Diagnosing

Getting diagnosed with a Deviated septum and enlarged turbinates:

I decided to start a blog to maybe help clarify any questions or concerns someone might have for getting Septoplasty and Turbinate Reduction surgery. Keep in mind, I can only relate and answer questions based on my experience and the information shared to me by my ENT (Ears, Nose and Throat) Dr.

Right now I'm on day 4 of post-op recovery but I'll get to each of the recovery day experiences in a bit.

Let me start with what lead up to me getting diagnosed because it is quite a process.

I was about 14 when I noticed I was having pretty bad sleep issues. I wasn't snoring mind you, but I was waking up choking a couple times a month. I felt tired all the time and constantly had headaches that sometimes turned to migraines. I often slept in class, on the bus, where ever. It took several months but I finally convinced my parents to take me to the children's Dr.

At first, the Dr had no reason to suspect sleep apnea because I was under weight and had decent blood pressure so he had a brain pet scan ordered. They found nothing abnormal and then another few months went by with no follow up until he decided to run a sleep test. Maybe I had restless leg syndrome.
The sleep study returned with possible sleep apnea but they wanted to run another test for comparison. My parents didn't see the need. I never went back in until this year (2016) in May.
My PCP referred me to a pulmonary specialist who then ordered a sleep study. Ya see, advances have been made over the last 14 years. They've discovered that even people who aren't over weight and don't have high blood pressure can have sleep apnea. They've discovered so many possible causes as well. I am no longer under weight mind you (after getting away from the abuse I was able to work on getting myself healthy). It's rare that people who aren't overweight have sleep apnea, but it happens. The specialist said it's normally from jaw development or a neural source.

Another sleep study was ordered. I was diagnosed with mild obstructive sleep apnea where I stopped breathing on average of about 8x per night. Keep in mind, most people don't sleep well during these studies, what with being in a different room and bed, hooked up to wires and patches that tangle around you while you toss and turn (I'm a toss and turner haha). So they were going off of maybe 3 hours of my sleep.

I want to say this now. If you suspect you have sleep apnea, tell your Dr. The effects of this can be pretty bad. It can cause depression or make it worse if you have it already and so many other dangerous things like nightmares/night terrors, sleep deprivation causing you to fall asleep at the most inopportune times like driving. It can cause severe fatigue, muscle weakness, memory loss, mood swings, irritability, and tons more. Not to mention, you stop breathing. I even saw a documentary on murders or attacks by people suffering from sleep apnea who had no idea what they were doing but the sleep deprivation lead to it.

Anyway, back on topic. After getting diagnosed I was told to talk to an ENT so that they could look in to the underlying cause while I waited for my next appointment which would fit me with a CPAP device a month from then. This was great because I was thinking about seeing one in regards to my constant bloody nose. Ever since moving from NC to UT, the bloody nose issue has only gotten worse. I was blowing out blood clots and gross goopy string of blood with mucus, the inside of my nostrils were almost always raw and sore like they were cut inside and ever since I remember I have never been able to breathe well through my nose. The Sleep apnea test, they told me, also revealed that I'm a very shallow breather. I laughed because how are you supposed to work on that in your sleep?

So I set up the appointment. I was then diagnosed with a deviated septum and enlarged turbinates as well as a grade 2 overbite which was most likely the main contributor to my apnea concern. We talked about options on what to do about my nose but with the sleep apnea determined it best to get a surgery called Septoplasty and turbinate reduction. I would have to see an orthodontist about the overbite which most likely meant surgery to bring my jaw forward and open up my airway. Until then, I'm focusing on my nose. See the septoplasty would work on straightening my deviated septum and the turbinate reduction would reduce the size of my turbinates, allowing more air to flow in and out of my nostrils as well as reduce sinus headaches. I was guaranteed this would not alter the outward appearance of my nose which was a relief. I'm fine with my nose.

The surgery was scheduled for 2 weeks after that initial appointment. I will tell you now, don't be afraid to call your Dr's office during that time to ask any questions or express any concerns you might have. It's surgery afterall, you're allowed to be anxious and they're there to help you and out you at ease. If they get at all irritated with your (unless you call like 10x a day of course) questions or your worry, find another office or express your concern to your Dr about their behavior.

