Sunday, November 21, 2004


On Friday, November 12, 2004, at approximately 8:30 in the morning I underwent a septoplasty and submucous resectioning operation, as well as removing over a half-dozen nasal polyps, some as large as a quarter. This was not my idea of a good time.

This is a side view that shows the
general position of the septum in relation
to the facial structure. The septoplasty
only dealt with the septal cartilage
and did not affect the bones in my nose.

My septum had become deviated.
That is to say it bowed out to one side
in its growth. This had the effect of
almost entirely blocking the airflow
into that side of my nose. This is not a good thing.

This blockage was leaving my sinuses on that side without enough airflow for them to ever dry properly. As a result, the nasal fluid which was being produced kept them too wet and also flowed down into my throat. This had several effects.

First off, it had left me more susceptible to colds. Over the past few years I would usually come down with four or five colds a year. All too frequently, this would also lead to a sinus infection and sometimes to bronchitis as well.

Also, whenever the seasons changed and/or the humidity varied greatly, my sinuses would react. Without any room on the right side to expand, this meant enormous pressure in that area and that meant for some whopping headaches on my part.

Finally, the near constant flow of excess nasal fluid down my throat kept me with a almost constant mild cough. That left me more susceptible to the bronchitis.

To make matters worse, my left side nasal passage was also becoming blocked. Not from the septum growing into it but because the septum was growing away from it. Along the fleshy portion of the insides of your nostrils are glands called the turbanates. These are there to warm and moisten the air passing through your nose before it reaches your sinuses. Because my septum had bowed over to the right, that left more space on the left. Space with the turbanate on that side began growing into. Once the septum was straightened this excess turbanate growth on the left side would serve to block my nasal passage on that side. So, I was being short changed on both ends! I also had several polyps, some of which had grown to the size of a quarter that were blocking 85-90% of the air flow through the left side of my nose. The solution was to cut loose the turbanate on that side, shave it down so that it was much thinner, and then reattach it. This meant that both sides of my nose would be a mess for the time it took them to heal. I also had to have the polyps removed, which would leave any untouched areas of my sinuses well-aggravated.

However, the surgery on both my septum and turbanate will hopefully correct my breathing difficulties, my constant drainage difficulties, and my over-susceptibility to colds, sinus infections and bronchitis. That is the game plan at least. I will have to wait for it all to heal up before anyone can tell.

The surgery itself went fine, near as I can tell. The recovery was pretty standard with no complications. That, however, doesn't mean it was fun or easy. In fact, it was one of the more miserable times of my life.

The first day I was very doped up from the surgery. The anesthesia left me very out of it and then the Vicodin that I took afterwards left me feeling very wired. I was exhausted from the surgery and in need of sleep yet the Vicodin was keeping me awake. That was my particular reaction to that drug. After the second night I stopped taking it because of that.

My surgeon told me that I should sleep in an upright position so that my sinuses would drain properly and also so as to reduce the circulatory pressure on the surgical incisions. For the first couple of days I was wearing a "mustache" gauze pad dressing over the end of my nose. This was to catch the near constant flow of nasal fluid and blood as my nasal passages recovered from the operation. After a couple of days I was able to dispense with wearing this during they day, I just had to keep blotting the end of my nose constantly. I would only put on the dressing at night so I didn't make a mess of things on my pillows.

Sleeping was extremely difficult for me in those first few days. I had propped up some pillows so that I was pretty well supported in an almost seated position. I was able to catch some sleep in that position but only some sleep. I would usually be able to doze off for about two hours or so at a stretch. Then I would wake up. I would wake up with just enough energy to not be able to sleep again for a while and then doze off again. For about two or three days I was unable to get any good, solid sleep. Certainly not any REM sleep and I was really feeling its lack. In short, I was exhausted. My body ached I was so tired.

