splint-free!

A week ago, I had a septoplasty and turbinate reduction surgery.

Today, I got the splints removed from my nose -- huzzah! It was an odd but not painful process. The splints are semi-rigid plastic, and about 3 inches long, so it felt weird when the doctor drew them out, but as I said, it didn't hurt.

Mine weren't blue, but they were at least 3 inches long and held in place by a stitch, just as these are. It doesn't seem as if all that should be able to fit into a nose, does it? (Image from Wikipedia)

Now I can breathe quite easily through my nose, although when I do, it feels as if the entire inside of my skull is filling up with air. It was cool out today, only about 55 degrees, and walking out of the building afterwards was painful, getting all that cold air up my snoot. I'm sure these extra-sensitive reactions will moderate with time.

While I was there, I asked my ENT about the painful upper jaw/front teeth I experienced, and he said that was common with septoplasty. It would have been nice if anyone had ever mentioned that, hmmm? I do like to know what to expect. It was not an issue with the intubation. I asked about the anesthesiologist's difficulties with intubating me, and the ENT said he didn't remark anything at the time, but would follow up with the other doctor. It's entirely possible that the anesthesiologist was just checking on me because he had such a tough time getting the IV in and wanted to make sure I wasn't in agony or anything, and I just misunderstood in my post-op drug haze.

I go back in two weeks for another follow-up, and to discuss what to do about the enlarged arytenoid cartilage that's making swallowing so problematic. For now I'll just continue with the saline nasal spray, and set up the cool mist humidifier (if I can figure it out, that's usually DH's job) so I don't become completely parched overnight.

It's so lovely not having those things in my face anymore.

post-op day 1

Not a great day.

I feel like I have a very bad cold, chiefly because 1) my nose has been dripping all day long and 2) for most of the day, I've been mouth-breathing.

My front teeth and surrounding tissue continue very sore, and I noticed that I have bruises on both my upper and lower lip on the left side. My throat is very sore and swallowing is difficult. I've been sipping hot tea through a straw all day; it helps.

Pain-wise: the nose is uncomfortable, but not excruciating; I'm still on just the extra-strength Tylenol. For much of the day, I would say there was no pain at all. The splints do feel weird, though, and have set me off sneezing several times. Sneezing is not a problem at all, although it does tend to set off more bleeding/discharge.

For most of the day, the discharge has been pinkish, more lymph than blood, and it is definitely slowing. I dislike the feeling of constant wet under my nose, and dislike that I tear up spontaneously (usually around sneezing fits) -- it feels as if my entire face is filling up, and tears leak out. It's weird because for the most part, I can breathe through my nose, I just forget to -- the drip pad placement is key. It has to catch the goop but not block the airflow.

Finally heard back from my ENT's office, and got the go-ahead to just use OTC saline nasal spray for my irrigation. It helps.

I feel like whining but don't, what would be the point? I just have to get through this. The timing is horrible. I want to be enjoying Christmas-y things and can't. I find this all incredibly annoying, specifically because it's self-inflicted. I didn't want to do this and now I'm miserable, but it's not like I can undo it!

I'll feel better tomorrow, and eventually say "yes, it was worth it," when I don't have chronic sinus infections anymore. Right?

I just wish my damn teeth weren't hurting so much.

11 hours ago

I got out of surgery. I whined about going, but I went anyway. While we were waiting for them to call me back, I told DH that if I had the car keys, I would've bolted, but I stayed put.

The pre-op was the most miserable I've ever had, as it took the anesthesiologist four tries to finally stick a vein that didn't collapse or blow out on him. The nurse took a look at my arms and wouldn't even attempt it. The doc hit a vein every time, but they kept failing -- even the one in my hand that is like Old Reliable. That was weird. Usually once the vein is stuck, it behaves itself. I've been off all my supplements for almost two weeks now -- perhaps my lack of EFAs has something to do with it. Anyway, each stick hurt very much, and the doc was apologetic, warning me with each stick: "A lot of pain here, sorry," as he shoved the thing into my arm. He finally got one in my right forearm -- if that one failed, he was going to try the veins in my feet. So far, I've managed to avoid that horror.

The surgery itself went well; I'm not packed, but I do have splints in my nose that will need to come out next week. I have been wearing "drip pads" since I came out; a small wad of gauze pads to catch the oozing (blood) from my nose. It's held on with strip that I suspect was cut from a surgical mask. The elastic isn't very tight but even so, I don't like having anything around my head and behind my ears for so many consecutive hours. The blood flow was pretty steady for the first few hours but tapered off this afternoon. I'm hoping it will stop altogether tomorrow.

I took a Vicodin when DH brought them home, but since then I've been just on extra-strength Tylenol. I don't like that spacy feeling that Vicodin gives me, and the pain is very manageable, so far.

