Tired of Packing and Unpacking

My nose! Marcia Brady: Ooh, my nose!

The Brady Bunch, "The Subject Was Noses" (2/9/73)

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If you're reading this post then you know I survived the surgery. So, I guess that's something positive, not to mention obvious.

Per standard operating (heh) procedure for this sort of thing, I was told not to eat or drink anything from midnight prior to the surgery. So at 11:00 PM I had a cup of tea and a single shortbread cookie before hitting the shower for the night.

I was scheduled for another CT scan of my head in the morning, then my surgery was originally scheduled to be at about 10:00. However, I'd gotten a call that said it had been pushed back to noon. Well, what are you going to do. GF and I went in to GBMC, and I did the CT at the original 9:00 time. Incidentally, since I'm still a little wired by the whole experience, I popped a Xanax (got the prior OK from the doctor) before leaving the house, figuring I'd be all kinds of cool by the time the fun started.

The point behind this second CT, by the way, was that there was some extra bit of software involved. The scan was called "Striker", and would be used by Dr. Hotstuff as a means of tracking the exact location of the instruments as he worked. As he explained it, most of what Dr. Hotstuff did, he did by watching monitors, not by actually looking up my nose. Because that would be gross, I guess.

So here it is, 9:30, and we have pretty much nothing to do until about noon. I took GF down to the cafeteria, and even that wasn't going to open until 11:00, but we were able to sit at the tables, and I read a little email and such until she could get some lunch. She had a meatball sandwich and tater tots, washed down with Pepsi. I, of course, had nothing. I think I had the healthier meal that day.

We head back to the check-in area and they take me in to a staging area, where I have to undress and put on the hospital gown, and then I'm going to talk to a nurse, and then an anesthesiologist, and then Dr. Hotstuff himself before I go into the operating room. The way it was presented, this was going to all take place in short order.

The way it happened, the nurse came in and chatted with me (mostly making sure my name was spelled correctly and getting my autograph on yet one more form). Then, an hour later, the anesthesiologist came by and told me what to expect. He also told me that the doctor had been delayed. Well, it's 2:30 now, so I KNEW that. Finally, Dr. Hotstuff came by around 3:00 or so. He apologized for the delay and I let him know that he no longer should feel compelled to rush things on my account, thanks. By this point, also, the Xanax had worn off, so I'm turning into a mess again (and a hungry one besides), so can we get moving anytime soon? Certainly, he says.

And off we go: we walk into the operating room, I lie on the table and the first thing they do is strap my legs down. I'm told that it's to prevent me from falling off (the table is rather narrow, after all, whereas I am not); I'm thinking that it's to prevent me from changing my mind at that point.

Anesthesia The anesthesiologist starts an IV in the back of my hand and asks, "What do you like to drink?" I tell him "Vodka". He tells me that pretty soon I'm going to feel like I've had several Kamikazes at once. The last thing I remember is my arm getting cold–

–and suddenly it's over and I'm freezing. My nose has a wad of gauze taped to it, my head feels like a brick and most of all, I can't stop shivering. Also, I have to use the bathroom. But since there are still a few details to work out (I still have the IV in my hand, for instance), can it wait a minute? So the nurse is giving GF some post-op directions and so on, and I'm still there shivering and kinda-sorta listening to them. Finally I say, "Okay, bathroom's getting a little more important, now." The IV is removed and I'm directed to a restroom nearby.

Now, I don't know how it is for women, but I don't think a lot of effort is involved with peeing, simply because the female urethra is pretty short. For guys, you usually have to make a little "push" effort to get things started. Prime the pump, as it were. Unfortunately, this little bit of "push" sends my blood pressure up just enough, I guess, that my nose starts bleeding. I can't even remember the last time I had a bloody nose, but here we are with the blood on my hospital gown, and on the floor, and me apologizing for the mess (which in retrospect wasn't that much at all). My memory here is hazy, but while I don't remember getting dressed, I do remember GF going to get the car while someone wheeled me out to the entrance and helping me in.

Later on, GF told me that someone came out to her and said that the operation was taking longer than they thought it would, and that she had to move to a different waiting area. They also offered to get her a meal. After the operation, Dr. Hotstuff had told her that there were clear signs not only that I'd had many sinus infections (well, duh), but there were signs that some of these infections had gone deeply enough to settle into the bone, causing extra calcification. So he really earned his bucks that day, working on me about an hour and a half longer than he'd planned.

