. Sometimes, we get more then we expect, or more then we wish to swallow. So, in our own way, we make haste for a trash or toilet or sidewalk and spit. Only now, mine have been somewhat volumous, and dark crimson. This must be more of the same or at least a lingering effect of the tampon removal yesterday. Like bloody stalactites in my sinuses breaking free.

And on that topic, perhaps the most anticipated milestone in this recovery will be the nasal rinse. Dr Rust says starting Saturday (tomorrow), I can resume a twice daily rinse. I have for years been using the NeilMed mixture packets and the squirt bottle. Even if you’ve got brilliant sinuses, I would recommend this product. Basically, you mix a pH balanced isotonic solution (saltwater, really) with a pint of warm water, then squirt it up one nostril. Well, you best lean clear over a sink, and tilt your head. Because the only place for the salt water solution to go is out the other nostril. Again, strange at first, to voluntarily be exercising that human pass-thru. But what comes out the other side is the crap and debris and hangers-on that typically generate or are byproducts of sinus maladies. I cannot wait for the sinus rinse. I can feel a lot of foreign matter up there, clinging on for dear life.

Overall feeling just about mid-range today. Not too weak, not to ancy. I watched Gonzo: The Life & Work of Dr Hunter S Thompson this morning with my mom. Then, felt well enough to drive her to the Marin Airporter. Some left-over pasta and a 3 hour nap.

D-DAY +1

For what my body has been thru in the past 24 hours, I’m most surprised at how bounce-back I have been. I have these dueling urges. On one hand: to carry on, walk around, be vertical. Which begets the opposing urge to give into the physical chimes to lie the fuck down and just repair. To that end, I’ve got a mother and wife making sure I’m not up for more then a few minutes. And a stack of Netflix.

My pain level, to use the standard hospital rating, is an unbelievable 2 or 3. No need to take any more of that crooked fucking Vicodin; just Tylenol. I had prepared for pain levels double this. So to only be grappling with a sinus pressure, a familiar discomfort, is a pleasant surprise.

Today is also the day I get the tampons taken out. The packings, which undoubtedly are a significant factor in the pressure I’m feeling up there, were placed an unknown distance up my sinuses, leaving these heavy black strings trailing out my nose and taped to my cheeks. I look like some feral cat whose picked & lost a fight. It will be good to get back into Dr Rust. Just to check-in, ask some questions, get some oral history of how the surgery went. Unfortunately, save for those few groggy moments when I woke from anesthesia, I haven’t seen Dr Rust since.

Sitting in the same brightly lit examination room I was in when Dr Rust first explained the myriad of best & worst case scenarios, I’m aware for the first time since that the deed is done. I’m on the other side. Sitting there alive. Post-op & pain free. Surreal. In the room with my mom, and she & Dr Rust are chatting about HER deviated septum, when he pulls out his spreader forceps and offers to take a gander up my moms nose. More surreal. And kinda funny, cause my mom obliges. So there we both were, Dr Rust and I, peering up my moms nose.

Dr Rust explains that he’s going to pull out the packings, and that I am going to bleed. A lot. For me not to worry. That he’s done “oh… only a few hundred of these.” When I ask where the tampons are up there, he informs me that they’re packed into the ethmoid sinuses, the honeycombed shaped cavities between the eyes. Hoe. Lee. Shit. We’re talking a lot further up there then I thought.

But first, he soaks some cotton balls in a solution not unlike the Vicks nasal mist: where it contracts the mucus membranes and opens everything up. Stuffing a soaking-wet full-sized cotton ball up each nostril is again, not too painful: just terribly uncomfortable. That weird line between sinus-tickle and sinus-pressure, each producing a physical reaction resembling pain. Whether it’s the residual anesthesia, or a general numbness of the whole area, I’m just relieved that I can’t feel pain up there. Like so many things in Life, this has been NOTHING like the warnings people gave me prior.

About 5-7 minutes later, Dr Rust comes back in, and places one of those pink kidney-shaped plastic dishes in my hand and positions it under my chin. Here we go.

