Brett's Septoplasty Adventure

On July 2, 2004, I had a septoplasty performed at the Stanford Medical Center. I did a fair amount of talking to my doctor and researching the web prior to signing up for this surgery, and yet I ended up feeling somewhat surprised by just how traumatic the whole experience was. So, I figured I'd share my experience in the hope that someone else will find it helpful.
If you got to this page, you probably know what a septoplasty is. But just in case, I'll start with a definition: it's surgery to straighten your septum, which is the little cartilige wall that runs down the middle of your nose, separating your two nostrils. If your septum is crooked, or deviated, it can impede the flow of air and other good stuff that travels through your nose.
Now, the background. When I was 5 or so years old, I was struck in the face by a wooden swing. Apparently there was a little girl standing on the swing seat as she swung, and I didn't see her when I ran around the side of the swingset to get on an attached slide. The swing clocked me on my nose. This was in a small town, and the nearest hospital wasn't able to X-ray me, apparently because the X-ray technician was home and didn't want to come in on the weekend. Thus, while there's no real proof that is what messed up my septum, it seems like the most likely story. I also have allergies, and the combination of that plus a crooked septum has caused me to be a mouth-breather most of my life.

My first attempt to open up my nostrils didn't work very well, though it sure impressed the kids.

So, it was time to let the professionals try. The first ENT I visited kind of annoyed me. She initially recommended that I get a septoplasty, but on my second visit upgraded her recommendation to a full rhinoplasty. She felt it was "medically necessary", and thus my insurance would pay for it. She also explained how life-changing a septoplasty would be, telling me the story of an elderly woman who insisted it was the best thing that had ever happened to her. While I kind of liked the idea of getting my nose straightened, something about this doctor bothered me, so I asked my allergist if he could recommend someone I could see for a second opinion. He recommended the ENT center at Stanford, so I made an appointment to discuss surgical options with Dr. Koch. His advice mirrored what I had read online: a septoplasty covers the functional aspects of a deviated septum, while a rhinoplasty is mostly for appearance. He said he'd be happy to do a rhinoplasty for me, but given the dramatic bruising and length recovery, I decided to go for a quick and simple septoplasty. Besides, beauty is on the inside, right? Now that I realize a septoplasty isn't quite as quick or simple as I thought, it's not clear the rhinoplasty would have been that much worse. What is clear, however, is that I'm in no hurry to have any more nasal surgery.

Day 1: Friday, July 2, 2004

I arrived at the hospital around 9:45. Sign-in was pretty quick and painless. I got an IV, and next thing I knew I was waking up with a big strip of gauze taped under my nose. By 1:30 they called my wife to come pick me up. I got a couple Vicodin for the pain, and then was sent home with a prescription for more Vicodin and an antibiotic (amoxicillin).
I changed the gauze under my nose, since the old stuff had filled with blood. The blood is coming out pretty steadily. I dropped the old gauze and my 4-yr-old stepped on it, making a big mess in the garage. Or at least that's what my wife told me the next day. It's all news to me...

Day 2: Saturday, July 3, 2004

I was feeling pretty crappy on Saturday. My nose felt like there was a Cornish Game Hen stuffed waaaay back in each nostril, plus I had general sinus pain. My nose was pretty noticably swollen. A couple Vicodin did wonders for the pain, but left me with a particularly dopey expression for picture-time. The open mouth is mostly motivated by the need to breath. I assure you, I barely drooled at all.

The strings/sutures visible below my nose are attached to the gauze packing that was wedged deep into my sinuses during the operation. More on that later.

Day 3: Sunday, July 4, 2004

I find that I'm reminded when it's time to take more Vicodin by a splitting headache. The same thing happened to me the last time I was prescribed Vicodin for post-surgery pain. According to the PDR (Physician's Desk Reference), some people show signs of mild physical dependence after a few days, so it's starting to seem like I'm one of those people.

Day 4: Monday, July 5, 2004

No Vicodin for me today. Just Tylenol for the headache.

