Undergoing a deviated septum operation

© October 2015 - May 2016 Paul Cooijmans

Introduction

The day after the deviated septum operation.
The day after the deviated septum operation.

From about age 8 or 9 on I have had problems like frequent bad "colds" that last only a few days, a blocked nose, and the sensation of my throat constantly filling up with slime, causing me to cough and throat-clear a lot. Around age 12 I was diagnosed with dust mite allergy and used medication for that now and then. From age 21 on the colds got much less serious and frequent, but the other symptoms remained: slime running down the throat ("post-nasal drip") and a blocked nose, especially at night in bed when I often had to breathe through the mouth. It was primarily the right nostril that was always mostly blocked. I could live with it, but finally in my late forties I decided to try to get rid of it for the rest of my life, partly because I was getting tired of it but also because I feared that the constant coughing would be bad for my lungs eventually. I had a notion that decades-long coughing and throat-clearing might damage the elasticity of the lungs, causing emphysema. I am not certain if that can indeed happen though, and a recent lung function test showed that my lungs work very well, so I seem to have got away with it so far.

After a number of visits to doctors, various examinations, and treatment with nose spray, nose drops, nose rinsing, and allergy pills, it was established that I still had dust mite allergy (which surprised me because it had got a lot better after my teenage years, so I had long assumed the allergy had disappeared by itself) and that the nasal septum was deviated. The latter I had already noted myself meanwhile; my right nostril was always more or less blocked. The ear, nose, and throat doctor proposed an operation under general anaesthesia to correct the deviated septum. After some thinking I agreed, hoping that this would improve the post-nasal drip and breathing problems.

Hospitalization

After a few months on the waiting list, the hospital called that I could have the operation the next day if I wanted. I quickly verified that someone would be available to drive me there, and called the hospital back to say I would do it. I packed my bag, having made a list of everything I needed some weeks before already. Around 13:00 hours the next afternoon I arrived at the nursing department, where I would stay one night. A nurse told me the operation was planned at 14:30, and gave me a green operation jacket, two paracetamol tablets, and a bit of water. She also put a wristband on my left wrist, which contained my name and date of birth and some codes. I did not receive a tranquillizer pill, unlike with the herniated disk surgery of 2011 (which took place under spinal anaesthesia). I had not eaten anything since about 22:45 the night before.

There were three other patients in the room, all recovering from operations (nose, foot, and back). I took my time to change into the green jacket (after drawing the curtains around the bed) and swallow the tablets (I let the paracetamol fall apart in the water first to avoid choking on it). I kept my underpants on as instructed. Around 14:00 hours two people came to take me to the operating room. I first went to the toilet to empty the bladder as much as possible, as I knew this to be a critical matter, and then lay down in the bed on wheels, which was subsequently pushed through a number of long corridors where it got progressively colder. I looked out of the windows now and then as we advanced; it is always nice being pushed around in a bed on wheels. I recommend it. Then, we reached the room where I would be prepared for the operation.

The operation

In a large oblong room I saw a number of beds with people about to undergo surgery. Next to me was a man with a broken finger, and opposite to me a woman with a broken hip. A man and a few girls came and began to apply things to me, like pads on my chest, a bracelet that measured blood pressure, a thing on a finger, and a drip in my left hand. I was connected to a beeping machine on my right. Meanwhile, the man said he was the assistant to the anaesthetist, and asked a number of questions to ascertain I was who I was supposed to be, and was undergoing the operation I was expecting to undergo. I was also identified by scanning a Q.R. code on the wristband. They looked in my papers and put them on the bed, on my legs. At one point some papers fell off the bed on the floor when I moved my legs. Someone who passed by noticed them and put them back.

After some time, during which I was calmly lying down and looking around a bit, it was my turn and the bed was ridden out of the large oblong room to the operating room around 14:30. Again, it got colder. In the operating room the bed was placed next to the operating table, and I was invited to climb on to the latter. The assistant anaesthetist remarked that I was in good shape and the climb should be easily doable for me, which it was. There were recesses for my head, heels, and hips in the table, and they put a pillow under my legs to relieve my back, which they knew to be a weak spot. They inquired how my back was, and how the result of the back operation in 2011 had been. The climb on to the table was a difference with the 2011 operation, when I had been paralysed from the waist down by the spinal anaesthetic by the time I entered the operating room, so that they had to lay me on the table manually. Also, I was facing up now, as opposed to facing down for the back operation.

While my arms were placed in the intended rests, I began to tremble with cold, and they put a warm preheated blanket over me. The anaesthetist and doctor were called in, and asked me questions to verify my identity and the nature of my complaints and the operation I was expecting. I was assured that good care would be taken of me, and the anaesthetist said she was starting the narcosis via the drip in my hand. An assistant placed an oxygen mask over my face and advised me to think of nice things, so that I would have a nice dream. Initially I did not notice anything, but after about 45 seconds I felt a dizziness in my forehead. The assistant suggested I would close my eyes, which I did, and again recommended nice thoughts to obtain a nice dream. I apparently fell asleep then; this was my first general anaesthesia.

