Nose 3

I'm the sort of guy that worries about everything in my life, so it'll be no surprise to you to learn that the spectre of my upcoming nasal surgery is continually lurking in the abandoned amusement park that is my mind. I related in my last post how I was a little frustrated at the lack of definitive information about what I can expect on the day, and I'm still mostly in the dark (mostly.) I did speak to my friend Emily about her experience undergoing surgery, and while it did settle my mind a little, the caveat remains that Emily's op was more complex, and involved a different NHS health board. Two, I think.

I've been wondering recently if my deviated septum symptoms are getting worse, if I'm just more hyper-aware of them, or if the increasingly cold weather is having an effect. I've been sneezing a lot, even the good (left) nostril feels blocked, and I've been experiencing some mild sinus pain. In addition, I've tried to walk while eating recently, and that hasn't really gone well; within a few seconds of starting mastication (stuffin' mah face), I find myself gasping for air.

Since my visit to the consultant, I've wondered if my breathing affects my sleep, and I read somewhere that if you have to consciously aid your inhalations, because you feel you're not getting enough oxygen, when you're sleeping, you won't be able to do that, and so you might wake yourself up to get more air. I'm not conscious of this happening, but the sleep app I use does suggest that I wake up on average 2-3 times a night. I'm not yet sure if this is normal or not.

I took a long walk yesterday morning in the cold November rain, and when I got home there was an appointment letter from the NHS, inviting me to a pre-operative consultation, to assess my health and ensure I'm fit for surgery, and for me to glean any further information. My appointment is next week, at the Royal Infirmary; my previous letter about the waiting list was from Gartnavel. So, that's a little confusing; do Gartnavel just oversee appointments for the north of Glasgow, or are various stages of the process handled by the nearest facility capable to do so? I suppose in the grand scheme of things, it's no big deal whether the procedure itself takes place in Gartnavel or the Royal.

A number of people whose blogs I've found through Google, and Emily, had their pre-ops a week before their surgery. I'm also a wee bit concerned by that; ideally I'd like my op to take place in early January, to allow me to enjoy the festive period. I've got a few, rare (social!) things on over the next few weeks. I'm sure Emily said she received her surgery date at the same time as her pre-op date; perhaps I should have received another letter with the date of the actual surgery? 

Still, I'll have the chance to ask questions at my appointment next week. In preparation for the assessment, I've been brushing up on my medical history. Generally, I've been quite a healthy person, with no underlying conditions...that I'm aware of. I had a physiotherapist appointment on Friday, and she told me she thinks I have mild scoliosis, but I don't think that's anything to be too worried about. Most of my surveys of hospital interiors have come as a result of minor injuries and trips to accident and emergency, but there have been a few outliers.

I'm not sure if it still happens, but teenagers in the United Kingdom used to receive inoculations to prevent against tuberculosis. You would leave class one day, visit the nurse, have some testing serum injected into your forearm (known as the Heaf test, in my day), and depending on how your skin reacted, you would either receive the BCG (Bacillus Calmette–Guérin) vaccine, or you would get a trip to the hospital for a nice chest x-ray. My skin did react, and so I had my lungs x-rayed, but I never received any treatment, or vaccination. As my mother was my guardian at the time, and therefore the point of contact regarding consent and information, and as she can be a little bit scatty in this respect, I never did find out what the story was behind the x-ray. And it bugged me a little. I mentioned it to the physio on Friday while we were talking about my medical history, and she’d had the same experience. It transpires that if your skin reacts to the Heaf test, but your x-ray doesn't show tuberculosis, it implies you've been exposed to the disease when you were younger, and developed a natural immunity. Which makes sense to me.

I've only actually been admitted to hospital twice in my life. Once was when I was born. The second occasion was five years ago. I’d been taking stronger and stronger anti-inflammatories to combat an ear infection, and one morning I took them without enough food in my stomach, due to my complete lack of appetite. Within a few hours, I was in the emergency surgery unit at the local hospital with the worst (to date, still the worst) pain I've ever experienced. While it eventually turned out to be gastritis, an inflammation of the stomach lining caused by the anti-inflammatories, a not-especially serious condition, I did find myself wired up to an electrocardiogram machine, and on a drip for a while. A week or so later, a trip to the ear, nose and throat department in the hospital revealed that my ear infection was actually a cyst in my ear canal; I don’t think anti-inflammatories would have helped.