Wednesday and Thursday were also pretty miserable for me as well, partially because I was so doped up on the painkillers. So I was dysfunctional and in pain anyway. I took half tablets during the day and a full tablet at night, PLUS a Xanax, hoping to get some sleep. This sort of worked.

Friday was the follow-up visit, where the packing was to be removed. Let me tell you what: if you're anxiety-prone like I am, THIS is the time to be heavily medicated. I went in with practically no medication and this turned out to be a big mistake.

Nasal Forceps First, an assistant (not Dr. Hotstuff himself; he makes her do this dirty work) spritzes my nose with some anesthetic. You know what the anesthetic does? It makes your lip numb when it runs back out your nose. Then, she has to clip a single stitch that's holding these splints in place (the ones they used to rebuild my septum). Then she uses these fine nasal forceps to pull the packing, and the splints, out of my face. This shit isn't in my nose, it's DEEP INSIDE MY HEAD and it was awful and uncomfortable, and before the last one was out, I made her stop so I could hyperventilate for awhile. They set the chair back, put a cool cloth on my head and gave me some Coca-Cola in what was probably a sample cup from the urology office down the hall. And they left me alone for about fifteen minutes. I am NOT making this up: I was not a model patient for them. I was gagging and weeping and groaning and making my pain clear to them (quote: "Ow"). Finally she came back and said that this last piece, which she described as being "between my eyes", was behind a spot that was still kind of swollen. So she took a clean bit of gauze and smeared decongestant on it, then shoved that back up my nose. A minute later she pulled that out, suctioned everything out again (the suctioning was very uncomfortable for me) and then went after the last bit of packing. I swear to god I felt something tear in my head just before it came all the way out. A little more suction (ow ow ow) and she was done. About ten minutes later Dr. Hotstuff himself comes in to inspect his handiwork. I get some directions for rinsing out my nose on a regular basis and I'm sent on my way. Oh, and because I was such a whacked-out chicken, I'm not going back to work until after the Thanksgiving holiday. Good news/bad news, that: a few days off are always welcome, but if you're not healthy enough to enjoy your sick days then what's the point?

Better Living Through Chemistry

Jack: Consult your doctor before using this product. Side effects may include oily discharge, hives, loss of appetite, low blood pressure. If you have diabetes or a history of kidney trouble, you're dead, asshole!

Sideways (2004)

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Wednesday was my pre-op physical, so I took a little time out from school (relax, I stayed late to make up fo the time I missed) and headed up to my internist for that bit of fun.

One of the things I wanted to make a point of sharing with my doctor was the fact that I've been so keyed up about the procedure. Why, you ask? Because I'm a big wuss, okay? i know the stats, and I've met with at least a half-dozen people who have also been through it, but I don't care. This is how I get, bottom line. Anyway, my hope was that she would take pity on me and give me something to get me through Tuesday and then I'll be happy. My doctor is not the type to just hand out prescriptions like so many M&Ms, so I knew this wouldn't be an easy sell.

Per SOP, the first thing I do when I go in is meet up with an assistant who takes my blood pressure (good, as usual) and my pulse (NINETY-SIX! maybe it won't be such a tough sell, after all), and my weight (I've lost a pound and a half since I was there last–but don't ask me about my diet secrets). And…into the examination room with me, where I get to undress and put on the gown.

Almost as soon as the doctor hit the room, I started to talk about how nervous I was about the surgery, and how I know it's irrational, but I can't concentrate, I'm eating badly or not at all, I'm sleeping even worse than usual…once I got started, I couldn't stop. My doctor and I have very good conversations about my health and my habits, but I don't think I've ever been such a motormouth. She might still have taken this as an act on my part, except for two things: first, I hadn't actually asked for anything yet, and second, when I first started going to her, I was pretty frank about my past with the dysthymia and mild depression and the meds I'd taken before I knew her. So she had some awareness that I had a past in that realm.

