Oh, hello there! Nice to see you all again. Nice to not be writhing with pain and nausea, too.
You may remember from my last post that I finally took the plunge and had the much needed sinus surgery I’ve been putting off for a decade. It went both better and worse than I expected. For those that like details, the surgeon widened all my sinuses (both those next to my nose and up in my forehead area), straightened my deviated septum and took out part of my nasal turbinates (bony things that stick out into your nose a bit. Mine were bigger than they should be and creating a blockage).
The actual surgery went so much better than I anticipated. As I believe I stated before, I had a lot of anxiety about going under general anesthesia. PTSD will do that, as will knowing that you get horrendously nauseous from pretty much any drug that isn’t ibuprofen. The first nice surprise was that a nurse I had gone to nursing school with was working there and took care of me in pre-op. It was so helpful to see a kind face! Just knowing I was being recognized as a person – not just a patient or a diagnosis – was hugely reassuring.
The anesthesiologist spoke to me before the surgery and was incredibly kind and respectful. I told illustrated for him (in vivid detail) how I would be puking up my toenails for twelve hours if they gave me anything other than the Propofol to put me to sleep and tiny bits of Fentanyl if needed for pain. He took me at my word and followed my requests. He also pre-medicated me for nausea with a scopalamine patch behind my ear. When I woke up after the surgery (it took me quite awhile to wake up, even with just those two medicines) the first lucid thought I had was, “I’m not nauseous!”
The post-op nurses gave me small doses of Fentanyl for my immediate post-op pain and that worked wonderfully. Still no nausea. I was still very sleepy, though, and having a very hard time staying awake. After an hour or two of that, the nurse gave me an oxycodone pill for pain, which I was not lucid enough yet to decline. That’s where things started to go downhill. It was a rapid-release pill and very quickly after taking it the world starting spinning and I became nauseous. They had to give me Zofran and Phenergan, and it still didn’t fully take away the feeling that I was going to puke at any moment. Any time I moved, the urge to hurl was very strong. So, of course, this was the time they wanted me to get up and walk to the bathroom, get dressed and then push me in a wheelchair to the car. All while I was also still quite sleepy. The good news is that I never did throw up, so I still count the surgery and post-op experience as a win.
I went home with a bunch of packing shoved up my nose into my sinuses, and a “mustache dressing” that had to be changed every few hours. The next morning I had a follow-up appointment to remove the packing. That was a horrendous experience! The surgeon pulled these huge five- or six-inch long “slugs” out of my nose. When she did the first one I had a vagal response and went clammy, pale (maybe green?) and felt like I was going to vomit. So. Much. Not. Fun. After that torture I went home with a bunch of instructions about taking only Tylenol or my prescribed oxycodone for pain (no ibuprofen because it can be a blood thinner) and about doing nasal irrigation to rinse out the blood clots. I was told to expect a lot of congestion to start now that the packing had been pulled out (basically, expect all the places inside that just had surgery to swell up and close off a bit. Or a lot.).
That afternoon was when things started to get ugly. There indeed was a lot of immediate congestion. And then the ear pain started. That’s right, my ears. A part that had NOT had surgery. My whole life I have been plagued by ear infections and painful fluid build-up behind my ear drums with virtually every cold and sinus infection (a key motivating factor to have this surgery done). I have narrow eustachian tubes and probably should have had tubes put in as a kid, but it was out of fashion to do so at the time. Twice my eardrums have actually ruptured due to the pressure build up behind them. This pain was very similar to the pain of my ear drums about to rupture. Only it was worse because it wouldn’t stop and was increasing. I took Tylenol around the clock, in the highest doses my liver could handle. It did virtually nothing. After a day or two of this I began to notice a pattern. The pain was constant, but would generally sit at a just-tolerable level of 5 out of 10 on a pain scale if I didn’t move. If I tried to swallow a bite of food or changed position at all (rolled over, sat up, laid down) the pain would immediately shoot up to at least an 8 out of 10. We’re talking close to childbirth levels of pain here. It was like a nail being driven into my ear (at times, both ears).
It hurt so much to eat anything that I pretty much stopped eating. You guys, I lost 15 pounds within a week. While doing nothing more than lying in bed. I was so weak from lack of nutrition and dehydrated that I felt like I was going to faint every time I got up. My hands and legs shook. I felt dizzy (which also could be due to all the congestion). I got desperate enough to try some of the oxycodone. It slightly dulled the constant pain, but did nothing against the sudden pain with swallowing or position changes. And it made me horribly nauseous again. I took half of one pill (for comparison, we frequently give patients in the hospital two to four whole pills at a time, a dose of 10 to 20 milligrams. I was taking 2.5 milligrams). That half of a pill again made the world spin and my body want to hurl. I took two zofran and still was nauseous and dizzy for the next three hours. I gave up on the idea of taking any more oxycodone.
I finally went back in to see the surgeon because I just couldn’t take it anymore. She said that in all the years she had been doing these surgeries, she had never had a patient with ear pain afterward. That only came after tonsillectomies, which she hadn’t done for me. She assumed it was some kind of referred pain from my throat (which felt mildly irritated, but not horrible) and that my “wires were crossed” in my brain about whether the pain was coming from my throat or ear. I see why she thought that, given that it hurt every time I swallowed, but it didn’t explain the pain with position changes. After I told her the oxycodone wasn’t working for me, she prescribed me Celebrex. It’s basically amped up ibuprofen, without the blood thinning properties. Here’s the key: it’s also an anti-inflammatory drug, like ibuprofen. Within two days of taking the Celebrex I was noticing improvement and starting to be able to eat again.
Once I got enough nutrition in me to be able to think clearly again, I put the pieces together and figured out what was causing the pain. (Warning: this part is a bit gross). My already-narrow eustachian tubes had likely swelled up a bit along with everything else in the vicinity after the packing was taken out. Then came all the congestion: the snot that filled all available space and dripped down the back of my throat in long strands, along with blood clots from the surgery. I could actually see it all going down my throat if I opened my mouth and looked in the mirror with a flashlight. All that snot and blood was also filling up my eustachian tubes. Since it was all connected to what was going down my throat via the long strands, every time I swallowed it would tug on the strands and create negative pressure on my ear drum. Basically, my ear drums were on the brink of rupturing backwards every time I swallowed a bite of food. Similarly, every time I changed position all that fluid would shift as well, again creating negative pressure on the ear drum. Once I started the Celebrex it not only treated the pain, it lessened the swelling. That caused the eustachian tubes to open up a bit and break the seal of snot. Allowing some air flow meant no negative pressure and thus no pain.
I was completely prepared to feel stinging, burning pain in my sinuses and nose. To feel bruised. To have a terrible sore throat. I was not prepared for 8 out of 10 pain in my ears. It was supposed to be a 7-10 day stint until full recovery and able to resume normal life. Instead, it was at ten days of absolute hell and misery before finally finding some relief. Then it was another full week of trying to rebuild my stamina and energy. As it turns out, starving yourself to the point of losing fifteen pounds in a week really takes a lot out of you.
I am now four weeks out and doing much better. My nose still feels a bit bruised (probably because Alden keeps hitting it. Thanks kid.) and there are sutures in my nose still that are driving me nuts (they should dissolve within another month). It will be two more months before all the congestion goes away and my sinuses become as big as they are going to get. So in June I’ll start to have an idea of whether this was all worth it. I really, really hope it was.