ENT Adventures - Turbinate Reduction

The time had arrived for me to get my first real medical procedure of my adult life other than a dental filling: it was time for my turbinate reduction.

A few people have asked me what the heck this is. From what I can gather (and I am NOT an ENT doctor, so this is about as basic as a basic explanation can get), inside your nose on the walls of your nasal passage are these turbinates. They interact with your body to make sure you... something... and secrete mucus whenever you cry, have an allergic reaction, get a cold, etc. When these things happen, they can also become enlarged and end up as assisting in getting sinus infections or continual discomfort because of these other things going on. Well, because I have so many allergies - my turbinates were working in overtime and were basically permanently enlarged. This procedure's purpose is to relatively permanently reduce or shrink my turbinates.

I got to the doctor's office and (thankfully) had Steve in tow. I hopped up in the chair and waited for Dr. Postal to come in, chatting with Steve while I waited. I noticed that the machine in the room looked like something out of one of those old-school sci-fi films you see featured on MST3K, and made a joke to Steve about them implanting a microchip instead of doing the procedure.It was right around this time that the doctor came in. He explained the procedure, strapped an RF grounding pad to my arm, and got to work.


***WARNING: The next few paragraphs might be a bit graphic - if you aren't big on medical procedures or procedures involving Novocaine: DO NOT CONTINUE READING! Go to the part where it says I indicate I'm done and read from there.***

This is basically what I had done. I'm 4 days into a 1-3 week healing process as of today. (Image found on flickr.com)

The doctor prepped some cotton on his little table (think similar to what they do to numb you up before the shot at the dentist), turned around, and shoved it up my nose. After 5 minutes or so, he said "Your front teeth should start feeling funny right about now." I hadn't noticed so I pressed my tongue against my 2 front teeth and yes indeed, they did feel a bit funny. After a bit longer (maybe another 5 minutes), he returned and advised that he was now going to remove said cotton and administer the Novocaine. He handed me a stack of tissues and said "This is incase you end up coughing. Because it's a needle there's probably going to be a little blood, so if you cough then catch it in the tissues so you don't ruin your shirt. Besides, it never looks good to the other patients if you come out of here with blood on your shirt."

My doctor thinks he's hilarious. So did Steve, incidentally, who chuckled at his joke. I, however, was nervous with a giant wad of tissues in my hand waiting for the Novocaine shot.

He needed to do two shots of Novocaine - one on each side - and started first on my left side. At first I felt a pinch, then a sharp pinch, then I felt liquid running down my throat. The liquid started to feel numb, and I went into an involuntary cough. Good thing I remembered the tissues, which I promptly lifted to my mouth. However, the doctor couldn't really rip the needle out of my nose; he expertly stayed with me - not once slipping on the needle - and continued to administer the remainder of the shot. All this time I'm coughing, I started crying (it freaking HURT before the numb!), and my legs were convulsing because of the pain/numb/coughing discomfort.

Also I was freaking out. Why was I freaking out? Because if all of that wasn't enough - I heard and felt a buzzing in my ears. This was possibly the most unsettling thing I had ever experienced. In fact, as the buzzing got worse and I felt a couple more tears flowing and another cough coming on, the doctor mentioned: "Oh, and sometimes patients have experienced a buzzing in their ears. This is normal and will pass in a few minutes."

Thanks, Doc. Now you tell me. I rolled my eyes and looked at Steve. I felt so bad for him but was so glad he was in there. He said: "Buzzing?" I nodded.

After a minute of letting the left side settle down, he proceeded to do the right side. This side went much smoother than the first, which of course my observant husband noticed. Never one to allow curiosity to escape him, he asked the doctor about it. "It seemed like that side went a lot easier than the first side. Is that normal?"

The doctor replied, "Yeah... she has a deviated septum on that other side. That always makes things a little more challenging."

Again - Thanks, Doc. Now you tell me.

***OK. The worst is over now. The rest is pretty tame and not so graphic.***


After that was all done, he got to work on the actual procedure. I'm not even joking when I say I did not feel a thing. I heard a "bzz-bzz-bzzzzz" come from the machine... and that was it. He spent about 2 minutes on each side with the radio frequency wand doing his thing, gave me some instructions for care over the next 8 weeks, set up a follow up appointment, and sent me on my way.

