Diathermy to Turbinate - One Week Later

Okay, it’s not strictly a full week later, more like six and a half days. In terms of my nose, I feel okay. For the first five days after I had diathermy to my nasal turbinate, my nose ran a lot. It was like having a bad cold, but the mucous that was coming out was a weird adobe colour. And the more physical activity I did, the redder the discharge became. I had a doctor’s line for a week, so I thought I would take things easy and let my body heal itself.

Now, my nose has cleared up, and has returned to how it was before my procedure; that is, I've got a fair amount of air going through the left nostril, and not much through the right. As far as I understand it, it might be weeks or even months before I notice any real improvement in my right nostril. And even then, it might not last long – months, a few years. In retrospect, if I’d been told my options were to reduce the turbinate, or do nothing, I might have chosen do nothing. A septoplasty was a far more tantalising and long-term solution. As it stands, I'm beginning to wonder if I'm doomed to a lifetime of crap breathing. I spoke to my uncle the other night; he mentioned that he’s had much the same issues as me with his nose over the decades. Still, I need to give the diathermy time to do its job before I completely write it off.

As mentioned before, diathermy of the turbinates attempts to reduce their size by cauterizing their internal structure. As scar tissue forms internally, the turbinates shrink. I'm not sure how long this process is supposed to take and as I've previously mentioned, the mucous lining of my nose went into overdrive almost immediately after the procedure. I'm going to try and get an appointment with my GP to ask his advice, as I think I'm still at least a month away from a follow-up appointment with the ENT consultant.

My sleeping hasn’t improved any. In fact, the last week it’s been terrible – five hours a night. However, while that’s partly been due to the mucous build up, it’s mostly been due to back pain. I’ve been having issues with my back for most of my life, but they've been steadily getting worse over the last 18 months or so. I had an appointment with a physio last month, and she suggested that I might have mild scoliosis, which is slightly alarming. However, in the last few weeks the pain has racked up a few notches – the internet suggests I'm perhaps having a sciatica attack. It’s not exactly pleasant, and I think it might be hindering my recovery a little.

So, if you’re considering having diathermy to your turbinates, and you’re not sure what to expect, I can summarise my experience below. Everyone’s different after all.

• The actual time spent in theatre was quite short – around half an hour.
• I didn't experience a huge amount of pain. I guess this is because the diathermy tool only leaves small holes in the lining of the nose. I did have a headache for a few days, an intermittent sore throat, and the occasional mild dull pain where the right side of my nose meets the cheek.
• My nose generated a lot of mucous for a week afterwards – mostly this was a very mild pink, though it got more red if I over-exerted or the blood rushed to my head.
• Generally, I felt a bit lethargic for the first few days afterwards. I suppose this is normal, as your body is using energy to heal itself. The recovery period in general felt like having a pretty heavy cold. 
• I've not had any other side effects, like dental pain, black eyes etc., although the back of my hand is a bit bruised and tender from the cannula insertion.
• I've had a few days off work, which is probably useful, particularly when you work in a large office with lots of other people, and it’s December…

I’ll blog again when I have my follow up appointment with the surgeon.

The Recovery Period

I suppose, technically, my recovery period started as soon as I came round from the general anaesthetic (I'm going to call it GA for short from now on.) I think it takes the body a little while to fully reboot following GA – certainly, it wasn't until 4pm on the day of my procedure, three hours after I came round, that my nose started to fill up with mucous. I'm led to believe that’s normal after a procedure in that area. Around the same time, I noticed that the mucousy discharge was occasionally light pink in colour; again, this is a bit of blood flushing out, and it too is normal.

Other than that, I felt pretty good. As mentioned in the previous post, I left the recovery ward with some saline solution to douche out my nose, and a week’s sick line. I've been taking paracetamol every six hours or so, but in general I haven’t experienced too much pain. I'm heeding medical advice that I’ve had a GA and undergone surgery, albeit a very minor one, so I'm trying not to overdo things. I got a decent night’s sleep at my sister’s, despite waking up at 5am, again. In terms of appetite, there’s not much happening there. I had some toast, and some crumpets, and a couple of sandwiches in the first 28 hours, which is a fraction of what I’d normally eat in a similar time period.