As usual, some incidental insult is giving me more trouble than the surgery itself. The stroboscopy last week showed I have some enlargement of the cartilaginous structures at the top of my throat, which explains the lumpy feeling and my difficulty swallowing. (Apparently, this is the result of compensating for the nerve damage from my cancer surgeries.) They had a lot of trouble intubating me for the surgery, and my throat is killing me. In addition, my front teeth are sore and the tissue just behind them is very tender, like I ate pizza right out of the oven and the mozzarella stuck to the roof of my mouth. (I resent greatly feeling like I have pizza burn without the compensating pleasure of eating hot, fresh pizza.)

Mouth-breathing about two-thirds of the time isn't helping, either. I can breathe through my nose, it's just having the gauze there makes me think I shouldn't.

So far I don't have black eyes and external swelling is minimal if at all present, so that's cool. Of course I look weird because I have this bloody wad of gauze under my nose, but it could be a lot worse. The only real hassle is, I have instructions for nasal irrigation, with specific directions for how to clean the device, but I didn't get a device, and no one told me what device I need, or when to start the irrigation. I think it's a safe bet that I shouldn't irrigate until the bleeding stops, but still, it's annoying. DH made a bunch of calls today, including one to the doctor's office, but we still don't have any answers. How annoying! I have to call tomorrow to make my follow-up appointment to get the splints removed, so I hope to get answers to these questions then.

Mom took good care of me and fed me soup and tea, and made dinner for the family while I slept. She made brownies while I was in surgery, and the kids are enjoying them so much. Tomorrow they have just a half-day of school, and then it's winter break. They're as ready for a break as I am, and won't mind a few days of lounging around while I recover. I hope!

post-op progress report

It has been six weeks since my surgery, so it's time for another update.

All the on-site help left at the end of my 3rd week post-op, so I've been flying solo (not really, it just seems that way when DH is at work) since then and doing generally OK. I haven't had, or needed, a melt-down yet. That's a relief. Sometimes when you haven't had to do something for a while and then it gets dumped back in your lap, it can seem harder than it really is. So far so good on the coping front.

My head and neck mobility are excellent, and Elf is very pleased with my progress. I still have slight right-sided weakness in the arm and shoulder that we're working on -- I'm in physical therapy 3x/week, and boy does that take a chunk out of my errand-running time. I was diligent about doing my p/t exercises at home for about the first month, but I have really slacked off in the past week or so. I'm either going to p/t or taking a yoga class every day, it seems, so is it really so important? Yes, I know it is, but I've been doing so much running around that I haven't been making it a priority. I'll ask Elf about it tomorrow, because I don't want to screw myself up by not doing them when I've made so much progress already.

I still have the numbness and very tight feeling in the right side of my neck and affecting my right ear, too. (Unexpected, related downer: I can't find my diamond stud earrings, last seen in Houston! I didn't wear them home because my ear felt too weird for studs, and I don't know where I put them to bring them home... I'm very upset with myself for losing them, but I'm still hoping they will turn up somewhere.) Elf has been working at massage to loosen things up in there, and it is helping; I'm having more and more electric-shock and tiny ice-pick feelings along the jawline and down the neck, lately. While annoying, these feelings are to the good, because it means that sensations are returning. I'm hopeful that eventually everything will be normal again.

Both Elf and my ENT commented that my scar is looking excellent and has good mobility. It twinges me from time to time, and I have been massaging it every day with Aquaphore (recommended by my dermatologist for all my other biopsies and scars, so why not this one, I figured.) Here's the scary picture with the steri-strips and the drain; here's the scar at 3 weeks out. Which brings us to today. Sorry these photos are a little blurry, my camera batteries were dying, so I took these shots quickly -- and poorly, it seems, but good enough to see the improvement, I think!




Because these photos are crummy, I didn't bother cropping them down, so consequently you can see a lot more neck than in the other photos. One thing that really leaps out at me is how much swelling I had in my neck, which has completely disappeared. The other obvious thing is that the depression in the center of my neck is slightly exaggerated, as my surgeon said it would be -- that's from the bilateral paratracheal dissection, he actually removed muscle tissue from in there, so it looks like my neck is caving in a little there. I'm sure it's not anything that most people would ever notice. Last, the act of holding out the camera to take the picture causes some of my neck muscles to flex a bit, and that is contributing to the ropiness of my neck in these shots. I don't always look like I'm straining!

The scar itself comes off a bit more red in the photo than it really is, but again, I'm too lazy to manipulate the photo to bring it into alignment with reality. At this point, very few people notice my scar, and even fewer comment on it -- that's fine with me.

One annoying thing is that because of the long incision and the nerve weirdness in my neck, I can't stand to have anything on it. Most winters I live in turtlenecks and mock turtleneck tops, and I have a drawer full of them that I simply cannot wear right now -- and who knows whether or not I'll get comfortable over the course of the winter? I went to the Gap today and bought some new long-sleeve T's. I looked a few other places but I went with the Gap's because I like how they fit me -- I know they'll fit.

They finally posted my statement over at MDA -- they say I only owe $1700. I'm not going to argue, but we are going to wait to pay it until closer till the end of the year!