The day of the procedure (Wednesday) was awful. I couldn't blow my nose so instead went through a box and a half of tissues keeping up with a nose that had been poked at. Thursday wasn't as bad, though I still couldn't exercise at all really and was still coughing a good amount. Yesterday (Friday) was even better in terms of nose blowing, and today has been the best day so far. I've blown my nose a lot less and was even able to go for a walk this morning (even though I didn't feel 100% while I was out there). I expect each day to get a little bit better, and am just making sure that I stay on top of the regimen that he prescribed to me. I expect that next week I'll be able to go to the gym again, and by the end of next week can do weights again (no heavy lifting for me for a few days). 

Steve and I expect that between this procedure and the changes that the move to the new house will bring, by the time my 8-week follow-up appointments for the allergist & the ENT hit, I will know if I'm able to breathe any easier. The big hope at this point is that I won't have to go through the procedure again. We'll find out at the beginning of August!

ENT Adventures - The Allergy Test

For the next couple of blog entries, I'm going to catch up on the latest & greatest in the world of trying to make me breathe easier. I forgot to do the update of my allergy testing back at the beginning of May, so we'll start there.

I got to the ENT office, checked in, and waited my turn to be called. When I was called, the allergy nurse brought me to the furthest room in the back of the office (to which I thought - are the needles that bad that they need to put the people in the back to stifle the screams?) and sat me in a chair. She pulled out a questionnaire and asked me a series of questions: do you eat this, are you ever around that, do you have this or that pet, do you find it easier or harder to breathe at certain times of the year, etc. I answered each one and she made some notes on her sheet. When she was finished the 20 questions, she pulled out a tray of tiny beakers and said what each one was. Turning one of the needles in my direction before she put them in the tray, she suggested that I touch one to see what the test would be like. Seemed harmless enough, almost like touching the end of a sewing needle and poking yourself in the forearm. She wrote on my arm with a ballpoint pen so as to not lose track of what pricks would be what, and began the testing.

 Image from myallergydr.com

The first round of testing was an initial screening and tested for airborne allergens such as pet dander, various pollens, and cockroach droppings (yes, seriously). She pricked my skin with 30 samples, set the timer for 10 minutes, and went on her way while we waited. I grabbed my book and after about 2 minutes noticed a few hives beginning to develop on my right arm. After 5 minutes, three of the hives had developed even more and were excruciatingly itchy. I took my eyes away from my book to see what they were - and they were the first three in the first row.

Cat dander, dust mites, and dog dander. 

There went my hopes for beige carpeting and a shih-tzu. I pretty much already knew about the first one (if you get asthma attack like symptoms when you're visiting a friend who has a cat...), was suspicious about the second, and the third was a bit of a surprise.

Oh well. When the 10 minutes was up, the allergy nurse returned and "read" my arms. She took notes on where the allergies were obvious, cleaned up the pen marks, and gave me an ice pack to relief the unbearable itching of the three huge hives on my arm. Oh sweet coldness, how I loved you in that moment.

Round two of testing was uneventful. Same pricks, but this time there were food allergens based on my normal diet placed on my skin. Just as I had thought - no food allergies. Since she tested for coffee - this was a huge relief. That would have been an absolute disaster.

Round three was more pricking with the airborne allergens, but this time with a bigger needle right under the first layer of skin on a select few. She drew up 10 vials to double check my pollen allergies (we narrowed it down to just tree pollen, so now were trying to see WHICH trees), some molds, and just incase it was a false negative - let's throw some more mouse & cockroach droppings in (why not, right). That round of testing showed that I am allergic to maple & hickory pollen as well as one or two kinds of mold. Still no mice & cockroaches...

No, Mr. Cockroach. I am not allergic to your crap. (Image found on flickr.com)

Then it was time for the last round. This set of pricks under the skin was just to see the severity of the maple & hickory pollen allergies as well as narrowing down the mold. She made more notes on my file, muted the Food Network (yes, I was watching TV... at that point I had given up on reading, TV was a better distraction to the itching), and gave me an education lesson on avoiding dust mite allergies. I walked out of there that afternoon a little bit less afraid of needles and a little more knowledgeable about how to manage my allergies. I go back in for a follow-up in August to see how I'm coping with some changes we'll be making, and if needed we'll discuss any alternatives to treating my allergies.

All in all, it was a great appointment. I geared myself up for the next step - turbinate reduction.

What's a Turbinate??

After 30 days of antibiotic treatment and 2 weeks without medicine, it was time to head back to my ENT doctor for a follow-up appointment. I assumed - incorrectly - that this would be an in and out visit because I was seemingly all cleared up. Turns out that there was more that my doctor wanted to discuss/do.

