Preparing for septoplasty - my pleasant story!
Posted Monday, May 28, 2007 at 11:18 PM

In the days leading up to my surgery, I was wrought with fear and anxiety. I made the huge mistake of googling septoplasty and rhinoplasty, and unearthed every horror story from New York to Los Angeles. I called my doctor in a panic, and luckily for me, he was incredibly supportive and kind. He said that when people have bad experiences, they usually tell everyone they know, and will often post their stories online. When people have a pleasant experience, he added, they are usually out enjoying their new noses, and not sitting in front of their computers! So, now that I am a few days post op, I wanted to share a positive experience for anyone out there like me who is grappling with pre-op fear and anxiety. Also, I thought I would share a few tips and shopping items that helped me through the past few weeks.

If you are preparing for this surgery, and afraid of what awaits you, the best advice I can give you is to go talk to your ENT. And if your doctor wont take the time to come up with a plan for managing your pain and anxiety, then find another doctor. Seriously, find another doctor. There are good doctors out there, who pride themselves on having pain-free, happy patients. If you dont have one of them, then keep looking till you find one. Youll be glad you did. My ENT told me that over the thirteen years he has performed this surgery, he has always kept notes on patients who experienced discomfort, vs those who did not, and analyzed what he had done differently during each surgical procedure. He finally chalked it up to how tightly he sutured and packed each patient. He told me that he had refined his technique for both, to ensure minimal discomfort for the patient. He was not wrong.

Preparing for surgery: For me, the best way to lessen my anxiety, was to be as prepared as humanly possible. For weeks, I wrote down any question that popped into my head, until I had a good list compiled for my pre-op appointment. Also, most surgery centers will allow you to choose a specific anesthesiologist, so ask EVERYONE you know for their recommendations. Ask your ENT, your GP, your friends, your Ob/Gyn or anyone you know who works in healthcare. People will usually want to share their experiences, good or bad. If you know you have a good anesthesiologist, it will help lessen your fear of being put to sleep. Also, see if you can pick up your pain prescription and antibiotic ahead of time, so you can just go straight home after surgery.

Physically, I did everything possible to ensure that I was in the best health possible, so that I could have a quick recovery. I didnt have any alcohol for several weeks, and ate super healthylots of protein, fruits and vegetables. Also, I made sure I was getting a lot of good sleep at night during the week before my procedure. Since I was told not to take any aspirin/ibuprofen for 7-10 days prior to surgery, I stopped at my local health food store for alternatives. I picked up MSM powder, which I drank with water daily. It is an anti-inflammatory (that does not thin your blood), and works well to promote healing. I also purchased topical arnica, and arnica tablets which dissolve under your tongue (for swelling & bruising). I used these for a week prior to surgery, and am still using them post operatively with no adverse side effects. My plan was (and still is) to be back at work after five days, and I think I will hit that target without complications.

Heres a quick shopping list of things you may want to pick up ahead of time: Two freezer gel packs (buy two, so you can keep rotating them), a good herbal tea for healing (I like the Yogi green rejuvenation tea), throat drops for dryness, drinking straws (so the glass doesnt bonk your nose), Q tips, chapstick, antibacterial hand soap (so your hands are clean when you clean your incisions), nasal saline, antibacterial ointment, a good soft box of Kleenex (go for the lotiony stuff!), a dark pillow case, a few dark colored button or zip up shirts (I went to my local thrift store for these), a large bottle of Tylenol, and some soft, easy to prepare food. You wont be able to open your mouth well for a few days, so I would suggest some soup.

Since your pain medication will probably cause constipation, perhaps pick up some corn chowder, split pea soup, bran muffins, or something that will help in that area! You may also be on some medication (such as a prophylactic antibiotic) which causes nausea, so something easily snackable is recommended so you can take your medication with food.