Her concern was actually that I was starting to move again toward depressive symptoms and that maybe I needed something a little more long-term. However, knowing how reluctant I am to go that route, she agreed to set me up with a week's worth of Xanax and, if the symptoms persist beyond next week, I would have to come back to her and discuss maybe taking something else. She also gave me a prescription for Ranitidine, because of some stomach discomfort I'd been having, possibly because I'd described it as similar to symptoms I'd had many years ago when I was being treated for an ulcer, even though I stressed that it didn't feel the same as the ulcer.

So I keep all these pills on the windowsill over my kitchen sink, all lined up. Now I have some for the evening: Xanax, Pravastatin, Ranitidine and Singulair (she didn't really think I have asthma, either, but she told me to keep taking it); and some for the morning: Xyzal, Fluticasone, more Xanax. And I have the Albuterol inhaler, which I've used exactly once, without being sure it was appropriate. Since August I've gone from zero  medications to up to seven per day.

Ordinarily, if it weren't for all the respiratory infections (and the weight issue), I'd be considered a generally healthy guy. It's disconcerting to suddenly be taking so many pills. And it makes me think about the folks who our President-Elect wants to help; the ones who are having trouble getting medical and prescription coverage (because, remember they're usually two different issues). When Bill Clinton tried this over fifteen years ago (remember the sample card he waved at reporters?), the measure failed miserably. With any luck, we've moved forward enough in our thinking to make this more of a possibility.

Counting Down

Wesley: [voice-over, after Barry calls him the man] I'm the man? Yeah right, Barry. I'm the man. In fact, I'm so much the man that I have a standing prescription for medication to control my anxiety attacks. God, I wish I had something else to relieve my stress.

Wanted (2008)

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Over the last couple of days I've heard from people who have read this site, or seen things I've written in emails. Most of them have said much the same thing: "What the hell is the matter with you, anyway? Why are you so freaked out about this surgery?"

The thing is, most people who know me since I've moved down to Baltimore see a generally even-tempered guy who appears to pretty much roll with the punches. And when I react badly to something, it's usually a pretty righteous reaction. But this is a state which has taken me a long time to achieve, and it doesn't always hold up.

Big pill For the better part of my adult life I've had to deal with free-floating anxiety issues. There were specific times and places when I could identify myself as having a little bit of a moment, other times it was more of a general malaise. Many years ago it was diagnosed as "dysthymia", which by definition is a mild form of depressive disorder, but without the crippling severity of major depression. Some years after that I was given prescriptions for Wellbutrin, Paxil, Zoloft, and Prozac (not all at once, mind you). They all had some result but they also had side effects that made it not worth my while to take them. So I gave up on the medication route, and I just deal with it as it comes.

I bet this all explains a lot to some people who wonder about my overall sociability. Hi there, Cheerleader Parents!

However, I think it's fair to get a pass on something like this. I don't remember if I've mentioned it before in this space, but I have NEVER had surgery involving general anesthesia before, and while on the surface I'm pretty nervous, it's only covering up the fact that, deep down, I'm pretty much terrified.

And I KNOW it's a relatively minor procedure and I KNOW that Dr. Hotstuff is very good and has done this literally thousands of times without a hitch (in fact, he's been called in to help fix other people's screwups), and I KNOW and I KNOW and I KNOW. But when you've got this mentality, none of that matters. As Woody Allen said back in 1976, it's not that I'm afraid to die, I just don't want to be there when it happens.

I go in to my regular doctor tomorrow for the pre-op physical. I think I'll be asking her for something to settle me down for the next week or so.

High Stress Manifesto

Glory: I look around at this world you're so eager to be a part of, and all I see is six billion lunatics looking for the fastest ride out. Who's not crazy? Look around. Everyone's drinking, smoking, shooting up, shooting each other, or just plain screwing their brains out 'cause they don't want 'em anymore. I'm crazy? Honey, I'm the original one-eyed chicklet in the kingdom of the blind. 'Cause at least I admit the world makes me nuts.

Buffy the Vampire Slayer, "The Weight of the World" (5/15/01)

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(warning: rant ahead)

There are some times when I really don't like my job. This week was about a month's worth of that feeling.

I'm tired of banging my head against the wall for the benefit of people who don't seem to like or respect me.

I have no patience for people who think that "technical assistance" means "do it for me". 

I don't understand the mentality of people who, despite repeated training, either don't know what they're doing, or don't care, or perhaps both.

