Talk me into or out of surgery

[robbob2112]

Interesting reaction to Azelastine HCI, I used it for a few years before my septum surgery and all it left was a bad taste in my mouth.  You may wanr to see if your insurance covers Dymista, it is a combination spray of Azelastine and Flonase.  It was insanely priced when it came out but should be better now as a generic.

[ejbpesca]

Interesting reaction to Azelastine HCI, I used it for a few years before my septum surgery and all it left was a bad taste in my mouth.  You may wanr to see if your insurance covers Dymista, it is a combination spray of Azelastine and Flonase.  It was insanely priced when it came out but should be better now as a generic.

I use Azelatine more than Flonase so I keep them separate.  Doc says, "Just spray it, don't sniff it up the nose." Why? Due to a bad taste, he explained.  I never experienced that taste,  and I snort/sniff the stuff up as far as possible for it to do what it does well.  Clear out the surroundings.  Maybe a nasal water irrigation pump device would also clear out the sinuses but the spray med also is an antihistamine that keeps my allergy symptoms at bay.  Air-born allergy test results = allergic to everything in the air here, the allergy capital of the universe.

[Sleepster]

He said he's got a better way now, done endoscopically, where the excess flesh is sucked up similar to lyposuction, and the bone is adjusted with a combination of small fractures and ultrasonic shaving if needed.

I was told a similar thing by a surgeon a couple of years ago. She said that I wouldn't be able to use my CPAP machine for a period of time after the surgery due to the risk of air being pumped through an unhealed bone fracture into my brain.

[BoxcarPete]

It's update time! Had the surgery on Friday morning, and so far, so good. Had quite a bit of post-op bleeding, which the doc told me to come back to the hospital for in case he needed to do anything more as he was there all day for other surgeries. Ended up slowing way down on its own a few hours later which is good, so I was sent home again. Bit of a restless night spitting blood into a trash can though.

Second night was better, very little blood anymore, and at this point I can already tell that it's making a difference. Had a night that I would describe as average in restfulness last night, which is not too bad for two days after the procedure!

I know most of the folks here don't believe that surgery can cure sleep apnea, but in my situation there were multiple obstructions all stacked up near the back of my nose, made from stuff that a few cmH2O can't push out of the way very easily. Steroid sprays don't move your bones either, and made me lightheaded anyway. The doc said it all cleaned up nicely, and I can feel that it's true. 10/10 would do again.

[SarcasticDave94]

If it works and you're happy with results that's good enough. Best wishes you mend quick.

[Sleeprider]

I hope your outcome matches your expectations and early results in the long run. I for one was supportive of this in your case. It may be a month to fully heal, and it will be interesting to compare results.

[dwedward]

Pete,

Please give us a few updates on how its going.  Maybe even with some charts from OSCAR or SHQ?

I'm looking at a similar surgery.  I have a "significantly" deviated septum and enlarged turbinates.  I'm going in for a CT scan and will see the ENT again in 2 weeks to decide.  I have a separate sleep doctor (the ENT is both), so I've asked her opinion.  However, I tried some nasal dilators based on a comment from Jay in another thread.  Last night, 0 AHI, with minimal flow limitations, and almost 2 hours of deep sleep.

If that's the result of just a dilator up my nose, then I imagine the surgery will be positive.

So, it would be great to continue to hear how you're doing, and if you have "before" and "after" charts from OSCAR.

Thanks!!

[BoxcarPete]

No charts yet, but it's something that I'm interested to do as well. Recovery has plateaued for now, the worst part is the feeling that my ears need to pop but are clogged up, and I can't hold my nose to blow them open. Can't hear properly, and annoying minor balance issues, but I tend to get dizzy and lightheaded on corticosteroids anyway, which they have me on to keep swelling to a minimum. Luckily I have a good book to read and work is pretty slow, so everyone knows that I can be bothered if they need something but otherwise I'm just kind of hanging out in my office.

One thing my ENT said is that it's not always the sheer size of the turbinates, but he's noticed a pattern in the position being placed farther back in the nose for apnea patients compared to others. This, combined with my extra adenoid tissue, was piling up all my obstructive tissue right where nose met pharynx. The other thing that I experienced that may be unusual for other folk here is that my PSG showed events ONLY in REM sleep, but they clustered like crazy. Once I got on CPAP I mostly saw isolated events here or there, but using a FFM several nights that look just like my PSG, with mostly clean sleep and a couple gnarly clusters. Using a nasal mask, I didn't see clusters so much.

One other thing to note is that I showed a smaller than expected tidal volume for my size, along with the bare minimum minute vent according to my weight. I have seen examples in my charts of spontaneous arousals that appear for no reason that I can identify other than the possibility of simple under-ventilation. Last night I was laying in bed and wished that I could have measured my breathing pattern, though it felt like more air was flowing through. I blocked one nostril and suddenly my breathing pattern became familiar: it's almost exactly how I felt before surgery! My breathing naturally sped up and got much shallower, then I unblocked the left side and suddenly more air was flowing and it felt more natural to breathe more slowly and deeply.

[BoxcarPete]

We are at the two-week mark now, and I went back on PAP because once I ran out of steroids the post-op swelling started to kick back in and I felt my sleep quality getting worse. I went with 8.6 because prior to my surgery I found pressures in this range to be quite tolerable, and personally find a constant pressure more comfortable than an APAP range. There is a 20 minute gap where I woke up with some nose irritation and dozed off with the mask loosely laying on my face and the machine off. I hooked it back up and the rest of the night went fine.

Without further ado, findings from night 1:

1. Leaks. Yes, I used tape, but as you can see in my pre-op chart I still had leaks. Post-op? None, zip, nada, nunca, arimasen. The 99.5% leak rate is 0.0 L/min. If you saw my early charts, you would know how much of a game changer this is for me. I was a little skeptical that cleaning up my nose would have much effect on mouth leaks, but my ENT said it would help and he was right.

2. Greater ventilation. This is something I had my eyes on, and was immediately apparent. In my first chart, the last night I used CPAP before the surgery, respiration is 15/min with TV of 460. This increased by 10% to 500, with a slightly increased respiration rate of 15.8, which together resulted in a higher minute vent, and fewer spontaneous arousals. I had suspected that some of my spontaneous arousals were related to simple under-ventilation, and so far it looks like I may have been on the right track.

3. Lower flow limits. We have gone from 0.15/0.39 to 0.04/0.25 after the surgery, and that's with a pressure reduction of 1cm H2O as well. Recall that I was feeling that my sleep quality was acceptable for several days before running out of anti-inflammatory drugs and feeling the need for PAP again. As the inflammation goes down further over the next month or two, I expect this one to continue to get better.

I will say it to anyone who will listen: if CPAP is not working for you, or it's only working a little, GO GET SCOPED! You never know what's up there till you find out, and a few weeks of suffering is nothing compared to the lifetime of misery you can avoid by fixing your problem at the root if it turns out you do have easily corrected obstructions.

[punkrockcholo]

I just want to say congratulations! Sounds like your surgery was a success!