Wednesday, January 23, 2008

Day 14 ... and I am Healing Well

Today is day 14... I was back at the ENT Centre to see Dr Tan for my review. I could feel the development of some crusting in my left nostril and was actually looking forward to have more of the bunk in my nose cleared. Overall, I have been feeling great. The inside of my nose still feels a little sensitive to touch and I have careful not to let any "trauma" happen to my nose. With 3 growing up kids and handling them, such a chance is actually not remote. When I am upclose with my children, I always warn them ahead "be careful not to hit papa's nose...". So far so good.

When it was time for me to see Dr Tan, I sat down as usual on the ENT chair. Dr Tan sprayed my nose and told me that he will proceed with cleaning and suction in a short while. The nurse manager came by to ask if I had taken my breakfast. She remembered that during my last visit I was dizzy during the nose toilet procedure partly due to the fact that I had an empty stomach. I assured her that I had taken my breakfast - I need to eat breakfast because that was a requirement before taking my antibiotics.

The suction began... with the scope down my left nostril first, I saw my nose upclose and personal again. The loosened crusts were picked up, the mucous sucked up, the old blood from surgery picked up. There were some areas that Dr Tan told me that he does not want to touch today as they may need some time to heal.

He went on to the right nostril. As he navigated the scope, he showed me where he had shaped the turbinate, the incisions that he made, the stitches and finally he navigated to the entrance of my bottom right sinus. There he picked the remnants of a blood clot from the surgery, he sucked it up, then came more...he sucked and he pulled, more came out and even more came out. In the end, a large blob of darken blood clot came out and my nose was even clearer! What a wonderful sensation!

Dr Tan told me that this is the reason why he emphasised post surgical cleaning of the nose. I am delighted that I am in good hands!

So, my journey through healing is almost coming an end... and the sun is shining bright!

3 more days of antibiotics to go... and next week I will be going back to see Dr Tan perhaps for the last time to do a final clean-up for my nose.

I am grateful for the offer of hope by Dr Tan nam Guan and his professional hands. To all the other caregivers in Singapore largest hospital, thank you so much for being part of such a special team providing best outcome, best experience for our patients!

Sunday, January 20, 2008

Day 8 went by without a hitch

Day 8 went by yesterday without a hitch! Still flushing my nose 3 times daily with sodium bicarbonate wash and continuing with the antibiotics.

The one thing that I did noticed was that I noticed some crust buildup in my left nostil that could not be removed with the flushing. I guess I will just have to wait for my next visit with Dr Tan and have them cleared during the nose toilet session.

As it was a saturday, my family had our usual weekly dinner gathering at TMCC with my in-law family. My nose became the centre of interest. They were interested in how the surgery went and more importantly was it effective. My brother-in-law enquired on how to make an appointment with Dr Tan for his friend who has been suffering the same for many years. I can tell, more people need the help that I got.

I will be happy to have a chat with anyone who wants to talk about the surgery and the comfort that it brings. Have a great weekend!

Friday, January 18, 2008

Day 7 - I am getting used to my new lease of breath

Today is Day 7... and I am now officially up to date with my blog. Frankly I am beginning to enjoy this written expression and that I am doing something good (at least from my opinion) out of the experience that I went through.

Day 7 was a non-event. I got into the routine of flushing my nose with the sodium bicarbonate wash 3 times daily, continue with my antibiotics and going about with the consciousness that I do not accidentally hit my nose. No pain, full flow of air into both sides of my nose and frankly I am beginning to get used to my new lease of breath! I am now fully on the road to recovery! Hurray!!

I may try to restart my exercise regimen tomorrow... provided my wife does not protest. Officially, Dr tan told me not to swim and exercise within the first week of my surgery, but tomorrow is Day 8 and I am off the hook!

Day 4 - What's happening, my nose is blocked again!?

I woke up on Day 4 and realised that my mouth was dry and I was struggling to breathe. Soon I realised that my nose was completely crusted up on both sides - if I try hard enough only a tiny stream of air managed its way through the nostril. What's happening!? The surgery did not work? Oh no!!

I sms Dr Tan, I told him what was happening and asked him what should I do. His reply came..."You have a post op nose. Come in to my clinic and I will clean you up. You will feel much better after that".

By 9am, I was at the clinic... Dr Tan waved to me when he saw me along the corridor. He sat me on the ENT chair, used a scope and looked into my nose and smiled. He started the Nose toilet procedures. Chunks after chuncks of crusts were taken out and instantaneously I felt much better. I could breathe freely again! He said "I may have to do this a few more times over the next 2 weeks and you will feel better". I thanked him and left.

What a close call? What I experienced was normal post surgery... It can be frightening but it is alright...