The day of surgery: I checked into my doctors office, and was escorted to the pre-op room. They asked the usual questions, and since I am a female of child bearing age, they did a quick pregnancy test on me for safety. I put on a hospital gown, booties and surgical cap, but was allowed to leave my under garments on. My personal belongings were placed in a container and labeled for safe keeping. The anesthesiologist came in to talk to me, and I told him that I was very prone to nausea. I made it clear that I was not interested in vomiting with nasal packs in, and that I wanted something added to my IV during surgery to prevent this. This is an important thing to discuss with your anesthesiologist! He told me that he would give me a cocktail of four different anti nausea drugs, each of which would target a different area of the brain. Throughout my recovery, I did not experience one single second of nausea of vomiting, and I have a great anesthesiologist to thank for that. (He was highly recommended to me by several doctors and nurses).

Finally I was escorted to the operating room, and asked to lie down on the table. The anesthesiologist gave me a quick numbing injection, which I barely felt at all. Then, he inserted the IV, which I did not feel whatsoever. He gave me something to relax me, and then a few seconds later I was out. It was all very quick, and the staff was talking to me, smiling, and putting me at ease the whole time.

The worst part of my whole experience was waking up after my surgery. I awoke and was a little disoriented at first, and was coughing and having a terrible asthma attack. My ENT used a ton of novacain on my face, and so my nose, upper lip and upper teeth were completely numb. This was a very odd sensation, but was probably a blessing because I had no facial pain whatsoever. Ask your ENT if this is part of his or her regime, and you will be glad you did. So& the numbing is very weird, and when they offer you ice chips, a popsicle, (or asthma medication in my case), it will be a challenge to get anything to stay in your mouth! Also, you will have a piece of gauze taped under your nose, which hangs over your mouth to catch dripping blood. Fun! Your mouth is going to be miserably dry, and the ice chips will feel great when you can keep them in. When I got home, the first thing I did was have a cup of hot tea, which really helped my mouth/throat feel better. (But, a word of cautionyou will be numb, so dont drink anything too hot or you will burn yourself!) Throat lozenges will help with the mouth/throat discomfort as well.

Because I was experiencing a severe asthma attack and having major trouble breathing, my ENT removed my packs the same day as my surgery. I remember wondering how on earth I was going to survive 24 hours with them in, because I felt really panicky with them in there. If you are a non mouth-breather like me, then you should talk to your ENT about this. My packs were in for a few hours until I stopped bleeding, and then he removed them. I have had no adverse side effects from their removal (yet).

The pack removal was a very weird sensation, and somewhat of a comedy too. I was handed a bottle of Afrin nose spray and told to give myself a large squirt as soon as the pack was removed. Unfortunately, due to the numbing and lack of mirror, I literally could not find my nostril! The doctor laughed and said oh, I guess I should have thought of that, and then did the squirting for me. That first big puff of air through my cleared nostril was the best breath of air Ive felt in years! The pack removal felt bizarre, but by the time my brain even registered the sensation, it was already out. It took a fraction of a second, and just slid right out. (Note that mine were nasal only, and not sinus). And that was that.

Pain Management: As soon as I got home, I took a pain pill, and programmed the alarm clock on my cell phone to remind me every four hours to take a pill, night and day for the first two days. I strongly recommend you do this. The key to successful pain management is to be PROACTIVE. Dont wait until you have pain, because by then it will be too late. Take the pills before you have pain. After the second or third day, you should be able to taper off to a half dose, or just Tylenol.

Going home: The rest of my surgery day was spent waiting for the novacain to wear off, and fearing when/how much my face would hurt. My ENT told me that I would have six hours from surgery until the feeling started to come back. Gradually, I could begin to feel my teeth and lips again, and so I knew the effect was starting to wear off. The tip of my nose felt cold and numb for at least 24 hours, however, and I was told that this was normal. There were a few twinges deep inside my nose, once the novacain wore off, but for the most part, my pain pills did a great job of keeping me comfortable. Most of the twinges I felt were due to movement, smiling, eating, etc. Anything that put tension on the splints and stitches can cause this, so just try to keep your face relaxed.