I douched my nose for the first time the day after; I was given a pack of three 20ml bottles of saline solution, and a syringe to inject them. It wasn't a complete success; my right nostril was too congested, so it all just came straight back out again. When I did it later, I did both nostrils.

My sister drove me from her house back to mine, stopping at a couple of shops on the way. Generally being in shops taxes my patience, so they were probably a good test of how I'm getting on. I feel that I have something a little worse than a heavy cold, but not quite as bad as flu; running nose, tiredness, occasional pain about the face, headache, lack of appetite, with the caveat that I can’t blow my nose to try and ease the pressure, at least not for the first two-three days. Writing on Saturday night, two-and-a-half days after the procedure, I still feel a bit fluey – I haven’t been eating a huge amount, I'm still getting a wee bit of blood in my mucous, and a bit of sinus pain. Any information I can find on recuperation for my exact procedure suggests I should rest for a week, and avoid places that are full of people with the lurgy. The thought of driving down to the shop crossed my mind earlier, but even if I was feeling up to it, I don’t think it would have been a good idea.

In terms of prognosis, I'm not entirely sure what’s going to happen in the next few weeks, because as mentioned earlier there’s not a lot of info out there on the internet. In retrospect, that would probably be my own complain with my treatment at the hospital; because I didn't have the same procedure that I went in for, I feel that I don’t have the same information about the procedure, recovery, prognosis etc. that I gleaned over the weeks leading up to my supposed septoplasty. I think the nurse on the ward thought I was being a bit neurotic, but I genuinely wasn't sure what to do with the nasal douches, what medication to take, how long I should hole myself up like a hermit.

I've got a doctor’s line for a week. I've been told not to take any exercise until I see the consultant again, which could be in up to 8 weeks’ time. What will be interesting is what happens with the site of the incision, such that it is. Slow and steady.

The Day of Surgery

Preamble – I apologise for the rambling nature of this blog post. I've tried to faithfully record my operation for two reasons; firstly, for my own record, before the details fade from my memory. Secondly, as I've mentioned earlier, while researching septoplasties, I didn't find many accounts of the process, and especially few relating to NHS health trusts in my area. If this does help anyone, then great. If it doesn't, I have my own record of my first ever in patient experience.

I haven't been sleeping well recently due to some ongoing back pain, and I don't tend to sleep at all before big events anyway, so I was never going to get a good eight hours. I went to bed around 9:30pm, and slept fitfully. My sleep app recorded me waking and falling asleep four times over the course of the night, before I eventually woke irrevocably at 5am. This wasn't such a bad thing; it was recommended I have a cup of water at 6am anyway, the last thing I could ingest as part of my fast before my anaesthetic. I lay in bed for a while until I had my water, and was then showered, dressed and out of the house by 6:30am. As you’re not allowed to drive after a general anaesthetic, I was taking the bus the couple of miles to Gartnavel. As I don't really trust buses, I wanted to leave plenty of wriggle room - unusually, I even packed my bag the night before, unprecedented levels of preparation for me. As a result, I arrived at hospital at 7am, a whole hour earlier than the time on my appointment letter. Thankfully, the surgical admission unit was already open for business, so I was able to get admitted straight away (I was the first day case patient to arrive.) I would meet a lot of nurses and doctors throughout the course of the day, and I can’t remember all their names, but they were all lovely and friendly and did their best to put me at ease, which isn't an easy task. I first saw Akua (I think), who checked my details. She wasn't aware that I'd had a pre-op assessment at another hospital, and seem frustrated the other hospital hadn't passed that information on when I told her. This meant she had to repeat everything that had been done at the pre-op – pulse and blood pressure readings, health questionnaire, height and weight (used by the anaesthetist to calculate how much anaesthesia you need.) She fastened an identity band on my wrist, and then returned me to the waiting area.

