Question:
First, the vitals… 34 y/o male, obese, CPAP via nasal interface @ 10 cm H20. In third month of CPAP. I have intermittant difficulty breathing nasally, which obviously interferes with the CPAP therapy. I take Nasonex, which provides some relief. I have also started a course of allergy shots. I have frequent sinus headaches, usually during high-to-low atmospheric pressure changes. After a CT and physical examination, my ENT determined I have a deviated septum, enlarged turbinates, and congested ethmoids. He was suprise that my maxillary sinuses were clear. He recommends one surgery to correct these problems: correction of the septum, enlarging the drainage opennings of the ethmoids and breaking up the honeycomb of bone in the ethmoids, and reducing the turbinates. He plans to pack my nose with dissolving packing, rather than the apparently more common materials that must be removed during an office visit. I expressed concern about having apneas during recovery, as I will not be able to breathe through my nose until the packing comes out. He did not seem concerned with the fact I had an average of 74 hyponeas/hour and 78% Oxygen saturation during my sleep study. My pulmonary doc perscribed low-flow Oxygen for me after the surgery, but the ENT was ambivelent about it. I am also concerned about the use of dissolving packing. I suspect he plans to choose this so I don’t need to make an office call Christmas week (on a previous visit, prior to an ultimately cancelled surgery time, he said I would need to see him two times shortly after the surgery for packing removal). The ENT said he would prescribe Tylenol with codiene for post-op pain relief, which strikes me a little weak. I generally have to take two Vicodin to surpress occasional severe headaches, and the pain never really goes away, it is just dulled. He said he could prescribe something stronger if necessary(!) He plans to perform the surgery under general anesthetic, which is also a source of concern. I believe I could tolerate being worked on during a local, but he won’t discuss that option. I obtain a second opinion from another ENT. He was very milquetoast about it. He said I could have the surgery, or not have it…it was up to me. For this they get paid the big bucks? Any comment and guidance would be much appreciated. My wife is of the opinion I should wait until early spring to have this done, after the flu/cold/etc. season has passed. TIA! Aric
Response:
In article <e970d4d.0312170850.1b823…@posting.google.com>, usenet_tar…@yahoo.com says… > First, the vitals… > 34 y/o male, obese, CPAP via nasal interface @ 10 cm H20. In third > month of CPAP.
<<<snippage>>> > Any comment and guidance would be much appreciated. My wife is of the > opinion I should wait until early spring to have this done, after the > flu/cold/etc. season has passed.
Much as I hate to say it… listen to your wife <g>. At least for this situation. Your first ENT sounds like he needs a boat payment or his country club fees are due soon. Doesn’t particularly have that patient- first sound to me. The second ENT sounds almost as bad- just that his golf and boat payments are probably up to date. Neither of them would be MY choice to listen to or have slicing and dicing MY face. Can your pulmonologist suggest an ENT for you? Might be nice if the 2 specialists would talk to each other- yeah? Cynical- hell yes. I’ve seen too many greedy or ambivilent doctors of late to be otherwise. Get a third opinion, or more until you find a doctor willing to listen to YOU and your concerns- especially with local vs general, and after-surgery O2 and care. Another reason to wait is that winter pressure changes may level off in the spring- fewer changes may help the situation, and being past the cold/flu/crud season will lessen chances for other infections. Good luck and happy, safe and healthy holidays, vic
Response:
- Hide quoted text — Show quoted text -Aric wrote: > First, the vitals… > 34 y/o male, obese, CPAP via nasal interface @ 10 cm H20. In third > month of CPAP. > I have intermittant difficulty breathing nasally, which obviously > interferes with the CPAP therapy. I take Nasonex, which provides some > relief. I have also started a course of allergy shots. I have > frequent sinus headaches, usually during high-to-low atmospheric > pressure changes. > After a CT and physical examination, my ENT determined I have a > deviated septum, enlarged turbinates, and congested ethmoids. He was > suprise that my maxillary sinuses were clear. He recommends one > surgery to correct these problems: correction of the septum, > enlarging the drainage opennings of the ethmoids and breaking up the > honeycomb of bone in the ethmoids, and reducing the turbinates. He > plans to pack my nose with dissolving packing, rather than the > apparently more common materials that must be removed during an office > visit. > I expressed concern about having apneas during recovery, as I will not > be able to breathe through my nose until the packing comes out. He > did not seem concerned with the fact I had an average of 74 > hyponeas/hour and 78% Oxygen saturation during my sleep study. My > pulmonary doc perscribed low-flow Oxygen for me after the surgery, but > the ENT was ambivelent about it. > I am also concerned about the use of dissolving packing. I suspect he > plans to choose this so I don’t need to make an office call Christmas > week (on a previous visit, prior to an ultimately cancelled surgery > time, he said I would need to see him two times shortly after the > surgery for packing removal). > The ENT said he would prescribe Tylenol with codiene for post-op pain > relief, which strikes me a little weak. I generally have to take two > Vicodin to surpress occasional severe headaches, and the pain never > really goes away, it is just dulled. He said he could prescribe > something stronger if necessary(!) > He plans to perform the surgery under general anesthetic, which is > also a source of concern. I believe I could tolerate being worked on > during a local, but he won’t discuss that option. > I obtain a second opinion from another ENT. He was very milquetoast > about it. He said I could have the surgery, or not have it…it was > up to me. For this they get paid the big bucks? > Any comment and guidance would be much appreciated. My wife is of the > opinion I should wait until early spring to have this done, after the > flu/cold/etc. season has passed. > TIA! > Aric