I wrote about the subjectivity of memory in my last post. While I was in the emergency surgery unit, a nurse affixed a red identity wristband to my arm, after having asked if I was allergic to anything. I am; penicillin, but that’s another long story. I thought that my allergy was written on the bracelet, but digging it out on Friday, it appears it wasn't. Further investigation suggests that the NHS, again, have a bit of a mixed bag policy as far as patient ID bands go. Some use different colours for different reasons; red for allergy, yellow for fall risk, etc. Some use coloured bands in addition to the standard white ID band. Some use coloured bands instead of the white ID band (as in my case above.) Some note the allergy on the band, some don’t. In a guidance document I found online, it was suggested that allergies should not be noted on ID bands, as care-givers should cross-reference the patient’s ID with their notes before any medication is administered. All of the above reinforces that there’s a fair amount of inconsistency in the NHS, but that’s perhaps to be expected in an organisation of its size. It does however mean that I'm still not quite sure about what awaits me over the next six weeks (yes, I'm very aware this is all paralysis through analysis.)

Still, I guess I'm about to find out…

Nose 2

A few years ago, I developed a bit of a problem with my knee. It swelled up one week, and when it returned to normal size, I found I couldn't ascend or descend stairs or run without experiencing a sharp pain.  I saw three physios, did a lot of strengthening exercises, and lost three stone in weight before it got any better.

Looking back on my contemporaneous blogs a year or so later, it amazed me that I'd managed to forget just how bad my knee had become and how limited my range of movement was. That's not surprising; human beings tend to process memories through a filter of subjectivity, and sometimes we selectively forget things. Remembering this, I'm going to record in this blog all the problems that I'm having that I ascribe to my deviated septum, in order to better ascertain in the future if the septoplasty was a success.

My diagnosis was somewhat unusual for me. I'm quite possibly a hypochondriac, so sometimes I collate physical symptoms and then convince myself that I have all manner horrific illnesses that match those symptoms. With my nose however, I received a formal diagnosis before I became aware of all the associated potential symptoms. I've always felt that my nose isn't right, but the two most annoying aspects about it have been that I can't breathe through it very well, and that it constantly feels like there's something stuck up there. My visiting the doctor was the result of finally becoming fed up with the two sensations noted above.

Since receiving a formal diagnosis, I've done a bit more reading into the symptoms of a deviated septum, and some of them are pretty familiar. According to Wikipedia, the symptoms of a deviated septum include the following:

Infections of the sinus - This I don't think I suffer from, but I am aware that my nose gets bunged up a hell of a lot.

Sleep apnoea - Potentially. Sleep apnoea is a condition where an individual stops breathing during the night, the brain notices a build-up of carbon dioxide, and signals the body to wake up. Generally sufferers don't know this has happened, but they do notice that they suffer from daytime tiredness. I've been using a sleep app for the last few years. It records how much I move in bed, and from that infers how much time I've spent in deep sleep, light sleep and awake. Without fail, I seem to wake up 2-3 times a night. However, sufferers of sleep apnoea wake a lot more than that – generally 5 to 10 times an hour.

Snoring - Yup.

Repetitive sneezing - I actually do this a lot. Apropos of nothing, in the office, I will suddenly start sneezing away. I had attributed it to my nose being interrupted by paper motes floating about the office, but in retrospect perhaps not.

Facial pain - In line with the infections of the sinus, I do regularly experience pain at either side of my nose and behind my eyes. Again, this might be related to spending all day staring at a computer screen.

Nosebleeds - Don't experience this at all.

Difficulty with breathing - This is certainly true. I can't breathe through my nose much; while my nostril is okay, I think it gets overloaded from having to do the work of two. I struggled to walk and eat at the same time, and I noticed that playing football the other night I found it really difficult to breathe at all. Of course, this may have been due to the cold.

Mild to severe loss of the ability to smell - This is certainly a concern.

I've also developed a mild case of gingivitis between my two front teeth, and apparently this can be caused by breathing predominantly through the mouth at night, which I do. The nose is far better at filtering bacteria from air than the mouth is, and so at night this can all fester in your gub. On top of all that, whenever I'm outside, my nose is running. Always. It’s ludicrous.

That’s everything I can think of for now. I’ll add anything else I can think of in later posts, to try and get the fullest picture I can of just how conked out my conk is.

Days of Lines and Noses

I've never been on the waiting list for an operation before. It’s a curiously discombobulating experience, mainly because I have no idea when the surgery will actually be scheduled, and that’s a massive known unknown. While I'm familiar with the long periods of nothingness between my GP referring me to the hospital for a consultation, and receiving the letter that confirms my appointment, that’s a slightly different kettle of fish. I've been to four such consultations in the last few years, but each one has lasted an hour at most. None of them have involved a two week physical convalescence. I think that’s what I'm most concerned about.