The next person I saw was the anaesthetist, who asked me many of the same questions I'd already been asked. I was reading the book ‘Adapt’ by Tim Harford, which describes how organisations become successful by learning from their mistakes; while I was in the waiting area in admission, I happened to read a passage which recounted the multiple security steps many organisations have in place, to try and catch cataclysmic failures before they happen. Clearly the NHS have a similar philosophy in place, where patients’ details are checked continuously to make sure they’re in the right place and having the right procedure carried out. Between 8 and 9am I met my surgeon for the first time. Mr. T is a pleasant Greek, and as he looked over my notes from the consultant that first examined me (Mr. B), he told me he didn't think that a deviated septum was my problem. Instead, he felt I had problems with the turbinates on the right side of my nose, but he'd carry out a closer inspection while I was under (‘Examination under Anaesthetic’,) and then proceed from there. I signed the consent form, and he told me he'd see me later. I had another short wait before I was invited to change into a gown (actually 2 gowns; one worn with the opening at the back, one with the opening at the front,) paper pants (far more comfortable than they sound), and a pair of foam foot-covering things I shall call ‘shlippers’. I'd brought my own slippers, but was told I couldn't wear them.

I then went through to another waiting area where a few other day case patients were waiting for a bed, and to be taken through to the anaesthetic room. Four of us were sitting in facing chairs, in matching gowns and wristbands anxiously awaiting our fates and it reminded me of the following scene from Hostel 2:

After a couple of hours (which I whiled away reading ‘What If?’ by Randall Munroe and filling in a questionnaire on nasal symptoms for Mr. T, it was my turn to get ready. A pleasant young doctor/nurse named Emma (I think) took me to my bed and got me ready, taking my outer gown and shlippers, covering me with blankets, and giving me a surgical cap to wear. She told me there was still a patient in theatre ahead of me, but she was getting me ready now to make things quicker when it was time to go. True to her word, she was back in ten minutes or so, and wheeled my bed the short distance to the anaesthetic room.

There, I was greeted by the male anaesthetist I'd met that morning, plus another female anaesthetist (I can’t remember either of their names.) They set about getting me ready, placing a cannula in the back of my left hand, to allow them to administer the anaesthetic, any other medication, and a drip. While the anaesthetist was pushing the needle into the back of my hand, ‘Emma’ patted my shoulder comfortingly. I'm okay with needles, being a regular blood/platelets donor, but I appreciated the gesture nevertheless. The team then fitted three sensors to my chest; one just below each collarbone, and one on the left side of my ribcage. Completing the electronic monitoring, they strapped a blood-pressure cuff around my right arm, and placed a blood-oxygen clip on my finger. The male anaesthetist emptied a syringe into my cannula, and told me I might become a bit woozy; I remember nothing after that. Not the cliché of counting back from 10, not feeling sleepy, nothing.

I came to in the recovery room, with no way of knowing how long I had been in the operating theatre for. I had a breathing mask over my mouth and nose, but I wasn't in too much pain, other than my right front upper tooth, and the back of my throat. Both are normal; the dental nerves run close to the nose, and the breathing tubes inserted during general anaesthetics often scrape the throat, apparently. I didn't, and haven’t experienced any nausea. The nurse at my side told me the surgeon had done a different procedure to what I'd gone in for, but I was perhaps still a little too out of it to comprehend her properly. I was on a drip, but she let me have a couple of cups of water, and some paracetamol, to help with the pain. After what felt like ten minutes in recovery, possibly longer, I was taken up to a ward to begin the observation phase.

Before your surgery, a nurse checks what your normal pulse and blood pressure (obs) is, as a baseline. Then, post-surgery, they check your readings every hour or so to make sure you're getting back to that baseline. Hospitals don’t discharge you until you've eaten, drank, and passed urine and your obs are what they should be.

I was wheeled into the observation ward at roughly quarter past one, and slid from the trolley onto the ward bed. The ward nurses measured my obs and checked in on me on a regular basis. Shortly, I had some toast, and a jug of water to drink from, and I amused myself by reading some more of my book and letting the world know I'd survived.  My surgeon appeared at half past three, and confirmed that he hadn't done a septoplasty. Instead, he had indeed felt that my turbinates were my problem, so he'd reduced these with a cauterising tool. He then gave me instructions to douche my nose with saline over the next few weeks.  A short while later, another lovely nurse (Mary, I think, a second year student around the same age as me) removed my cannula (how I can’t remember her name for certain when I was staring at her namebadge throughout that fairly painful process, I attribute to the anaesthesia), and brought me some orange juice, just in time for my sister and my niece to arrive to collect me. When you've had a general anaesthetic, hospitals mandate that you should be looked after by someone for 24 hours afterwards, and that you shouldn't do too much. My sister had volunteered to be my carer for the night, so I was free to go with my letter of discharge, my sick line, and my nasal douches.

