I can't breathe through my nose (Part 3)

Continued from Part 2.

Turbinate reduction surgery

First, a digression. Midway through grad school, my anxiety shot through the roof and I started having panic attacks every day. Minor panic attacks were nothing new to me. I've struggled with some level of social anxiety for as long as I can remember. Raising my hand in class or meeting someone new would always send me into an anxious spiral. During grad school, anxiety over my thesis and ultimately the direction of my life become overwhelming, and I became constantly anxious.

Most of all, I was afraid that I would need to start an anti-anxiety medication. Looking back, I had no reason to be afraid, but I had built up the idea of taking medication as an admission that I was hopelessly ill. Eventually, after struggling with this for over a year, I decided that there was no way medication could be worse than what I was going through, and I took a leap of faith. And...it helped. It was a sign of maturity, not of failure, to recognize an issue in my life and do what it took to resolve it.

In the same way, nasal surgery has been in the back of my mind for over a year as my doctor and I have explored medical treatments for my nasal obstruction. But after 6 months of steroid sprays and rinses and various allergy medications, I was still sleeping poorly and felt congested all the time. Just like in grad school, I catastrophized. What I feel like this for the rest of my life? What if I need surgery? What if I get an infection? What if I have to spend time in the hospital? But eventually, just like with my anxiety, I came to believe that any temporary pain I might have with surgery couldn't possibly be worse than the suffering I was enduring without treatment.

So on the morning of my surgery I was actually quite calm when friend dropped me off at the outpatient surgery center. I checked in and filled out a standard set of dull medical forms, trying not to think about being sedated and dismembered.

Let me back up a bit. Inside the nose, there are bony structures called turbinates which protrude into the nasal cavity. Turbinates have a soft mucosal lining which expands when you have a cold or allergies. If you have genetically large turbinate bones (like me) and/or have chronic allergies (like me), the nasal airways can become chronically obstructed. For me, this resulted in poor sleep and low energy during the day. After reading patient stories on reddit and watching youtube videos, I was pretty sure I needed a turbinate reduction surgery, and my ENT agreed.

Back at the surgery center, I am lying on the prep bed in a hospital gown, an IV in my arm, and the nurse is rolling my bed into the operating room. With her help, I move to the surgery bed while forcing conversation with the anesthesiologist about my work. Are you working from home a lot? Yes. What do you do? I work on medical ultrasound R&D. Did you study that? No. I studied astrophysics. There's actually a lot of overl...

Suddenly I am in a new bed in a new room, lightheaded, coughing up blood. The nurse hands me a plastic bag to cough into. I feel fluid in my airway. I don't really understand what's happening. I'm coughing and doing what I'm told. The anesthesiologist comes in and says something about a rare complication. I'm coughing more. Now my nose is bleeding. The nurse asks if I want to watch TV, I say no, I just want to listen to some music from my phone. My blood pressure and oxygen are low. No time to think. I cough and cough.

I was originally told I'd be able to leave mid morning, but it's past noon and I'm still in the recovery room. The doctor comes back in to check on things, and explains what's going on again now that I'm more cogent. I had a rare complication known as negative pressure pulmonary edema. If a drop of blood or saliva hits the vocal cords, they can spasm, blocking your airway to protect your lungs. If you are awake, you can cough it up and continue breathing. But if you are unconscious, then you can't cough, so you could suffocate.

To avoid this, patients are typically intubated during general anesthesia. In rare cases laryngospasm can happen after the breathing tube is removed, but before the patient fully awakes, which can result in the patient effectively “breathing” in fluid from the alveoli because the airway is blocked. This occurs due to the negative pressure created during inspiration relative to the surrounding tissue. According to my anesthesiologist, this occurs in 0.1% of all surgeries, though [1, 2] quote up to 10% of ENT surgeries due to the higher incidence of bleeding around the upper airways. In fact, risk factors include being young, male, and otherwise healthy. (Less healthy patients are less able to produce as much negative pressure during inspiration against closed vocal folds.)

It's been almost a month since the surgery and here is where things stand now: My nose is producing a lot more mucous than normal due to the trauma from surgery, and I am cleaning it regularly with nasal saline rinses and sprays. The constant sniffling is frustrating, especially at night, when the mucous dries, and partly obstructs my nostrils. But I've been back to my ENT twice for quick cleanings, and after each one my nose has felt much clearer. He says that it may take 2-3 months for the sniffling and inflammation to completely subside, so in the mean time I'm living with saline rinse spray bottly and a pack of tissues. But I'm already sleeping and breathing better than before the surgery, and I know/hope/pray things will continue to improve!


Posted by Abraham