Yet for the first two nights I was also very wired from the Vicodin pain killers I had been prescribed. I tried switching to Darvocet but got much the same reaction. It was a jittery sort of feeling for me. Much like you'd get from having one too many pots of coffee. This isn't good if it is sleep that you need the most.
Finally on Wednesday night/Thursday morning at about 3:30 I had had enough. I couldn't take trying to sleep in that position any more. I had to lay down. So, I did. I first laid flat out on my back. I did feel some increase in pressure in my nose but not much. Then I went for the gusto and tried rolling over on my side. That is my preferred sleeping position. I did it! I was able to lay on my side - and do so without my nose exploding all over my face! I was elated! This was the first time I was able to be in this position since the surgery. At last, I could now get a real night's sleep. And that I did. I slept for about four hours that night, the longest straight through time since the surgery. Things got better after that.

Thursday night/Friday morning I awoke in the middle of the night to find myself shivering. I was deeply chilled - and this while I was under sheet, blanket and comforter! I was shivering so badly my whole body was physically shaking. This was very strange. I got up and moved around my house hoping that this would warm me up. It didn't. I was shaking worse now. So I tried a trick I learned from watching a science program on TV. No, I'm not kidding. It was a cable show that had been on a few years back and it was called "Beyond 2000."

In this one episode they were demonstrating some of the new equipment for dealing with cold weather accidents. One of these was a device to more effectively treat hypothermia. Whereas most previous methods only warmed the body from the outside in, this one warmed it from the inside out. A much more effective and faster means of doing the job. To get about this they used steam. They had a small burner and water container. The idea was to get the water heated quickly and then have the victim inhale the steam vapor. This would get the hot vapor into their lungs. That would both warm the chest cavity with the vapor's heat and it would warm the blood in the lungs which would then course through the rest of the body warming it as well. All in all this is a very neat idea. So, I tried to emulate it.

I put some water in a saucepan and turned up the heat beneath it. In a short while it was steaming and I was breathing in directly over the pan. I quickly realized that I was probably inhaling gas vapors as well so once the water was well steaming, I turned off the burner. The water continued to steam off and my inhaling that really did the trick. In short order my shaking had stopped and I felt much warmer. I was able to go back to sleep soon thereafter. The next night I also experienced a chill while in bed but it was nowhere near as severe. Strange indeed.

Friday, November 19, was a big day and one that I was much looking forward to. That was the day I would go back to my surgeon's office and he would then remove the splints he had placed in my nose. They were there to keep the septum together and straight as it healed. I wanted that to happen as I didn't want to have to undergo this procedure again. I also wanted those damned things out of my nose as well. Mostly because I knew that it would be a major milestone in my being fully healed. Those things had been up my nose for a week and it was high time to be done with them!

Hard to believe this is what was up my nose for a week. Gross huh? Yes, I did clean these off before I scanned their image in - you don't think I'd want to mess up my scanner do you?

Even more amazing are some of the details. These splints are actually pieces of a whitish translucent flexible plastic sheet. Cut to shape to fit the inner contours of my nasal passages. Each splint is about a sixteenth of an inch thick, and inch wide and about two and a half inches long!

The numbers in the photo above show where the suture went through the splints to hold them in place. To do that they also ran through my septum. There were six such punctures. That meant they had to run through my septum cartilage six times. Through one side and out the other. Six times. Ouch! This also means that I now can say that I have had my nose pierced! And not just one little old piercing but six! I'd like to see anyone with some piddling little 10 gauge nose ring try topping that! Hah!

You'll notice I also pointed out some "grip marks." Those were the down side of these splints. I have been told in no uncertain terms that having splints up my nose for a week was a helluva lot better than having a surgical packing up my nose for a week. Packing my nose would have meant stuffing gauze dressing up my nose. Lots of gauze dressing. Yards of it in fact. No, that is not an exaggeration. Gauze is thin enough and there is enough space in the nasal cavities that most packing does involve yards of the stuff. Not a pretty thought and even less pretty when it comes out after a week!