I've had it with people who KNOW I'm running IEP meetings, but who will call repeatedly over an issue when a single call will do, and leave a message please. Or, just send me an email. AN email. Not four over the course of a couple of hours. I'm more than happy to comply as soon as I'm not, you know, doing my own job.

I've had enough of people who don't think I'm doing my job because I don't happen to respond within twenty seconds.

And by the way, it's MY cell phone, and it's MY cell phone bill, so if I don't answer? Tough. As soon as the taxpayer picks up that bill, I'll do whatever the hell you want me to do with it. That phone is a convenience for me, not a leash for everyone else to lead me around on.

I don't appreciate IEP meetings that start twenty minutes late because we don't have everyone we need. Thursday is ALWAYS meeting day; you got the schedule weeks ago, what's the problem here? At one school where I work, we have yet to start a meeting within ten minutes of its scheduled time. Yesterday it actually had me ranting in the hallway. With any luck I scared a few people.

I'm sure that underlying all of this grief is the fact that I'm getting more nervous about my sinus surgery. By the time GF takes me to the hospital I'll be seeing the Grim Reaper sitting on my shoulder and chuckling like some ghoulish mohel: "It won't be long now." (Trust me, that was pretty funny.) But that doesn't mean that these aren't legitimate gripes.

What it does mean is that I'm on a pretty thin wire, right now.

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Incidentally, for those who are counting: this is my 600th post. My Blogoversary is in another few days so I'm looking at an average of 150 posts per year, which isn't awful.

Getting My Head Examined, Part II

Tony: She looks so peaceful when she's sleeping… Like a doll.
[Lucy snores loudly]
George Wade: A doll with a sinus problem.

Two Weeks Notice (2002)

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After I left the allergist, with a stack of prescriptions that suggested that I couldn't type this sentence without stopping to catch my breath, I had a couple of hours to wait before I was back to the ENT. So I availed myself of the facilities at GBMC's cafeteria.

Hospital cafeterias aren't nearly what they used to be. I remember when Daughter was deciding to be born and there was a break in the action. I decided to go down to the cafeteria at that hospital and it was basically a lunch counter. Remember those episodes of Roseanne where she was a waitress in a luncheonette that was located in the middle of a department store? Like that, only not as well-lit. I went down, waited ten minutes for someone to acknowledge me, then gave up and went back upstairs. Which was just as well, since stuff really started moving at about that point.

Nowadays, most hospital cafeterias are pretty nice deals, with assorted stations for different types of food. There's a salad bar, a saute station, a burger grill, and so on. And, it's usually a pretty reasonable price besides. I've thought a couple of times about just going to Sinai for my lunch break since theirs is of a similar quality as the one at GBMC, and it's easier to get to, besides.

So I got a Caesar Salad with grilled chicken. I had the option of "garlic" or "no garlic" and, naturally, went with the "garlic" option. This is how much garlic there was in my salad: at 10:30 that night, GF told me I smelled like garlic. Since my laptop was low on power, my seating priority was "near an outlet", which I managed to find. I fired up the computer and surfed away.

GBMC has a wireless internet connection, but it's not especially fast and, as I mentioned in my last post, you have difficulty connecting to certain sites. I noticed that anything that involved streaming wasn't likely to work, not that I was interested at the time, but still. Typepad behaved like a DNS error; websites that had video links would usually have just a big blank spot where the video belonged. Ah, well. I still got to surf 'n' stuff for awhile.

This was also the time I took to copy the CD-ROM that the Radiology people had given me. I opened up the program and took a look at my head, but I have to admit that I didn't really know what I was looking at. The interpretation would have to wait.

Back to Dr. Hotstuff, finally. I had to wait in the waiting room for a bit, then they put me in one examining room, then they moved me to another room. Finally the doctor came in and explained what the pictures were all about.

Mine Head This picture to the left is, indeed, my own personal head, which is why I've blurred out some information (my social security number was on there). As I understand it, this is a diagonal slice that goes through the front of my head. The key to the colors is thus:

–White stuff is bone;
–Black stuff is air;
–Gray stuff is soft tissue.
–The lines radiating from one of my teeth are caused by a filling. Cool, no?

(Boss and co-workers, please note that the space behind my eyes is brain and not air. Thank you.)