OK, one little bitty half-Vicodin-so-I-can-sleep pill. Yes, much better.

Day 5: Tuesday, July 6, 2004

Today was my first day back "at work". Lucky for me, I have a job that allows me to work from home periodically. I originally expected to be back in the office by now, but of course the whole experience has been full of surprises.

It hurts to move my nose, or any body part connected to my nose. So, I've decided not to bother shaving at least until the pain and those dangling sutures are gone.

The Vicodin I took to help me sleep last night seems to have made me a bit groggy this morning. Plus, the general anesthetic from Friday is probably still affecting me a bit. The net effect is that I'm not quite at 100%, mentally. Makes me nervous about working on important stuff. Ah, what the heck, that's why we use revision management software...

Day 6: Wednesday, July 7, 2004

Today I had an appointment with the doctor to check my nose and have the packing removed. Despite assurances from the doctor that the packing removal would be painless or at worst there'd be "mild discomfort", it felt like passing cornish hens through my nose. Frozen hard-as-rock cornish hens. I think it was the most painful part of this whole ordeal so far. When the assissting doctor pulled out the first gauze strip, I really expected to see my tonsils dangling from the end of it.

The packing itself appeared to be a roughly 3" long strip of non-stick gauze that had been folded over to make a strip maybe 3/4" wide and a few layers thick. It started pretty far back in my nose, and then of course it extended 3" deeper into my head from there. I had no idea there was that kind of room in there.

Since the packing came out, my nose has been bleeding a bit, somewhat painful, and very tender to the touch. It feels like there's something poking me deep in my sinuses now, so I keep having to sneeze. Very annoying. The good news is that the dangling sutures are gone.
Immediately after the packing came out, I was able to get a little air through my nose. Sort of the same constricted breathing I was used to before the surgery. However, as the day progressed, my nose quickly sealed up until it was pretty much as plugged tight as it had been before the packing was removed.

I'm trying to look creepy in that picture, but somehow I think I just look constipated. Wierd.

Day 7: July 8, 2004

The first big development today is that my nose is no longer draining nasty stuff. That is, for the first time since the surgery I don't have to carry around a Kleenex to wipe the blood and, uh, stuff that until now has been seeping out. It's a wonderful thing. The downside is that I can feel my nose drying out inside, which makes me fear for the splint removal. I can't blow or otherwise clean my nose, which means there's a lot of former liquids in there that are currently curing like industrial adhesive. I'm guessing at least half my nosehairs are probably permanently bonded to that splint by now. I'll miss them...
I still can't breath, but at least now I can go out in public.
The second big development is that I'm starting to feel a lot better. I had a reasonable appetite at dinner tonight, and more energy than I've had for the past several days. This is good.

Day 8: Friday, July 9, 2004

Friday! Still can't breath, and not quite feeling 100%, but not too bad. As is our weekend tradition, we went out for Friday night dinner with friends. I kept everyone on the edge of their seats with my tales of woe and disgusting discharges.

Day 10: Sunday, July 11, 2004

Saw "Spiderman 2" today. Excellent film. I was glad to see both Ted Raimi and Bruce Campbell in prominent roles this time. The kids liked the fighting parts, but no so much the talking and kissing. I could do with a little less of that myself, but it's a good package as-is.

I wasn't feeling particularly good in general, though. My nose remains completely plugged, and I'm feeling kind of like I have a cold. Not much energy, slightly upset stomach, bit of a headache. Actually, I'm feeling a lot like I typically feel when I'm battling a sinus infection, which seems like a reasonable guess. My daily antibiotics end tomorrow, and I'm looking forward to not having to take them anymore. Hopefully I won't get sicker once I stop the drugs, though.

Day 12: Tuesday, July 13, 2004

I got a really painful migraine today. I've been getting the occasional migraine since high school, but generally they're just a vision disturbance, and I simply wait for them to pass on their own. Today's was a splitting headache that started before lunch. After trying to self-medicate with coffee and Tylenol, I finally talked to my doctor and got a prescription for Imitrex. That helped, but not as much as the Vicodin I had left over from the septoplasty. I suspect the stress of the surgery combined with trying to get a bunch of stuff wrapped up at work before my vacation next week was the trigger for this migraine. Calling the past two weeks "stressful" is a bit of an understatement.