Luckily I didn't have to go through that. So the week I spent with these splints up my nose was not made more uncomfortable by their being there. It was the removal of them that was problematic.

You'll notice there are six holes in each splint where the single long suture strand was placed to hold the splints in place. The suture was very effective at doing that. Perhaps the job could have been done with just two or three "anchoring" cross through punctures. Perhaps. Six though, served to anchor those puppies in there but good.

On Friday morning, my surgeon looked up my nose, sprayed some Neosenephrine up there to dilate things and then sprayed some Novocaine up there to numb things. Then he set to work removing the suture. That was not a particularly painful thing. The Novocaine was helpful in this and the suture itself was pretty easy to remove. When you got to it. Satisfied that he had gotten to them, my surgeon then picked up his forceps, locked them in place on one of the splints, and pulled it out. Or at least he tried. And he tried pretty hard. Several times. On both sides. He failed. Badly.

They wouldn't budge. They didn't move. They were still anchored in place. I was in pain. REAL pain. A deep, grinding, howling pain - and howl I did! I think everyone in the Conway Regional medical office building heard me yelling in pain. My doctor heard me too. Good thing, that. I was covered in a cold sweat and I was panting for breath it hurt so bad.

"Sorry about that. They usually come right out. I think I need a longer pair of scissors" he said and then left the room. A few minutes later he was back with that longer pair of scissors. Some more Neosenephrine, some more Novocaine a little bit more work with those longer scissors, and then it was back to the forceps. I braced myself for more pain and was relieved that it didn't happen. Instead, the splints came out. Not quite "right out" but close enough considering what had happened just before. I was relieved that this was over and amazed to see what they looked like.

I also realized that the good doctor had screwed up. He had missed cutting loose one or more lengths of the suture thread he had placed in my nose to hold those splints in place. That is why they wouldn't budge when he yanked on them. He gripped them hard enough to leave those "grip marks" in the plastic. And he pulled really hard. Those lengths of missed suture anchored those splints in place like they were welded there. Lucky me. Is this what medical malpractice suits are made of?

In his defense though, it was rather easy to miss one or more of those things. There isn't a lot of space (width wise) in your nasal passages. With the nasal fluid and swollen glands obscuring things it is hard to see what you are doing up there. Also, the ends from one length of suture threaded through my septum could have easily blended with the ends of another length and the suture thread itself was of a color that didn't stand out where it was placed. Still though, this was not a fun thing to have to go through. Although it does at least it make for a good story.


Anonymous said...

This was extremely helpful as I'm having my splints removed today. I've been searching all over the internet to find out what is involved when they remove the splints and your comments were the best description. I guess the medical community wants to keep us in the dark so we won't go in there screaming and kicking. Thank you so much for writing about your experiences!!

Anonymous said...

Your experience mirrors mine pretty closely, the only differences were:

1) The vicodin didn't wire me so much as zone me out. I was in a perpetual haze for days. Even still, I also didn't sleep well, and had trouble regulating my temperature, which sounds like the waking up with the chills experience you described. Much like yourself, once I got the bandage off my face at night and could sleep on my side I slept pretty great.

2) My splints were even longer than yours... maybe close to 4" and 1" tall, but they came right out and were surprisingly not painful even though the doc didn't use any anesthetic.

All in all it was worth doing. Hawking up bloody loogies and wearing a bandage mustache for a few days was a small price to pay for the ability to sleep at night without snoring :)

You're supposed to be able to breathe through your nose? Who knew?! :)

Anonymous said...

I'm also getting my splints taken out in a couple days. Thanks for the information. I was also looking around on the web to find out how they do it. I'm glad to hear it's not that painful. Taking out the packing was such a strange feeling and in my opinion, painful.

Anonymous said...


People should remember that we are all human, we all make mistakes and DR's are not gods. Damn law suit culture should be banned... and no I don't work in the Health profession.

Unknown said...

Do any of you know what could happen if you pull on the long end of the suture holding the silastic splints in place? I did that once.