The next few minutes of my life will be ones that I will neither forget nor ever be able to accurately recount. If my mom wasn’t there to witness it, I don’t think I would have ever believed it possible. And she only SAW it. She couldn’t HEAR what I heard.

First, he tilts my head back, spreads my nostrils with the forceps, and needle-noses the cotton-balls out. One. Two. Each a mix of red & black, slapping into the dish followed an involuntary drip of tears from my eyes.

Next, he precedes to finger-nail the surgical tape from my cheeks, to free the cat whiskers attached to the tampons. No fear. No apprehension. No worries. In hindsight, I suppose I should have been concerned. I mean, if you know a dentist is about to do something such as this, your body goes into reaction mode, to prepare for an onslaught of negative feelings. But with this, none. Perhaps because we all kept talking, a bit about the colour of the cotton balls, a bit about just general stuff. I can’t remember.

But I knew I was in for a ride when with one hand he twisted-up & knuckled the strings, and with the other, he squarely palmed my forehead. As if for leverage. Inside of 2 or 3 short seconds, the tampons, which looked like halves of french toast sticks, were out.

There was no one-two-three. There was no advance direction. There was only the pull. And that fucking sound. Like eggshells cracking. A lot of eggshells. My head pivots at the neck in response to the resistance. My vision goes all funny in that moment. With one action later, my head is downward, over the kidney-shaped tray that I am still holding. Thank god I didn’t close my eyes for any of this. For close on the heels of the tampons, out both nostrils and my mouth, comes an unholy stream of blood. Mostly bright red (fresh) blood. But also some bits the same consistency & colour as charred steak.

The tears are pouring out of both eyes, so I hand my glasses over to my mom without looking. I don’t want them to fall into the tray, the bottom of which is now completely filled. For a long & solid 15 seconds, both nostrils flow uninterrupted. Then for another 20, they drip with the cadence of a drum roll. Then for the next 5 minutes at least, they drip with a slow taper. Eventually, the right nostril stopped altogether. But left nostril never stopped dripping, even well into the night.

I have never seen so much blood come out of my body at one time. My mom remembers that it was all she could do to fight back the urge to react as if I was hemorrhaging; that this routine post-op procedure had gone terribly sideways for her son. But we were BOTH re-assured by Dr Rust’s warnings of blood, as well as his relaxed reaction to the blood. The force with which he had to pull, the crunching sound, and all this blood: As hard as this all was to reconcile, it was normal.

I have ALWAYS had a penchant for gore. I was that kid in 8th/9th grade who had Freddie Kruger and pages from Fangoria up on my walls. I was one of those early adopters who frequented Rotten.com long before they went paid-only. Same with Ogrish. I was fascinated with how the human body reacted to trauma. What we looked like. How our limbs & internal organs looked rendered free from our bodies. I know it sounds macabre, but I didn’t so much enjoy these images & videos as I gained strength from them. Almost as if I was able to feel alive by these graphic reminders of how close accidental death is at all times.

So to be staring down into this dish filled with a half-inch of blood spanning no less then 4 shades of red, and the black & white mottled tampons coagulating within, I was fascinated. Only a small fraction of the people I know would share such sentiments. Even regarding their own discharges. You know who you are.

Following the tapering of the dripping, Dr Rust went back up there with a dentist-like vacuum to clear away some of the debris that had either coagulated or otherwise failed to drip. Again, tickle. No pain. Another moustache dressing and a few handshakes later, and I was slowly shuffling with my mom back out to the car. Whether it was the loss of that half-pint of blood, the physical debt of the actual tampon removal, or just too long being vertical, I was spent. I nearly fell asleep in the car ride home. With messy dressings.

I can’t really remember much about the rest of the day. In retrospect, a lot of the post-op days have blended into each other. I know I took 3x Tylenol and had another bowl of soup. And sleeping. A lot of sleeping. With visions of french toast sticks on strings.