In my sister’s house, I noted that my discharge letter was printed off by my surgeon at 12:12pm. The last time I looked at a clock in the surgery unit, the time was half-past elevenish. Allowing for ten minutes preparation, I think I must have spent around half an hour in theatre. I sent a message to my sister just after I arrived on the observation award, at 1:18pm. I don’t feel like I spent an hour in the recovery room...but assuming the clock on the computer that printed the letter is right, I think the approximate timeline of the day is as follows;

07:00 Arrive at hospital

07:10 Admitted

08:00 Speak to anaesthetist

08:30 Speak to surgeon

09:00 Change into gowns

09:30 Arrive in pre-surgery waiting

11:30 Prep for anaesthesia

11:40 Anaesthesia

11:42 EUA/Surgery

12:12 Recovery

13:18 Observation

16:30 Discharge

My discharge letter does show the full title of the procedure I had – Submucous Diathermy to Turbinate of Nose. Having spent the previous two months preparing and researching septoplasties, to undergo another procedure entirely has messed with my head a little. I've tried to read up a little on what this new procedure actually involves. The nose is apparently much bigger internally than that little flesh triangle that protrudes from our faces. There’s a lot of bone and cartilage in there; the first consultant I saw thought my chronic rhinitis was due to a deviated septum, which is a kink in the cartilage in the middle of your nose. However, there are sea-shell shaped (their Latin name is Nasal Concha) bone shelves in your nose, called turbinates. You have a pair of three, either side of the nose, and the largest can be similar in length to an index finger. The turbinates are covered with mucosal tissue, and effectively they act as a filter for air before it enters your lungs. Mr. T clearly thinks my rhinitis (runny & blocked nose, loss of sense of smell, sneezing) has been caused by turbinate hypertrophy, or swelling, in other words. Unlike septoplasty, there’s less information on the internet for submucous diathermy (other than its abbreviation being SMD), but it appears to involve using a cauterising tool to shrink the troublesome turbinate, while leaving the mucous membrane that sits atop it intact. I'm somewhat unclear as to whether this means shrinking the turbinate bone itself or the underside of the mucous lining atop it. While I thought that a septoplasty was a relatively minor operation, it appears that an SMD is even less complex, and since I came round from surgery, I haven’t experienced too much pain. I have however been taking paracetamol on a regular basis.

I have to confess to being incredibly anxious in the 10 days or so leading up to my procedure (I don’t think I can call it an operation with a straight face any more.) I said as much to the anaesthetist in the morning, hoping he might give me something to settle my nerves. He reassured me the process was quite low in risk; I was fairly accepting of the risk, but I'm just one of those people that gets nervous about things. Still, as I mentioned previously, the nurses and doctors were brilliant and fussed over me to an extent even I found acceptable. As far as my nose goes, it’ll probably be between 2 weeks to 2 months before I notice if there’s been any improvement. Guess I’ll just have to be…ah, I've already used that gag, haven’t I? 

The Pre-Operative Assessment

I’d probably write a blog about my experiences during my upcoming septoplasty operation anyway, because I enjoy writing, and I think it’s important to record my experiences, because memories fade, and are subjective at the best of times.

Doing my research into the procedure though, it’s become evident to me that not all operations/health boards/patients are created equal. There seem to be a lot of differences in the way neighbouring NHS trusts in the UK go about their business, and I've found it difficult to find any accounts of anyone having undergone the same procedure as me in the same health board as me. I'm probably worrying too much about Having An Operation, but I thought I’d try and include as much detail in these blog posts in case anyone else from Glasgow finds themselves looking for an account of what happens throughout the entire process.

As I mentioned in my last post, on Saturday I received my appointment letter for my pre-operative assessment. On Monday, while I was trying to check with my manager that they were okay with me attending the pre-op, my mobile started ringing. It was an 0800 number, and as I dithered about answering it, thinking it might be some sort of scam, it went to voicemail. Checking the message, it was from the appointments department at Gartnavel, so I rang them back immediately. “We can offer you a date for your procedure,” the lady on the other end of the phone told me. “10^th December.” The stylus was ripped from the record of my mind. “10^th of December,” I could only mindlessly repeat. “I’ll need to think about it.” “That’s fine, but could you let me know by 1pm?”