Okay, my sinuses. If you look in the middle of the picture, you see a curly black area just to the right of center, then as you move left there's a straight-ish gray zone, then a similar but much narrower black area. This is the worst of the problem with my sinuses. The straight-ish thing isn't straight enough; I have a deviated septum that basically wavers back and forth (and has a spur on it besides), and the left side of my sinuses are almost completely occluded. There's just about enough room for air to pass, but in general my head is a series of infections waiting to happen. Which is why I've been getting sick every few weeks lately, instead of a couple of times a year. The right side is better but not by much. There should be much more air passage going on in there. In short, says Dr. Hotstuff, I'm a good candidate for surgery.

Now, never having had real, knock-em-out-and cut-em-up surgery in my life before, this was not necessarily what I wanted to hear. So I had a million questions for him, most of which he was able to answer through his narrative of what needed to be done, what happens before, during & after the procedure, and what possible complications there were to this whole thing.

Neti I'm told that, barring complications, this is an outpatient procedure: surgery on Tuesday, recuperation on Wednesday and Thursday, remove the packing and splints on Friday, spend the weekend in a drugged stupor, back to work on Monday. Spend the next several weeks irrigating my sinuses with a neti pot, thus rinsing out clots and whatever else from my nose in order to speed healing.

I may have to do this part at work, just so people will leave me alone.

Getting My Head Examined, part I

Father Dougal McGuire: Father Stone's been in there a long time, hasn't he? Do you think he's dead?
Father Ted Crilly: Probably doing tests.
Father Dougal McGuire: What sort of tests? General knowledge?

Father Ted, "Entertaining Father Stone" (4/28/95)

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I was rather hoping to do this during the day, but for whatever reason the WiFi network at GBMC just didn't want to access Typepad. So you get this recap instead.

I had three stops at the hospital today, all of them related to my visit to the Ear, Nose & Throat guy a couple of weeks ago. My first stop was at Advanced Radiology, where I had to get a CT scan of my sinuses to figure out what's sinus and what's not (say it fast and get a giggle). As it happened, they mislaid the original orders, so there was a short delay, but the scan itself took only a couple of minutes. I was under orders to bring the films to the other doctors, so I waited around.

Did you know that you don't "bring the films" anymore? They hand you a CD-ROM. It used to be that you'd hand the films over and that would be that. Now, if they happen to hand you a CD-ROM, and you happen to be wandering the GBMC campus with your laptop computer, well. You're going home with scans in your possession.

Because of the delay, I had to go directly from the CT Scan to the allergist. I signed in, and they had me wait in their "Internet CafĂ©", which is a rather nice waiting room that has countertops to accommodate laptops. There were network jacks, but I figured I wouldn't be there long and simply worked on writing up an observation report that I wanted to get done by the end of the week. After a few minutes I was called into the exam room.

A nurse took my vitals (never game 'em back, bitch) and after another few minutes' wait the doctor came in. He and I chitchatted for a bit about my medical history and then it was time for the allergy tests.

Allergyskintest Now, once upon a time When Dinosaurs Ruled the Earth and I was a young adult, I went through the scratch tests. This involved being scratched repeatedly with a series of sharp objects that had been dipped in assorted irritants. After a half hour or so, they'd look at the marks to see what you reacted to and what you didn't. The worst part was getting this series of scratches up one arm and down the other. By the time they got to the last one, the first few scratches on were already itchy. One of the reasons it took me so long to go back to an allergist was facing those things again.

SkinTest As it happens, it's different nowadays. They have this gizmo which is pre-dipped in the irritants, and they can do a bunch of them at once. It's no worse than getting a fingernail scratch on your arm, and they get it done in six applications. Then, to distract you from the itchiness, they show you a Power Point presentation that give you information on rhinitis, sinusitis, asthma, and so forth. Shortly after this is over, it's time to check the marks. As it turns out, I do have a couple of allergies. Some of the allergies I don't have were surprises. I'm not as sensitive to pollen or pet dander as my actual reactions would suggest, but there may be a reason for that. Oh, and there was a section where I had to get my lung capacity measured, before and after a hit from an Albuterol inhaler.

The allergist gave me a prescription and wants to see me in a month. He wasn't thrilled with what he saw on the CT scan, but refused to elaborate. In retrospect, though, stuff he said was setting me up for the ENT's analysis.

More to come, including screen shots of my sinuses.