Day 13: Wednesday, July 14, 2004

Got the splints out today. I had been dreading it after the pain of the packing removal, but overall it wasn't so bad. The same doctor who removed the packing removed these. She was supervised by another doctor who was filling in for my doctor, who is on vacation. This time they sprayed some anesthetic into my nose first. There was a single suture in the front of my nose, going through the septum to hold the splints in place, which had to be removed first. Then she grabbed the splints with tongs and pulled. The second one was tougher, and her tongs slipped off a couple times before she got it. It hurt, but the pain pretty much ended once the splints were out, unlike the packing removal that made my nose hurt the rest of the day.

For an hour or so after the splints came out, I could breath pretty well. However, as the day wore on, my nose slowly became congested again. It stabilized at a point where I can breath through it, but not quite "freely". I'm a bit late on my monthly allergy shot, so that probably doesn't help. Plus, despite their attempts to vaccuum out the big nasty stuff with a suction tube, I still have a lot of stuff in my nose. The doctor asked me to wait until Monday before I start spraying saline solution in my nose to clean it out.

Day 17: Sunday, July 18, 2004

Not being able to blow my nose is really frustrating, since it's so stuffed up. I've actually been cheating a bit, by blowing "just a little" and even spraying a little saline solution up there. But, I'm trying to be gentle.

Tomorrow I'm heading out for two weeks of vacation (including one week at Disney World), so my next update will be in August. My doctor advised me to avoid anything very strenuous for the next couple weeks. He said swimming is OK, but he'd prefer I not swim underwater. He's worried my nose will start bleeding again.

Day ??: Friday, August 6, 2004

Florida was hot, sticky, and full of alligators.

My nose, on the other hand, had relatively few alligators. The trip was uneventful, at least as far as my nose is concerned. The biggest change is that blowing my nose is now very productive, and after a good blow I can actually breath. This is a definite improvement over my old nose. I had a follow-up visit with my doctor on Wednesday, and he said my nose is now healed enough that I can resume all activities. He also prescribed Flonase for me, since my allergies are still keeping my nose more congested than it might be. I've used Flonase in the past with mild success, and I'm hoping it will be more effective now that my nose isn't physically blocked.

As this last group of pictures shows, by the end of the vacation I had shaved my beard (OK, the pictures don't show the final me with no facial hair, but you can imagine the next frame in the sequence), and I was feeling much better.

Update: September 3, 2004

My nose is good. Very good. The Flonase seems to be working, as I can now breath pretty easily all the time. It's very nice. People keep asking me if it was worth it, and honestly I'm not sure if it was worth it just for the improved airflow. I mean, after 30+ years of mouth-breathing, I was kind of getting used to it. I haven't gotten solid data on whether or not I snore less, nor have I seen the dentist to find out if there's any improvement in the condition of my gums (which aren't bad, mind you, just receeding a bit). The big test, and the thing that will make it all worthwhile, is if I can go a year without getting a sinus infection. So, the clock's ticking.

Update: September 29, 2004

I had a followup appointment with Dr. Koch today. My nose is looking good: it's clear and I can breath. The only problem is that it's pretty dry inside, and there's a bit of scabbing on the right. Dr. Koch advised more frequent use of the saline spray to keep my noise moist, and to apply Bacitracin ointment to the scabbed areas to help them heal. I stopped by a drugstore on the way home to get some ointment, and also picked up some Ayr saline gel to try out. So far I like the Ayr better, because it has a nice smell and doesn't feel quite as greasy.

Update: March 10, 2005

I really should have updated the page before now. Since the last update I've had two sinus infections and another appointment with Dr. Koch.

The first sinus infection occured over the Christmas holiday break, when I was visiting my parents in North Carolina. After a week of waiting for the sore throat and general malaise to go away, I finally went to an urgent care center and got some antibiotics (Amoxicillin) and decongestant (pseudovent). That cleared it up pretty quickly.