I sat in the chair and let him know the success of the antibiotics (no more headaches, post-nasal drip dramatically reduced). When he asked about congestion, I let him know that I have had a little bit but that I've noticed it's not unusual for this time of year. He thought about it, nodded, made a few notes, and then came at my face with a pair of what I call "nose-forceps". I don't know what this tool is called, but I know that he uses it to widen my nostril so he can see up my nose. After asking if I felt congested at that moment, and me responding yes - he said "I'm going to decongest you."

My first thought was... uh.... how??

He did some things I couldn't see, made a comment about making a mess, and shoved cotton wet with something up each one of my nostrils. Then he said "We'll let that sit for a bit and wait to see what happens and if that helps you" and left the room. I stayed sitting in the chair, looking at posters showing the anatomy of the nasal passageways, and breathing out of my mouth.

A few minutes later he came back, made more notes, and removed the cotton. Then he went up my nose with the fiber-optic scope, took a look around, and made some more notes. Then he turned around, crossed his arms, leaned against the counter and began to relate to me what the next steps would be.

More good news for Danielle: because I responded so well to the antibiotics, he does not see a need for the sinus surgery (I think this is what is commonly referred to as the 'roto-rooter' treatment for your sinuses). This made me happy because I generally like to avoid having surgeries done. I also get to avoid the deviated septum correction surgery which - again - is good because I generally like to avoid surgery.

While the good news was good, the bad news is that I do have a narrowed nasal passage. The decongestion that he did was to see how my nasal passages would react to what he did, and that allowed him to discover that I have enlarged turbinates. When he informed me that my narrowed nasal passage was due to the deviated septum as well as the enlarged turbinates... he sensed my confusion and showed me where my turbinates were on the poster (they're bony structures along the nasal passage). The in-office procedure - called Coblation Turbinate Reduction - should take no more than 20-30 minutes, is done simply with local anesthesia, and then I can go about my day. Once usually does the trick to correcting the problem over time, but sometimes he has had to do it twice.

Learn about Turbinate Coblation

The other thing that needs to happen is that I need to see an allergist to address what my ENT doc suspects are underlying issues causing my enlarged turbinates. Even with the procedure, allergies are allergies and need to be properly addressed. I've had a long standing suspicion that I've been allergic to adult cats and seasonal polled, and my doctor thinks I may be allergic to dust and mold as well. 

This has turned into a much longer process than I had originally thought it would be, but I'm glad that I am finally getting some answers about my nasal discomfort. It will be nice to have them resolved and not always sound like I have a cold.

Adventures at the ENT - Antibiotics OVER!

4 weeks and 56 pills later - I am finished taking the antibiotic treatment for my mild to moderate sinus infection that my ENT doctor saw on the CT scan.

I am very glad to not have to worry about taking the antibiotic anymore. While it was easy to remember the bedtime dose because I was taking it nightly with my vitamins, I was having a hard time remembering to take the morning dose. Clearly I did not want to miss a pill, so there were several days when I was taking the pill rather late. No matter - I got it into my system to work its bacteria-killing magic.

So what exactly was I taking? Dr. Postal prescribed me a 875 milligram tablet of Augmentin twice per day. This is a rather large pill made up of a penicillin derivative and is pretty potent. If you've heard of it before it's probably because it's commonly prescribed to children who suffer from ear infections; my sister Becky took it a lot as did my brother when they were kids. They were prone. There are a great number of medications that can be prescribed for sinusitis, this just happened to be the one that the doctor chose.

So what exactly happened to me while I was on the medication and did it help? The short answer is yes. After 1.5 weeks on the antibiotic I ran out of my decongestant at home and tried to go a couple of days without it. It was fine, so after 2 weeks I went ahead and eliminated the nasal rinse as well. I did not use the rinse the entire time we were on vacation and had no adverse effects. This was great. There were a couple of days when the weather changed and I could feel a little bit of pressure, but otherwise breathing has improved, the headaches have decreased to minimal or none (at least sinus related), and exercising has been a dream. I still have a little bit of postnasal drip and some congestion, but since my doc suspects that I may have dust/mold allergies - this should not surprise me as I live in a basement apartment.

The downside. Just about all antibiotics (and all medications for that matter) have a litany of side effects you can get. They can range from digestive issues like nausea and diarrhea to fungal issues like thrush or yeast infections. This is because they kill bacteria - even the good kinds that your body naturally has to help maintain balance and health. The side effects can be prevented or minimized by eating lots and lots of yogurt. I made sure to eat a yogurt every day, some days adding a bit of frozen yogurt as well. However - 4 weeks of antibiotics is a long time, and I was not so lucky as to avoid any side effects. Somewhere around the end of week two I began to suspect that I might be falling victim to a yeast infection. A visit to the doctor confirmed that I was correct and I was diagnosed with my very first yeast infection (wasn't feeling very reassured with the nurse welcomed me to the club and said it would be the first of many...). The good news, however, is that it's nothing that a simple little pill can't fix. Because I still had some antibiotics left to go, she gave me a script for 2 antifungal pills; one to take immediately and one to take at the end of the pill cycle.