My letter confirming I was on the waiting list stated that I am ‘guaranteed to be admitted for treatment within 12 weeks.’ The 12^th of January 2016 is the latest date I should expect the operation to be carried out. That’s almost as much as I know. Ideally, they would schedule me in between the 6^th and the 12^th January – otherwise, I'm a little concerned that my festive period would be disrupted. I have a few nights out, a friend’s birthday do/Star Wars showing, and 2 weeks’ annual leave planned at Christmas; I would be a little disappointed if I missed out on any of that, even if it were for the long-term good of my health. So, I've been trying to find out more about what's likely to happen, partly due to my increased research dependency.

When I was studying Standard Grade Art at secondary school, the teacher emphasised the importance of research when preparing to start work on a drawing or painting. I wasn't particularly receptive of this wisdom when I was 14 – surely I knew what an apple looked like? However, over the intervening 20 years, I've come to value the importance of research, through my studies and my professional career. Today, in my job, I have to be able to put contracts in place for various, disparate commodities, and quite often the subject matter can be things I've had no real prior knowledge of. Learning about the product, or the service, rapidly, is key.

I like to write fiction in my spare time, with the semi-serious aim of one day being a published novelist. Again, as I've grown older, I've found that the time I spend researching my stories outstrips the time I spend actually writing (of course, some of this ‘research’ is diversion; like good writers, I procrastinate a lot.) I find that I have to completely understand all facets of the story I'm trying to tell, lest it appear inauthentic. This is probably a reaction to 30 years of being exposed to popular culture that is riddled with plot holes and factual errors, and dedicating several person hours to reading TVTropes.org from cover to cover.

If you’re not familiar with TV Tropes, it’s a fantastic wiki-style site where users (or Tropers) catalogue the various conventions, crutches and plot devices (tropes) that fiction writers often use when creating films, TV shows, etc. One of the Super Tropes documented on the site is ‘Reality is Unrealistic’, which collects a series of tropes that describe the disconnect between what culture portrays as ‘reality’, and what reality actually is. These tropes cover situations that arise when the viewer or reader thinks a situation described in fiction lacks verisimilitude, but which is actually firmly based in actual science or real life events. A very quick example might be that Brigadoon wasn't filmed in Scotland, because the location scout allegedly couldn't find anywhere that looked Scottish enough. Take a look at the trope page; there are many more examples.

Clearly for writers, there’s a danger that no matter how much or how little research they do, there’s a danger that the end product of their endeavours comes across as realistic, or unrealistic, depending on cosseted by TV and film their audience is. While I await my letter inviting me to have the inside of my nose hit with a hammer (I'm assuming that’s what they’ll do, I haven’t looked into the actual procedure too closely,) I've been trying to find out what I should expect to happen, as a patient.

The NHS being is a large UK-wide bureaucracy, but there are devolved elements in all four constituent countries. Each country’s service is then further broken down into regional trusts, and some (but not all) of these trusts have issued their own guidance on septoplasties. Apart from the trust carrying out my operation. There are a number of minor differences in each guidance, mostly relating to things like the time spent in hospital post-op (a few hours to overnight) to the recovery period (one week to two weeks.) However, I suppose every patient and case is different, and requires different treatment. At this stage, therefore, I still don’t quite know what to expect. My research has uncovered a fair amount of variables.

I'm taking part in National Novel Writing Month (NaNoWriMo) again this month, a contest of sorts where you challenge yourself to write a 50,000 word in 30 consecutive calendar days.  As alluded to earlier, I find myself being drawn towards more and more research, fastidiously working out the logistics that underpin the characters’ existence. But sometimes I worry that I'm doing too much research, and that it’s stifling my creativity. My experience of reading up about my septoplasty suggests that my experience of the procedure might be very different to someone that had their op in Ayrshire, or Devonshire. They might find my account of my surgery less realistic, because there are things that our respective NHS boards and specialists did differently, or our physicalities are not quite the same.

Hopefully, this will inspire me to be less anal about the levels of research I'm doing. The great thing about novels is that they capture a world that doesn't exist. They’re escapist and fantastical, and I'm not entirely sure readers would mind if I made up the location of a motel in the Florida Keys that my protagonist spends a night in, instead of spending time in Google Earth trying to find one that actually exists. I think verisimilitude is important, but I'm worried that I've become a slave to realism. Back to the Future is one of my favourite films, a ridiculously tightly-plotted tale with some of the finest mise-en-scene in cinema. Yes, Robert Zemeckis and Robert Gale did pain-staking research for all three films in the trilogy, but the central premise still involves travelling through time in a DeLorean. Great fiction doesn't have to be realistic.