Day 3 - the Packing comes out and the air goes in

Day 3 was an expectant day for me. Dr Tan told me that the packing that has remained in my nose for the last 48 hours will come out and that I will feel much better. After breathing through my mouth completely for the last 48 hours, I was literally counting the minutes for the doctor to arrive.

The nurse came at about 6.30am in the morning and call out in a soft voice to me..."Mr Foo, sorry to wake you up from your sweet dreams. I need to prepare you so that Dr Tan could remove the packing from your nose at about 7...". She gave me my change, asked me if I needed help to wash up (...I declined) and told me to push the call bell when I am ready so that she can give an injection of pedadine for some pain relief when the packing are being taken out.

I took a hot shower, careful not to wet my nose and the "nose tampon". The nurse came gave me the injection and within 10 mins I was feeling sleepy from the shot. I was told to lie in bed and not move around by myself... as usual I obeyed...

Dr Tan was busy, so he sent his registrar. The doctor assured me "...I have done this many times, don't worry." I was asked to sit upright and held a tray below my nose. He sorted out the strings that were attached to the packing in my nose to make sure that they do not tangle together as they were being removed. He started with the left nose. He held on to one of the string and with the hand on my nose, he gently pulled out the first packing.

The feeling was very very strange but not painful at all. It is not common to have a piece of sponge like packing about 6-7 cm long slide along the wall of your nose. Frankly, it felt like a very thick of mucous being dragged out from the nose. For the chronic sufferers, you know what a nice feeling that would be. next came one packing from the right nose, then the left and then finally the right again... now all the packings were out, stained with blood and mucous. Then the most amazing thing happened, air gushed into my nostril, my sinuses were filled with air for the first time in many years and my lungs fell open... I thank God for the success of the surgery...my worries were completely wiped away.

The doctor told me to hold the tray below my nose for the next 10 mins as it is common for bleeding to occur when the packings are taken out... but he was wrong because there was none!!

At 11am, I was told that I could go home. My medicine came... a 2 week course of antibiotics (amoxylin), some panadol for pain relieve and if the pain got bad I was given acoxia as well.

The hardest part is now over, all I need to do is to rest and recover...

Day 1 (Surgery)... The Suspense, Ice Cream and Worry

Day of surgery came on 10th Jan 2008, a Thursday. I had my last meal at 6.30am with a piece of toast and a cup of coffee. This was the pre-op instruction given to me during my pre-admission testing. I was told, take a sip of water at about 9:30am if you really need it or gargle your mouth with water if you are really thristy because my surgery was scheduled at 1pm.

I packed my bag, threw in my laptop, brought Atul Gawante's book on Better and Fred Lee's If Disney Ran your Hospital in anticipation that the surgery would be small deal and would soon find myself doing some good readings (I was wrong... but read on).

At 11.30am, I arrived at the hospital as a Same Day Admit (SDA) patient. The SDA is really good because patient is spared the anxiety of being admitted the day before surgery and of course the cost of one day stay as well. Given how busy Singapore"s public hospitals are, one day saved is an available bed for another patient, perhaps through the A&E, who needs it more. I was welcomed by the nurses and got settled in my room.

The nurses began to prepare me for surgery. In hospital language, the "clerking" process started. I began to find that it is really a little awkward being hospitalised in the same hospital that you work in, no fault of anyone, just the need to answer even very basic questions that we don't talk openly about... "How many times do you move your bowels everyday?", "Do you have any false teeth?"... Soon all these were over, and the reality of going for surgery soon sank in. My wife, who was with me said a prayer for me and asked for God's protection as I enter for surgery. Even though I tried not to think about it, I could tell I was anxious. It was helpful that the nurses dropped by my room regularly to keep me informed every step of the way... trolley on the way, your surgeon has arrived in the OT. The sense that everything is in order and that the hospital was ready for me was very comforting.

The trolley soon arrived to bring me to the OT... I traversed corridors horizontal and picked up a few tips... we need to make our ceiling more interesting... we also need to make the gaps between the floor tiles much smaller so that the wheels do not bumble along when the patient is being wheeled to and from the OT. Just before I entered the OT, I realised that a regular picture on the wall was missing... I thought just let go now, remember you are going for surgery!

At the OT, I was given a hair cover, I slipped it on and with a few verifications on my identity and purpose of my surgery, I was confirmed as the right patient and sent to the operating theatre. Two senior nurses were with me in the prep room. It helped that they kept me mentally occupied by telling me jokes. The anesthetist came in, set the plug, gave me an injection and then came by Surgeon Dr Tan. He asked me what do I want as the ideal outcome of this surgery... I said no congestion, that I can breathe well with both sides of the nose and not be miserable from the post nasal drip, infection etc. He smiled at me and said let's go...