I now am to wait for 2 weeks and see how I fare without the antibiotics. I'll still continue with the Flonase spray for my postnasal drip during that time (it's the spring which means pollen which means I'll get the postnasal - joy!). My next appointment with my doctor is on April 1 as a follow-up to the antibiotics and 2 week absence of the medication. The big question at that point will be:

Great - so we've cleared up this particular chronic infection. But this happens to me at least bi-annually. What is the underlying cause? Am I just lucky enough to be susceptible to sinusitis?

In the meantime - my sinuses feel better than they have in MONTHS. I am extremely grateful for that, that's for sure!

Adventures at the ENT - Part 2

Yesterday was the reading of my CT scans at my ENT specialist. I left work at 1:30 for my 2:10 appointment, CD copy of the CT scans in my hand ready for review. I checked in with the nurse, paid my co-pay, and read some more of "A Farewell to Arms" while I waited for my turn. While I read, I had a simple reminder that I was in an ENT specialist's office was the man sitting next to me making the worst sinus noises ever. I felt awful for him - hopefully the doc was able to give him something to help.

Anyways.

When it was my turn the doctor took the CD into his office and started to look at the pictures of my head and sinuses. Then he called me into his office to take a look over his shoulder so I could also see what was going on. He explained to me what was my nose, showed me where my septum is deviated, and then pointed out my sinuses. I was encouraged when he pointed out that the black was air and advised that "that's what we like to see - a good amount of black". He then pointed out where there were areas of congestion in my sinus walls that were not normal; one of the shots had a good comparison of a "normal" area - then a not so normal one which he advised was "ten times normal size".

After going through about 10-15 of the many shots of my head with me (well over 150) he said that it looks like mild-moderate chronic sinusitis. He was glad to see based on my scans that it is not severe - and I was glad to hear him SAY that it isn't severe. We left his office and went back to the exam room to discuss next steps. He looked over my chart and the notes he had taken over the last couple of appointments, asked if I was allergic to any antibiotics, and announced what the next step would be.

For the next 4 weeks, I will be taking antibiotics (Augmentin) and continue my Flonase treatments. Then I will be off the medication for 2 weeks to see if the symptoms are over, and see him again on April 1. This means that I need to be paying SUPER close attention to my sinuses over the next month so I can see if I notice any improvement or changes during those 2 weeks. It also means that I need to be paying super close attention to my food intake for the next month because antibiotics clean you out - and they CLEAN YOU OUT - so I need to be sure to replace my good bacteria with what I eat and drink lots of fluids to keep me hydrated.

A little bit of a lifestyle change for the next month or so - but - at least we're onto whatever it is that's causing my head to feel like that giant nose from the old Afrin commercials.

"Legs Do It" & Adventures With My ENT - Double Update!

So - confession time.

Last week was an overall bust for Danielle with the "Legs Do It" challenge. I did my first day of paying attention to my legs on Tuesday (lunges, steps, etc.) - and then I ran into issues.

I think I mentioned in my first post about my sinus issues that I have a routine that I follow every night in terms of making sure I don't run into any problems. Well I ran out of Sudafed and didn't get to get to the store to get any, so I went two days without. I could feel this starting to catch up with me - and then I didn't give myself enough "upright" time with my nasal rinse. By Wednesday my sinuses were not in a good place, Friday I could feel myself starting to fight a cold on top of it - and Saturday I had a massive headache (probably unrelated, but still not a help).

Needless to say - we learned about what happens when Danielle strays from her routine that took her forever to arrive at. And while I did get to the gym, I did not get in the amount of leg-specific work that I wanted to. I got some time in on the elliptical just so that I could stay active - and was happy with that.

To close out the ENT update: I had a CT scan on 5th and was given a CD. Tomorrow afternoon I meet with my ENT doctor to go over the scans and see if I am to proceed on to meet with an allergist or not.

Now - On to the "Legs Do It!" challenge!

Monday/Wednesday: Strength
- 20 minutes on the bike (since that is concentrating mainly on the legs)
- Weight Machines (I was excited yesterday to note that my weight is increasing on a couple of machines - that made me happy).