D-DAY

When I woke up from the anesthesia, I’m sure I was a groggy mess exhibiting little or no cohesion of thought or process. But I am also sure I executed a mental checklist which peppered my thoughts immediately prior to the warm serum.

Alive? Check.

Vision? Check.

Brain Damage? Ummm….

But there I was, staring into the eyes of the same doctor who’d been there prior to lights out. What felt like a 10 minute nap had afforded Dr Rust the time to do his thing. He says: “Complete success”, “No complications”, and “Nothing out of the ordinary”. In my dirty semi-consciousness, I hear myself let out a “wooooo….”

No pain. Strange, given the tools and augers that have been violating my cavities. But nothing. Perhaps it’s the residual anesthesia. But I’d take a little pain, if I can just have something to drink. Any fucking thing. Cause it feels like I’m about to swallow my tounge.

The next 2-3 hours were to see me steadily regain footing amongst the living. Slowly sitting up & sipping apple juice. Letting the nurse change the nose-sling (the moustache of gauze sponges taped to my face). Being walked to a chair where the pressure cuffs were removed and Anna (either willingly or begrudgingly) took photographs. The whole rest of my day, even on the drive back home, only 3 hours after the surgery, was pain FREE. Only discomfort.

But as the day progressed into night, I began to feel acutely aware of not only the sutures on the left wall of my septum (to repair the deviation to the right), but to the packings that were stuffed up there, trailing 2x strings each out each nostril & taped to my face. These dressings were an unknown distance up there; I couldn’t tell. The strings we’re becoming blood-cemented to the architexture of my sinuses, then stripped away when I had to change the moustache sling.

But it was the pressure that was becoming intense. More significant then even my most severe sinus infection. THIS is precisely where & why I was prescribed Vicodin, that evil fucking pill that does more harm then good, IMHO.

I was able to get a hearty bowl of soup up me, and watch Apocolypto, the first of about a dozen tactically chosen & queued Netflix’s. Despite having to sleep sitting up, and all the cascade effects that plus the Vicodin were having to my rear end, I did sleep very well.

All in all, a good day. I was finally on the other side.

T-MINUS 21 HOURS

At or around 7:30 tomorrow morning, a well-compensated anesthesiologist will jack into my IV and inject a solution that will inside of a few seconds put me to sleep.

When I wake, roughly 3 hours later, other well-compensated people will have violated my sinus cavities. Breaking cartilage (septoplasty), snipping tissue here, cauterizing tissue there.

Most specifically, they are going to remove the extensive and significant level of polyps I have growing in my nose. A full polypectomy. Literally caking the turbinates, these bulbous outgrowths have for years acted as a clogged drain, backing up the main sinus cavities with gunk. It’s these polyps and the gunk they begat that must go.

Most significantly , they’re going to create an opening between my two frontal sinuses: the ones above & behind the eyes, working millimeters from the brain. And once back there, the doctor will most likely be taking a look at the sphenoid sinuses, behind the ethmoids. Now we’re talking more or less about the geographic center of my head, where the optic nerves and some fairly important blood vessels meet the brain.

I’m sort of past the elements of concrete fear that clouded my days 2 weeks ago. I am now more on auto-pilot then anything else. Just getting things wrapped up at work for what will most likely be 2x weeks of sick leave recovery time.

Those fears included all the rare exception cases of brain infection, injuries to the eyes, and a total loss of my sense of smell as a direct result of the procedure.

For the past few days including today, I am focused on preparing myself for the recovery. I’ve had 5x root canals in the past 10 years. So I am preparing myself for at least that level of discomfort.

Strange, but what I am really most interested in is the peculiars of the procedure. I wish I could film it, or in some way view the video feed from the scopes that they will undoubtedly be capturing. Those little bastards up there have caused me all manners of hell. And knowing they’re gone is one thing, and I am happy with that. But seeing them snipped off, sucked out, and burned shut would be a very satisfying bon voyage for the little motherfuckers.

http://sinusinfocenter.com/sinus_treatment_endoscopic.html