I was transferred to the operating table. There is this roller that was put behind my back and as I slide over to the op table, it was this massage feeling... I thought what a way to start the surgery, with a massage! The anesthetist told me to breathe in the oxygen through the mask and that I will soon sleep. I took one deep breath preparing that I would be knocked out but I did not, I took a second but I was still awake, so I took a third and I did not remember anything after that (i was later explained that the "breathing part" was a decoy, the real thing that sent me to sleep came from an an injection into my plug on my hand...).

Between going to sleep and becoming wakeful, I could not remember anything...which was great! "Mr Foo, the surgery is over, everything is ok, we will be pushing you back to your room..." came the voice presumably from an anesthetist. I wanted to respond but felt almost completely immobilised... plus I was feeling really dizzy.

The journey on the trolley back to my room was a most uncomfortable one, mainly because I was feeling nauseous plus I hated the bumpy ride due to the big gaps on the floor tiles... I must do something about it!

I soon realised that my surgery had lasted 5 hours as my nose was woozy. My wife and children were already in the room waiting for me. The comfort of my wife's hand on mine was most welcoming. She stroked my forehead and said that I am fine. I was told that my daughters were both too afraid to look at me as I looked weak - not something they were accustomed to. But my dizzy spell was so distracting. I decided that it must be due to the long period between meals and that I am probably dizzy due to being "low on sugar". I told my wife to ask the nurse for something sweet, like coca cola and have it smeared on my lips. My wife came back with ice cream, provided by the hospital. The sugar from the ice cream did wonders and within minute I gained energy and was soon feeling much better.

To stop the bleeding post surgery, my nose was packed to the brim and I had to breathe completely through my mouth. With a Nose "Tampon" located just below my nose and above my moth to catch the blood and mucous, I felt kind of strange. When I thought about what the surgery could bring me, this is a small price to pay. At about 10pm, my surgeon Dr Tan came to see me perhaps after attending a function or dinner. He updated me about the surgery and assured me that the surgery went well. My confidence swelled plus I am thankful that Dr Tan would find the time to see me at such late hours...

Throughout the night, I kept sipping on water tinged with organge syrup as my mouth was very dry. This produced a side-effect... that I need to pee. The problem is that I did not have enough energy to walk to the toilet myself to pee (neither am I allowed) and also do not want to have the prospect of nurses whom I know help me with such basic instinct like peeing. The urge soon grew so great that my shyness soon gave way. I asked for a urinal instead and decided to pee while in bed. I pushed the nurse call bell, the nurse turned up within 20 seconds, handed me the urinal and she politely asked if I need help with the urinal. My immediate reply was "NO" even though I have perfectly no idea how to "do it". After the nurse left the room and pulled the curtain, I quickly set my brains into action... I slanted my body slightly to the right, position the urinal and found relieve. One problem is that in a lying down position, one cannot empty the bladder fully... I think need most gravity help or what. Throughout the night, I had to ask for the urinal 5 times as I did drink plenty of water as I had to breathe through my mouth.

Oh, did I tell you one of the most important thing to bring for your admission? For me, it was my own personal favourite Tempur pillow... can't tell you the difference it has made to my rest :-)

Day 2 morning came quickly. The medical team on call from ENT came, saw me briefly and said that I am doing well. They tole me that Dr Tan would be coming to see me soon. Dr Tan soon came, told me to stay another day because he wanted to leave the packing in my nose for another day as my wound was woozing during surgery and it was better to make sure that the bleeding stopped. I agreed. For the rest of the day, I took my regular antibiotics and pain killer and watched TV... another luxury that I don't have in normal daily life. Friends, colleagues, family members stream in during the course of the day to see me. All this made me thankful for the gift of family and friends! The effects of the anesthesia lasted through the second day... I was sleepy and dozed off every once in a while. Not only did I missed colleague's visit in the process but I did not find the energy to read (remember the books and laptop that I brought...) or anything else.

Quietly, I was beginning to worry if the surgery would work as I was not yet breathing through my nose... I remembered my wife's prayer for me, and faith rushed back into my heart. I will be well...

Thursday, January 17, 2008

Watch this video to understand what is a balloon sinusplasty...

Balloon sinuplasty is a new but less invasive procedure - part of the surgical combo that I went through to clear my sinuses. The video may take some time to load but well worth it. I do not personally endorse the company who invented the balloon sinusplasty medical device but am glad they did come out with something that could help patients, like me.

Day 5 and 6 - The Splints are out and the Nose is Clear!

It is already Day 6 today and I have yet to start on Day 1! I guess it will take me some time to get used to the rhythm of blogging...

The splints - 2 pieces of plastic about 5 cm long - came out of my nose yesterday. They were put in my nose to line my straightened Septum post surgery for support and continue to keep my "new" septum in line. Taking them out was quite an experience. The splints were well anchored in the flesh of my nose after 5 days and taking each out inevitably mean some scratching of the nose inner surface. The feeling sent tears down my eyes - I didn't cry, just the automatic trigger as the nose and eyes are related.