Friday: Sculpting
- 25-30 lunges per leg (Going to see if I can push it - I didn't get much pain last week)
- 40 jumping jacks
- 100 steps/leg on the plyobox
- 15 minutes lower body ONLY on the Elliptical trainer (3 min. intervals front-back)

Saturday: Strength
- 30 minutes on the Elliptical
- Weight Machines

Stretching:
Rather than dedicate just one day for stretching, I am going to make sure I stretch every day both in the morning and at night. I find that I don't really have a good place to do Yoga at home, so this will be the best way for me to stretch I think.

That's that! Let's see if I can manage to follow this a bit better this week, shall we?

Adventures at the ENT - Part 1

For about 8 years or so now, I have struggled with chronic sinus issues. If I cry - I get congested for a day. If I stir up too much dust - sinus headache. 2 glasses of wine? Dry sinuses and discomfort (if I don't have enough water afterwards). Change in weather? Pain and congestion. Pollen time? Ouchies. If it's not one thing wreaking havoc on my sinuses, it's another. 

In December 2009, I had a bout of really annoying sinus problems that wouldn't quit. I went to my doctor and she advised that it was not an infections, she renewed my script for Flonase, and sent me on my way with instructions to call back if (this is gross) the color of my snot changed. It did, so I called back and went in. She looked again, and $20.00 later she advised that I had no infection. This time though she gave me another tool to tackle the old sinus issue and advised I continue to take decongestants and Advil to reduce the swelling in my sinuses (which theoretically would relieve pressure). It all began to work right around Christmas.

About a week ago, they started up again in full force. Yicky snot, etc. So I started up my routine again of the Sinus Rinse, Flonase, Sudafed PE Non-Drying Sinus, Advil, and a humidifier at night. Three days later I had a sinus headache that hurt so badly that I had a hard time getting out of bed. Clearly, the myriad of things that I am taking to treat the symptoms are not doing their job to the best of their capacity.

Two days after that I had a persistent enough sinus headache that I decided it was time to call an ENT (ears, nose, throat) specialist, or an otorhinolaryngologist. A doctor who dedicates their entire life to relieving the pain and suffering of those whose upper respiratory system gives them nothing but trouble. I got a couple of recommendations on Facebook, and set up an appointment with Dr. William Postal at Andover Ear, Nose, and Throat Center.

Here's where I have to make the confession that I went into the appointment nervous to begin with. I had heard enough about sinus surgeries, polyps, and deviated septum surgery to legitimately shake me up a bit before I made the appointment. I've never had any sort of surgery done EVER - not a tooth extraction. The closest I've ever had to surgery was stitches in my knee after a car accident I was passenger in. So yes - I was nervous while I sat in the waiting room.

The very friendly Russian nurse/secretary woman brought me into the examination room and advised that I should sit in the chair. I waited, and Dr. Postal came in, introduced himself, and asked me a few questions about the issues I have. He took a look in my ears with some contraption that puffed air into them, opened my nasal cavities up with what I can only describe as mini-forceps to take a peek, and looked down my throat with a popsicle stick.

First look diagnosis: Chunky tonsils (whatever that means, he didn't seem too concerned) and a deviated septum. On a deviated septum 0-4 scale of severity, I'm at about a 2. Again - he didn't seem too concerned.

He then shakes up a nasal spray container and informs me he's going to shoot NOVOCAINE up my nose. Yes. NOVOCAINE. Why? So that he could numb it up and take a look with a scope.

I got a little bit nervous.

Then the very sweet Russian nurse knocked on the door, said "Oh yes! You're by yourself!", exited the room, and returned with this:

THAT is a flexible fiberoptic nasal scope. THAT is what the nice doctor intended to shove up my nose to "take a look".

As I felt the back of my throat and back of my nose go numb, the good doctor came back in the room and proceeded to unceremoniously shove said scope up my nose. Talk about an eye-watering experience. It didn't hurt, but it wasn't comfortable whatever he was touching was making my eyes water something fierce.

I didn't care. I want to know why the heck I keep getting sinus headaches.

Scope and Novocaine Diagnosis: No signs of polyps (yay!), no immediate signs of infection.

Next steps: CT Scan to see if I have signs of chronic low-grade infections or other signs of inflammation that he couldn't see with the crazy nasal scope. Depending on how that goes, probably a meeting with an allergist to see what I'm allergic to. He seems to think that it's related to some sort of dust or mold or other allergies. I've never had a CT scan and from what I understand the allergy test is a bajillion little needles with allergens in them.

I look at it this way: It's a way for me to get over my fears. I'm afraid of medical proceedings in general and especially of needles. And hopefully at the end of it, I'll have a bit more insight into whatever is going on with my sinuses all the time.