My pre-op instructions included:

• No unprescribed blood thinning medications which are things like aspirin, ibuprofen (advil, motrin, aleve) at least 5 days prior to the surgery date.
• Stop smoking and drinking at least 3 weeks before your surgery (I advise as soon as you find out you're getting surgery but then again I'm not a smoker anyway and I can't comment on the difficulty of quitting).
• Immediately tell and list all medications and supplements you're taking to your Dr. This includes informing them of the dosage, how often and when (ie, morning, noon, bedtime) and what they're for.
• DO NOT eat or drink ANYTHING after midnight the day before surgery. This includes water, gum, hard candies, mints. Your Dr may tell you that you can have a sip of water to take any prescription meds though.
• Ask someone to take you home after the surgery and for someone to help nurse you for the first few days. The sooner you set this up the less inconvenient it will be for your friends and family so that they can work their own schedule around for you and less stress on you to scramble last minute.
• Invest in a Sinus Nasal Rinse. Probably not a Nedi Pot but I would recommend the NeilMed Nasal Rinse bottle. You can get it from a local pharmacy like CVS, Walmart, etc. Like this:

How to video 1: 

How to video 2 This one is really cute and gives a more realistic idea of how it works.

So this is an out-patient surgery, unless you have some concerns that the Dr may want to admit you for a day just to keep an eye on you. Mine was a simple out patient where they used general anesthesia.

I came in in the morning and provided a urine sample then went to a curtained room that would be my pre-op and post-op area. They set me up with an IV in the hand to give me fluids which they described as clear Gatorade. I was wearing a decent hospital gown, with hospital socks and a surgery hair cap. I confirmed and filled out more paperwork. They had the Dr come in and confirm the surgery and answer any questions I may have had then the anesthesiologist came in to let me know how general anesthesia works and what to expect when I come out of surgery.

They injected a sedative before wheeling me on my bed from the pre-op room towards the operating room. I remember going through a couple hallways, passing a Dr who greeted the nurses at my side, going through a few doors and that's when the sedative kicked in. I was in a hall then suddenly my bed was next to an operating bed and they were moving me to it then I was out.

After I woke from surgery they put me in one of those brief recovery rooms until taking me back to the pre-op room they gave me and brought in my spouse. She had a great time recording my post-op haze as I fell asleep in the middle of eating half a cracker and talking about how the roof of my mouth felt like I ate a hot pizza too eagerly and burned it.

I had no black eyes, only thick gauze folded under my nose held there by medical tape to my face and it was getting soaked with blood which is completely normal. The nurses were there to keep changing it out and checking on me. 

The surgery lasted about 1 hour and the post-op to let the anesthesia wear off some is about 2 hours. It depends on what you're having done and the amount of surgery required that will determine how long your surgery lasts. I was still pretty out of it when I was getting released, I barely remember the rest of the day except for bits and pieces. I remember the Dr telling my spouse that I had tube stents in my nose and would need to schedule an appointment to get them removed in about a week. That I would crave more cold things than warm because of my throat and that I should get a nasal rinse. He recommended a brand called NeilMed Nasal Rinse about 3-4x a day a few days after surgery to help clear out the blood, mucus and clotting.

After Operation Instructions:

• Don't use blood thinning medication after surgery, your Dr will tell you for how long.
• You should be prescribed an antibiotic. I was given amoxicillin 2x a day. Because I've been on antibiotics most of my life, within the last 5 years I noticed that I tend to develop yeast infections after. If you are worried about this or you know it happens to you, don't feel ashamed to let your Dr know. I was given Diflucan for this.
• Take all medications as prescribed.
• Follow all Dr's instructions.
• Expect some swelling and pain in your mouth and nose.

I spent the next couple days in a painkiller haze, I was given Norco and I tried not using it but ended up being in pain with my nose. I noticed that at some point, probably right after waking up, that I must of scratched my cornea while rubbing my eyes. Anesthesia always makes my face feel like the skin on it is crawling and my eyes dry yet watery. So I spent the first couple days with a wet eye gauze patch on to let it heal. My face was covered in gauze which was pretty funny.

The wet gauze helps keep the eye moisturized and speed up the healing.