The second sinus infection wasn't fully confirmed, but I'm counting it anyway. In mid-February I thought the symptoms were all there. It was about time for my follow-up with Dr. Koch, so I described the signs to him. He seemed a bit skeptical, but prescribed some Amoxicillin, anyway. It seemed to do the trick. The general conclusion from the appointment was similar to last time: the inside of my nose looks pretty good, but it's dry. I also frequently get a little blood when I blow my nose, which Dr. Koch said could still be leftover from the surgery, or some cracking/scabbing from the dryness. He recommended even more saline spray or Ayr, with another appointment in a couple months. He also advised me to cut my Flonase dose in half, from two squirts per nostril twice a day to the same thing only once a day.

Update: December 22, 2006

I get a fair number of emails from people who have found my website, and the common theme is along the lines of "wow, I just found your website, and I'm so happy to hear that I'm not the only one whose septoplasty wasn't a painless walk in the park." I obviously enjoy receiving praise for my web creations, and I'm very happy to hear that the unflattering pictures of myself on this page are serving a greater good. So send me an email if this page has been useful to you! And, if you post your own septoplasty blog or web adventure, email me and I can include a link to it from this page. We former mouth-breathers have to stick together.

Actually, speaking of mouth breathing, one question I got was regarding how was I able to cope with the packing. Apparently people who are used to breathing through their nose (even if it's partially obstructed) have a big problem with their nose being totally blocked by the packing. This was annoying for me, too, though as a long-time mouth breather it wasn't much of a hardship. For those of you with nose-breathing experience, you might want try holding your nose and breathing through your mouth for a while before the surgery, to prepare yourself for this exciting part of the adventure. Or, maybe that will just ruin the surprise. It's your call.

With that out of the way, it seems like a good time to post an update on my status. My surgeon, Dr. Koch, has left his old practice and now specializes in cosmetic surgery, so I haven't been back for a followup visit since, gosh, early 2005 or maybe even 2004. I'd say my nose is doing well, though it continues to be dry. Before my surgery, I had read that this could be a side-effect of the procedure, though Dr. Koch told me that he had never observed this in one of his patients. So either I'm the first, or our definitions of "dry" differ. My definition is: I have to coat the inside of my nose with vaseline every night, or else I get scabbing. The main scab is always in the same place, on the inside right of the septum. I also use Ayr or Simply Saline gel occasionally, plus Ocean saline spray each evening, though I probably don't do either as much as I should. And finally, I'm still taking two squirts of Flonase in each nostril every morning, and that keeps me breathing easily. I like the Flonase: good stuff.

Update: April 30, 2011

I still get frequent emails regarding this page. Whereas I used to mostly get emails from people after they had gotten the surgery and were realizing they might not be ready to return to work the next day, more of my emails lately are from people considering the procedure. I'm glad more people are doing their homework before it's past due. Hurray for the Internet!

The most common question I get is simply, "was it worth it?" I usually pause for a few seconds before replying, then use a bunch of words to basically say "yes." When I most recently answered this question, I remembered that a big part of my original motivation for getting the surgery was to hopefully reduce the number of sinus infections I was getting. Pre-septoplasty, they seemed to be a yearly annoyance. Then I thought back, and realized that I can't remember when I had my last sinus infection. I don't think I've had one in five years or more. So while I can't be sure this happy outcome is the result of the septoplasty, I will say, "mission accomplished". And I don't mean that ironically.

Another common line of questions involves mouth breathing. As mentioned above, some people are apparently horrified to discover that during the days immediately after the surgery, no air will pass through their nose thanks to the packing, and thus they're forced to breath through their mouth. If you're not used to mouth breathing, prepare to get some practice. The follow-on question is whether or not I still breath through my mouth, either out of habit or due to congestion. And the answer is "not much." Most of the time, my nose is clear, my mouth is closed, and all is well. Or so I like to believe.

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