Next came the "Nose Toilet" - a term that I thought was quite accurate and interesting. Here is what it means... after surgery, blood clots and mucous as part of the healing process and exposure to new found gushes of air caused quite a bit of "crusting" in the nose. These crusts are known in common lingo as "noise shit". Because there is so much crust in the nose, breathing may be impeded. Hence, the need for nose toilet. My surgeon Dr Tan, skillfully put me on a ENT chair, navigated a scope down each channel of my nose and sucked up the "debris". There were huge pieces of crust and for these he would use a combination of scope (to introduce light and visibility) and a caliper to bring the "rubbish" out. With the suction and removal of the crusts, I could instantaneously feel the gush of fresh air through my nose, filling my lungs.

The nose toilet session is not all plain sailing. I experienced some bleeding and at a certain point, I suddenly felt dizzy from the pain. After Dr Tan applied some pressure on my wrist, I was better within 3 mins. He told me that such is a natural body reflex, when the body encounters some pain or bleeding, and it may trigger a reduction of blood pressure leading to sudden dizziness.

The bleeding stopped after some packing were introduced into my nose and removed after 1 hour. Before I went home, I was given a prescription comprising Sodium Bicarbonate power. This is to be mixed with 250 ml of water each time and used to flush my nose 3 times per day with the help of a syringe. This would help alleviate crusting and keep the nose clear all day.

That is all I have been doing for Day 6 (today) - flushing - not a very complimentary term especially after my description of a nose toilet. I realised that flushing with sodium bicarbonate really works. The crust seems to "melt" and cames out mixed with mucous. I am really excited about my new found freedom in my nose!

By the way, I met 2 staff yesterday as I was waiting around the clinic for the packing in my nose to be removed. I soon found out that they too have loved ones who have been 'suffering" the way I have been for many years. They are keen to see if their loved ones could benefit from treatment.

Tuesday, January 15, 2008

Why did I start this Blog?

I just had an amazing experience. For the first time in the last 25 years, I could finally SMELL THE ROSES... For those of us who have taken nice big breath of fresh air through your nose for granted, you may find my expression of esctasy hard to understand. I don't blame you.

In medical terms, I had just gone through 3 surgical procedures on my nose - a balloon sinuplasty, septoplasty and turbinate surgery - the combination designed to clear my sinuses so that I may breathe properly.

In layman's terms (I like this better...), perhaps 3 highways to my 4 sinuses are "jammed" and needed to be cleared. Otherwise, I experience what is known as chronic sinusitis, and with post nasal drip of the mucous back to my throat when I sleep, I get the "regular cough", throat infection and flu like symptoms.

I have suffered these nasty symptoms plus regular running rose, continuous sneezing, itchy eyes, congested nose (at least one side of my nose will be blocked at any given time)... for the last 25 years. I have accepted it as a way of life. I have been told all through the years that I have allergic rhinitis - a common ailment. Other than the usual medicine including steroids to relieve the symptoms, there is nothing much else that can be done. Breathing through my mouth when my nose was not working became the norm!

But I know that I am not alone. I know of many others who suffers the same. Some more diligent with their medicine, others tried some form of surgical intervention like "laser" (like I did some 15 years ago without any effect) and got discouraged, and many got tired (like I did) and just live life with the condition without medication. In fact, I have some friends who are waiting to see "how things go with my surgery" before they decide for themselves and/ or their loved ones and friends.

In November last year, I decided that I will do something about my condition. I signed up with Dr Tan Nam Guan from SGH for surgery. On thursday 10th January 2008 I had my surgery - determined the start 2008 on the right note. Today is the 5th day post surgery and I can tell that the surgery was a success. Now I can breathe through both sides of my nose... it is a wonderful feeling being able to fill your lungs with each breath...and I must say that this is so energising! My nose still bleed a little off and on, it still hurts but I already tell that this is all going to work out. Had I known this, I would have done the surgery a long time ago... so this is reason number 1.

Reason number 2 is that planning for surgery was a source of anxiety for me - who wouldn't be... Even though my doctor has been most helpful and forthcoming with information, I wanted to be able to hear the information from a patient's perspective - was the surgery painful? how did they feel post surgery? could they breathe immediately or was it a long process of healing? I surfed the web but found little. Now that I have gone through this procedure personally, I can share with others who may be searching for the same information.

Suffering from allergic rhinitis and chronic sinusitis is not a life threatening ailment but they are personally and socially debilitating. I felt tired from the symptoms. I have little energy left after an "attack" to play with my kids, spend time on things that I like to...If my experience is anything to go by, there is HOPE. Smelling the Roses, through your Nose (wow they rhymm...) is possible.

If you have something similar to share, pl add to this blog. Over the next few days, I will be adding to this blog detailing my experience from surgery to recovery. This is a way for me to keep myself occupied as I recover at home. Cheers!