Waking up

I dreamt that people were standing at my bed and talking to me about an operation that was finished. With some amusement I thought this could not be true because the operation was still to follow later that day. After a few minutes I noticed a big white thing under my nose and began to consider it might be true after all, and eventually I asked if I was really waking up. Someone said yes, and I said I had been thinking it was a dream. "Yes, there is weird stuff in that anaesthetic", she said. I saw on the clock it was 16:00 hours. I heard someone say something about 5 mg of morphine in the drip.

I was now in the recovery room, with a number of other people. A bed arrived to my right with someone who had had a hip operation; perhaps the same person I had seen in the other room. I felt excellently and had absolutely no pain, nausea, or dry throat. I could breathe only through the mouth, but that did not bother me. I was asked if I had pain, and said no. I saw the clock advance toward 16:30, and around that time I was pushed back to the nursing department after removal of most of the appliances on my body, except for the drip in my hand which stayed in place.

Back to the nursing department

It was again a long ride back to the department. Once there, a nurse helped me out of the operation jacket and into a pyjama top; this is a somewhat intricate procedure after surgery because of the presence of a drip in the arm. I had brought an old pyjama, with buttons, that did not need to be pulled over the head. That had seemed wise, given the nature of the operation. Right thereafter, it was dinner time, and I was told I could eat. I thought it was a bit soon after the operation, but still I started eating just before 17:00 hours. The food — chicken with curry, rice, peas, and a dessert — tasted very well, in sharp discordance with the often heard claim of "If you can not smell, your food has no taste". In fact, I could taste the food exactly as well as always. I could not smell it, but I could taste it. I understood that people who say "If you can not smell, your food has no taste" are confusing smell with taste, that is, are suffering from a form of synaesthesia. I, as became clear to me then, do not have that mental shortcoming, and can distinguish between my senses.

Eating was a bit hard because of the thing under my nose, a kind of "moustache" attached behind the ears to catch blood coming out of the nose. I had to keep it up with one hand while putting food into my mouth with the other. The woman who had brought the food looked at me and said there was blood running over my cheek. She wiped it off with a tissue, and suggested I would leave the "moustache" off while eating. I tried, but put it back because blood kept running over my lips then. This would last for almost two days, and I had to regularly replace the "moustache".

To avoid stomach problems so soon after the operation I ate only half of what I got, but still, after eating I had a kind of pain and full feeling in the stomach for about 45 minutes, and for a while it felt like it would come back out. Next time I will eat even less, after general anaesthesia. I had not had this problem in 2011, after spinal anaesthesia. It was nothing serious though.

A bit before 19:00 hours I told the nurse I wanted to go to the toilet, and she fetched a drip pole on wheels and my pyjama trousers. I sat on the edge of the bed until I was certain I would not get dizzy, and walked to the bathroom. My mother and brother were just arriving for the visiting hour and had to wait in the corridor until I was ready (I had meanwhile called home to say that the operation was done and in which room I was). I did not succeed in urinating, which is a problem I had also had in 2011 after spinal anaesthesia. After some time I heard my mother say to the nurse, "Why does it take so long? Is everything all right?", and the nurse knocked on the door. I got off the toilet and went back to bed for the visiting hour. Close to 20:00, when the visitors had gone, I tried again and succeeded in urinating, with some effort. This was more than five hours after the beginning of the operation, similar to 2011, but on the whole it felt easier this time. All in all, I would say I slightly prefer general over spinal anaesthesia now because of the absence of the completely paralysed and numb sensation in the groin area which makes urinating so difficult with spinal anaesthesia. Relevant is also that my prostate has likely grown between 2011 and 2015, making it harder to urinate, so that the fact that I nevertheless managed to urinate in about the same time as in 2011 seems to imply that general anaesthesia hinders urinating less than does spinal anaesthesia, at least in my case.

Perhaps some background information is appropriate: in the bladder, near its exit, resides a muscle ("sphincter") that has to relax to be able to urinate. This muscle is under control of the parasympathetic nervous system; that is, one has no aware control over it. Certain substances used in anaesthesia, such as opioids, affect the parasympathicus such that this sphincter can not relax, is blocked, for some time, making it hard or impossible to urinate. The effect differs per individual, and most affected are men with prostate enlargement. Statistics show that urine retention (not being able to urinate) is somewhat more common with spinal than with general anaesthesia.

The first night and next day

Later that evening the drip was removed, probably because I indicated that I did not have pain, so there was no need to give me anything through the drip (I did get paracetamol now and then). I read in a book on the evolution of life I had brought with me, and listened to the radio a bit. They told me I would be allowed to go home the next morning, and have to return the day after that to remove the tampons from my nose. The night went not bad, although I did not sleep at all. I had throat candy with me and ate one now and then against the dry throat I got from breathing through the mouth. It was all bearable.