The letter I received when I was added to the waiting list stated that the absolute latest I would undergo my op would be the 12^th January, so that was the date I had in mind, and had planned for. A date almost five weeks earlier was entirely unexpected. I’d been worrying about the surgery and recovery time eating into my festive period, but some quick mental arithmetic informed me that even with two week’s recovery, I should be in decent shape by Christmas Eve. That was encouraging, so I confirmed with my bosses, and phoned back to accept the appointment.

I wondered in my last post if my symptoms are getting worse, or if I'm just imagining it. I do seem to be experiencing a fair amount of pain in my sinuses, I'm constantly having low-grade headaches, and the entire front of my face feels incredibly muggy. This might be down to the fact that it’s been raining in Glasgow a fair amount the last couple of weeks (it normally rains less than you’d imagine.) My sleep app, which records my movement in bed at night, suggests that I'm more restless and my sleep is worse when the weather is wet. The trouble is, I've no idea if this is normal for humans, or it’s symptomatic of people with sinus problems. Oh, and I'm sneezing a lot as well.

The most complicated part of my pre-op was getting to the hospital. While the Royal Infirmary is my nearest hospital, it's a near two mile walk. I didn't particularly want to turn up for a physical assessment being a bit sweaty and smelly, which ruled out walking. My manager informed me that parking at the Royal is terrible, so I decided to get the bus. The trouble with public transport in Glasgow is that it's atrocious. It's deregulated, and not joined up, and under-funded. I had planned on buying an electronic ticket using the First Bus app, but it transpires they don't do day tickets via the app. As I didn't have any change, I had to walk to Buchanan Bus Station.

Like most bus stations, Buchanan is not a place where logic thrives. Trying to work out which bus to get, and where it departs from requires a fair amount of local knowledge, patience, and time. Online timetables say one thing, the printed timetables another. The comings and goings of the buses themselves don't agree with either. Google maps told me I was better walking to Cathedral Street and catching a 38, so I did, and I was at the hospital within a few minutes, and 15 minutes early for my assessment.

Regarding the pre-op itself, I felt like I do when I take my car for an MOT; nervous about what close inspection might throw up. The world’s worst disease, found only in me, and named for me. But my examination was over in 15 minutes. I was asked a few questions about my general health, had I had an anaesthetic before, do I have any dental veneers (yes, one.) Then my nurse measured my height and weight, and recorded my blood pressure and pulse. She fielded a couple of questions that I had, and then I was free to go.

There was one small element of confusion, when we were discussing who would collect me from the hospital after my operation. Logistically it would probably be easier for me to stay overnight, and the nurse said that wouldn't be a problem at the Queen Elizabeth. “But my operation’s at Gartnavel,” I told her. “Oh,” she replied. “Well, they don’t have beds. You couldn't stay overnight there.” I got the bus back into town, bought my lunch, and waited for another bus that would take me back to my flat. After 20 minutes, no buses for either of the routes I can take had turned up, so I walked the mile or so home.

As I’d arranged my appointment over the phone on Monday, I still hadn't received a letter of confirmation. When I got back to the flat, there was still no sign of it, so I phoned the number I’d been given on Monday. They told me to phone my consultant’s secretary, which eventually cleared up the confusion. The consultant I’d first seen, Mr. B, operates at Queen Elizabeth. It transpires a different consultant, Mr. T (I know,) operates at Gartnavel. And evidently that’s where the first free appointment is. I was given the option of rescheduling, at the Queen Elizabeth, but I feel committed to the date now.

Having got the pre-op out of the way, I feel a little more relaxed now. I think I was actually more concerned about latent illnesses being exposed during my assessment than the surgery itself (latent illnesses remaining undiagnosed I'm quite comfortable with; out of sight, out of mind.) As for the operation itself, I suspect I’ll be doped up to my eyeballs most of the time I'm not awake, so that’s not such a big deal. The next seven days will fly in, in all likelihood.