Did your pulmonologist agree with the ENT? De your pulmonologist see the CT. Did the ENT also do an endoscopy? Did he write a report. Did your pulmonologist read it? Can you find a pulmonologist diplomated sleep doc for consultation, i.e. look at CT, reports, etc. http://www.absm.org/Diplomates/listing.htm You sound intelligent enough to understand what you need to do, based on the questions above. If not, repost with any additional questions you may have. HTH
Response:
- Hide quoted text — Show quoted text -Aric wrote: > First, the vitals… > 34 y/o male, obese, CPAP via nasal interface @ 10 cm H20. In third > month of CPAP. > I have intermittant difficulty breathing nasally, which obviously > interferes with the CPAP therapy. I take Nasonex, which provides some > relief. I have also started a course of allergy shots. I have > frequent sinus headaches, usually during high-to-low atmospheric > pressure changes. > After a CT and physical examination, my ENT determined I have a > deviated septum, enlarged turbinates, and congested ethmoids. He was > suprise that my maxillary sinuses were clear. He recommends one > surgery to correct these problems: correction of the septum, > enlarging the drainage opennings of the ethmoids and breaking up the > honeycomb of bone in the ethmoids, and reducing the turbinates. He > plans to pack my nose with dissolving packing, rather than the > apparently more common materials that must be removed during an office > visit. > I expressed concern about having apneas during recovery, as I will not > be able to breathe through my nose until the packing comes out. He > did not seem concerned with the fact I had an average of 74 > hyponeas/hour and 78% Oxygen saturation during my sleep study. My > pulmonary doc perscribed low-flow Oxygen for me after the surgery, but > the ENT was ambivelent about it.
Two suggestions: 1. Have your ENT discuss the surgery and post-op care with whatever physician (pulmonologist presumably) is treating your apnea. They should agree on a COMMON treatment plan. 2. Instead of doing the sinus surgery on an outpatient basis, ask your ENT about staying in the hospital for a night or two so that your apnea can be monitored. If something goes wrong, they can spot it and deal with it. Your ENT should be able to convince your health insurer that your apnea necessitates at least one overnight stay in the hospital. — Steven L.
Response:
On 23 Dec 2003 16:11:30 -0800, turbina…@hotmail.com (turbinates) wrote: >I ‘ve just read an paper on nasal packing (in Pubmed). It said that >the packing is only good to control bleeding. Adhesion rate is the >same for packing and non pakcing patients. Packing causes more >discomfort and can be damaging…
Yes I believe that that is the current view….
Response:
Don Brady <dbr…@pobox.com> wrote in message <news:e9p7uv4rr4sarlvk443dcfuc291auv4ppq@4ax.com>… > On Fri, 19 Dec 2003 21:33:57 -0800, nos…@nospam.com wrote: > >Having that packing taken out is supposed to be pure hell… > It really didn’t bother me at all – one quck pull…….
I had no packing at all even though three turbinates was resected and a significant amount of cartilage was removed? I am unable to work this one out…
Response:
On 23 Dec 2003 05:05:18 -0800, turbina…@hotmail.com (turbinates) wrote: >I had no packing at all even though three turbinates was resected and >a significant amount of cartilage was removed? I am unable to work >this one out…
I tihnk that some surgeons do not use packing much. Actually, mine only uses it for some patients - I think part of the reason was that I had a septal correction…… It as removed the next morning…
Response:
Don Brady wrote: > On 23 Dec 2003 05:05:18 -0800, turbina…@hotmail.com (turbinates) wrote: >>I had no packing at all even though three turbinates was resected and >>a significant amount of cartilage was removed? I am unable to work >>this one out… > I tihnk that some surgeons do not use packing much.
My surgeon didn’t plan to use packing with my surgery. When I woke up in the Recovery Room, I had no packing and my nose felt clearer than it had been in years. Unfortunately, I had so much post-nasal bleeding that my surgeon was forced to put packing in. — Steven L.
Response:
Don Brady <dbr…@pobox.com> wrote in message <news:ne5huvgmamhrb5didcmek882u5nkmjjrps@4ax.com>… > On 23 Dec 2003 05:05:18 -0800, turbina…@hotmail.com (turbinates) wrote: > >I had no packing at all even though three turbinates was resected and > >a significant amount of cartilage was removed? I am unable to work > >this one out… > I tihnk that some surgeons do not use packing much. > Actually, mine only uses it for some patients - I think part of the reason was > that I had a septal correction…… It as removed the next morning…
I ‘ve just read an paper on nasal packing (in Pubmed). It said that the packing is only good to control bleeding. Adhesion rate is the same for packing and non pakcing patients. Packing causes more discomfort and can be damaging…
Response:
On Fri, 19 Dec 2003 21:33:57 -0800, nos…@nospam.com wrote: >Having that packing taken out is supposed to be pure hell…
It really didn’t bother me at all – one quck pull…….
Response:
I have had two sinus surgeries, the first three years ago and the second a year ago. My sinus surgeon commented that my CT scans looked like a poster for sinus disease. He showed me some sample images on a poster used to educate patients, and mine definitely looked as bad or worse than anything on it. Today, I feel fantastic, with very, very few sinus problems. In fact, I feel better, sinus wise, than I have in thirty or so years. I can smell things fine, very rarely get infections, and don’t do much in the way of maintenance. I do irrigate with the Grossman unit (nice device, but tough to keep clean