Beyond that, I had an all over feeling of creepy crawly skin, and insomnia. The skin crawling started after a few hours (from the anesthesia), but it wasnt awful, and it eventually wore off. In general, I felt like I was itchy all over, and then just tired and weak. The first night I didnt sleep at all, and when I called my doctor, they told me this was normal. Apparently one side effect of anesthesia is insomnia, and they told me it would wear off after 36 hours or so. Luckily it did, and I slept much better the second night.

Saline and cleaning: I was told to squirt saline up the nose as many times a day and night as I can stand to. It helps with the tight swollen feeling a little, and improves my overall comfort level. At night, if Im really having trouble breathing, I can do a squirt of Afrin nasal spray. None of this hurts, and mostly feels pretty good. Also, I am supposed to apply antibacterial ointment onto a Q-tip, and apply gently to my stitches (inside and out). Again, not painful, and it helps to keep everything lubricated. This is supposed to help when the splints and stitches get removed.

Stitches, casts and splints: You will probably go home with a cast on your nose, and stiches and splints in your nose. These will have to be removed at 5 days or so. For the most part you wont see or feel the splints, but on occasion it will feel like someone stuffed leggos up your nose. There is a sensation of something foreign and hard up there, but its pretty minimal and occurs mostly if you apply any tension or resistance. Keeping your nose relaxed will make a world of difference, and many people dont even know they have splints in there. As for the cast, the biggest drag here is the itching. Much like any cast, your skin will begin to itch underneath it. And, because its adhered to your nose, you wont be able to scratch!

I finally (in a moment of utter desperation), took a small metal nail file, and slid the smooth end underneath the adhesive to scratch the outside of my nose. This is probably a really bad idea, but aaaah, what a relief! I didnt come into contact with any incisions, and there was no pain, but I still worried about what damage it might have caused. I phoned the on call ENT, and he told me to apply a little hydrocortisone around the edges if I wanted to, but it wasnt the edge that was troublesome. It was right there in the middle of it all, naturally! All I can tell you, is just to try to relax. An ice pack to the area will help too. If you have any cosmetic surgery, you will probably have stitches on the tip of your nose. These wont hurt, but they will itch quite a bit too. Anytime you wipe your nose, you will feel a tickle and itch from them as well.

Ice packs: Everyone will tell you to apply ice, and you should heed their advice! You will probably experience a challenge trying to ice around/through your cast. Its hard as a rock (mine is plastic with little holes), and wont allow cold to directly reach your skin. Not to mention the fact that it doesnt feel great to have the weight of an ice pack on the bridge of your nose. What I finally found to be successful, was to lay the frozen gel pack flat on my pillow, and then rest the whole side of my face on it. Alternate sides, every time you roll over. This will get the cold to the side of your nose, and also around your eyes and cheeks. On Day Two, I was thrilled to discover that I had no black eyes, and so didnt bother to use the ice pack too much. This was a big mistake, because on Day Three, I woke up with a major shiner, and my cheek was swollen and purple all around my cast and bandage. My advice to you is to keep icing, no matter how good you feel and look! Day Three seemed to be my worst day as far as swelling, and overall feeling run down.

Nose blowing and stuffiness: After Day Three, I was told to gently try to expel some of the gunk from my nose, and that was both weird and wonderful. Trying to blow your nose without really blowing your nose is a challenge. So, I have just been gently but firmly expelling air and snot out, in an attempt to try to be able to breathe again. Everything inside feels dry and swollen, despite the many saline squirts I have been doing daily. Once you get some of the stuff out, though, it feels a ton better!

Now, I am on Day Four, and have two more days to go until my splints and cast get removed. I can hardly wait to see how things look under there. My nose looks like a pitbulls nose, and the only place for the swelling to occur is straight out the bottom of the cast. It looks ridiculous, but I assume this is going to get better! Overall, I feel a little tired, not too hungry, and my pain has been very manageableI have had nothing but Tylenol for the past 18 hours.

Overall, I have to say that my experience has been a million times more positive that I had imagined, and I would not hesitate to do it again. Hopefully I will be happy with the finished result, and will not only be able to breathe well, but will be happier with my appearance too. I wish good luck and a speedy recovery to all of you, and I hope that this has been somewhat helpful.