In the morning it took until about 11:00 before my papers and appointments were ready. Meanwhile I washed myself carefully in the bathroom, also removing the cream or ointment from my eyes that had been put there during the operation to keep the eyes from drying out. I had first noticed it the evening before. It reminded me of operations on animals I had seen on television. Two of the other patients were also going home, but the one of the back operation had to stay. A physiotherapist came to practice with him; I recognized the therapist from 2011, he was the same who had instructed me then after the herniated disk operation. The ear, nose, and throat doctor came by in the course of the morning and told me the operation had gone well and the septum had been corrected successfully. Eventually I was free to go and called a brother who came to pick me up. I had a number of "moustaches" with me for the rest of the day and night. I felt good, only eating was still difficult because of the thing under my nose.

In the evening when eating a pear, I felt something strange in the back of my left nostril, a kind of pain, as if a piece of pear had got into the nose. I tried to get it out, and ended up with a long string of something in my mouth, coming out of the back of the ceiling of the mouth on the left side. It turned out to be a kind of cotton wool; I understood the tampon on that side had unravelled a bit. It was the opposite of comfortable, and I was afraid it would go further and I would end up with the entire thing in my mouth. I called the hospital, and they advised me to go to the emergency room of the hospital, where one would be able to cut the thing off.

Since it might be unwise to drive that distance myself so soon after an operation, a friend drove me to the emergency room, and a few people looked into my mouth and confirmed it was part of a tampon that was hanging there. They cut it off and I went home again. The rest of the evening all went fine.

The second night and the removal of the tampons

That night I did succeed in sleeping, with some interruptions. However, while sleeping my mouth dried out tremendously, and a sore spot occurred in the back of the ceiling of the mouth on the right side, near the throat. It later appeared to be a kind of big mouth ulcer, and kept hurting very much for a bit more than a week when eating or swallowing. This was worse than anything from the operation itself.

Mouth ulcer in the back of the ceiling of the mouth on the right side (for the viewer left)
Big mouth ulcer in the back of the ceiling of the mouth
on the right side (for the viewer left).

Late the next morning a brother drove me back to the hospital, and in the nursing department the tampons were quickly pulled out while I was lying comfortably down on a bed. It hurt, but it was just bearable. Then, after waiting for half an hour in bed to see if the nose would not start bleeding, I could go home again.

Immediately after tampon removal, both nostrils were open well, especially the right one, which is the one that had always been more or less blocked. A few hours later though, both sides were mostly stuffed again, I think with snot, blood, and through swelling. I had to rinse out the nose twice daily with salt water, which went well for the left nostril. I could not get the water properly through the right one though (the water was supposed to come out of the mouth via the back of the nose). Over the next few days, a single drop of blood came out of the right nostril now and then, but otherwise all went well. The pain of the sore area near the throat was now the worst.

Appointment with the ear, nose, and throat doctor

Four days after the operation I saw the ear, nose, and throat doctor, who looked into the nose and said the septum was straight and without bulges. She sucked out both nostrils with a small vacuum cleaner, and now they were open well, like after tampon removal. Alas, a few hours later they were blocked again, although I could rinse out the right nostril correctly now. About two weeks later, the left nostril was reasonably open again, but the right one remained mostly blocked, I think because of swelling.

Until almost two weeks after the operation, blood clots kept coming out of the nose when rinsing with salt water. During the third week, the right nostril opened slightly more. I kept rinsing out the nose for about five or six weeks from the operation. The right nostril was still partly blocked for part of the time, probably due to swelling of the turbinates said the doctor. I tried using allergy pills for two weeks, but that made no or little difference.

12 weeks after the operation

Twelve weeks after the operation I saw the doctor who had operated the nose. He said the nose had healed well and I would not need to come back again. The right nostril is now clearly better open then before the operation, and almost as wide as the left one. Part of the time it is still partly blocked though, but that is in itself not a serious problem.

Regarding the slime running down my throat, or "post-nasal drip", the possible improvement of that is harder to observe. There is still slime, but a certain amount of that is normal, and I can not yet say definitely whether this has improved much. During the past few months, since the operation, I have been coughing somewhat less than usual, but I believe a longer period is needed to judge this with certainty. The winter and early spring are the hardest time for my nose and throat, and it is now only early December. I will report again on it next May or so.

Eight months after the operation

It is now May, the cold part of the year has finally ended, and it is as follows: The right nostril is better open than before the operation, but not as good as the left one. In the daytime I can breathe well through the nose, at night in bed I can sometimes breathe through the nose, but part of the time I still need to breathe through the mouth. This does not seem to cause severe discomfort though.

Regarding the slime running down the throat and the coughing, as such I do not notice any improvement to that, which is somewhat disappointing because it was the primary complaint. I do not worry much about it any more though, perhaps because I know I have done what I could to improve it by undergoing an operation.

Remarkable is that I have not had a regular cold yet since the operation, which may be a good sign in itself. I have also not had much irritation of the ceiling of the mouth or the throat this winter. On the whole, the nose, ceiling of the mouth, and throat have felt better this winter than in the past.