I am, as I said, allowing myself to think that I'm done with the active management/eradication phase of the Cancer Cycle. I could be wrong, but I hope I'm not. Right now the biggest worry I have is getting new prescriptions out of the endos at MDA in time for me to get them filled by the mail order folks. I'm sure it will work out one way or another. It's great to contemplate a future in which no horrofic procedures or treatments involving radiation are planned.

the neck dissection experience: 3 weeks post-op

Three weeks ago at this time I was sitting in pre-op in Houston, nervous and thirsty, and just wanting to get it all over with. I think if I had known how weird my neck would feel afterwards, I would've spent a lot more time enjoying the fact that I could move it so freely! I can't believe it has been three weeks. That doesn't seem possible.

For the record, the procedures I underwent were: a complete right neck dissection, a bilateral paratracheal dissection, a central compartment dissection, and a superior mediastinal dissection. Here and here are links that explain some of these terms.

I finally removed the steri-strips after my shower this morning. It wasn't at all painful, although it was a little nerve-wracking because I expected it to be. Now I have a lovely wrap-around scar. Since this photo is a lot less grim than the first one I took, I'm posting it. It's certainly no worse than a lot of stuff you'll see on TV, so I hope nobody gets too upset about it.



Just so you know, that "lovely" up there wasn't at all sarcastic. This is a really nice-looking scar, as scars go, especially given that I'm only 3 weeks post-op. Comparing the two photos, you can see how the swelling has gone down considerably.

Now, as to the rest of it: the numbness persists with no discernible progress, except that my right ear lobe feels itchy now and then. I suppose that is progress! I get the itchy feeling also sometimes under my jawline, but for the most part, the "novocaine hasn't worn off yet" feeling persist in the ear as mentioned, under the jaw, all the way down the front of my neck along the right side. It's very funny (weird, not ha-ha) in that there is a definite line of demarcation right down the center of my neck, sensations registering on one side, while none do on the other.

My head, neck, and shoulder mobility are very good. Certain stretches, like tilting the head so the ear goes to the shoulder, are more challenging than others, but even those are working out. I am trying to massage those very tight muscles during some stretches and that helps, too. I am religious with the exercises and with my physical therapy. Elf really makes me work! But it's good.

I would feel very comfortable driving today if I had to; the main issue with driving is being able to turn my head far enough and without hesitation -- that's something I find myself doing constantly just in dealing with the kiddos while I'm sitting at the computer. I'm sure I can turn my head farther now than a lot of non-surgically-impaired drivers can, so it's not an issue.

One thing that pops up from time to time is right-sided weakness in the arm and shoulder. Last night I made a pot of sticky rice to go along with our sesame steak, and I had a very hard time holding up the pot with my right hand while I scooped out the rice with the serving spoon in my left. Since I am left-handed I often use my right arm for the steadying/holding role in situations like that, and whenever I do, now, I notice how much weaker it is. PT will continue and hopefully it will improve. It's no fun to have such an imbalance.

I still don't do much lifting, although I did carry a laundry basket upstairs a few days ago. I do carry DS2 to bed every night now, and toss him in when we get there. He only weighs about 35 pounds and I'm not even supporting his weight with my arms; he wraps arms and legs around me and holds on like a koala. Adding back this part of our routine has made him a very happy boy. I haven't noticed any aches or tweaks from carrying, but I'll continue to be careful.

One twinge I've noticed is a kind of "crunchy" feeling right in my shoulder joints, both left and right, when I'm doing the shoulder lifting exercises. Elf says I need to be sure to keep them back while I'm lifting, and that has helped a lot, but I do still feel it from time to time. I'm wondering if that could be from my RA.

Med-wise, I'm taking Aleve twice a day, and Tylenol as necessary. I haven't had a really bad headache day since Tuesday, but I'm pretty sure that sitting at a computer all day will contribute to a headache. I get brutal muscle tension along my shoulders and the back of my head; Elf showed me some new stretches that really help a lot to relax them and reduce the headaches.

I get tired easily, and admit to being down more than up these past few days. I forgot to take my Prilosec two days in a row and having acid churning around in my stomach didn't help at all. I'm trying not to be on edge regarding my pathology report, which I still don't have, or my prognosis, which I have no idea when I'll get, in spite of emails I've sent, asking when I could expect it.

It does no good to think about these things; there's nothing I can do about them right now, anyway. Even though I'm doing very well and am a long way back to normal, it will take a long time to really recover from this surgery, both physically and emotionally. For now the thing that bothers me most is how weird my ear feels -- it calls attention to itself whenever I tuck hair behind it, for example, or else it just feels cold. I suppose I should be happy that I'm feeling something but it's ennervating.

I'm glad I can ignore it for the most part. The plan now is to continue to focus on regaining both strength and mobility.

for the curious.

And for comparison purposes as the scar heels in the weeks and months ahead -- here is a photo of my incision and the bandage over my drain, at 5 days post-op. Don't click on the link if you're at all squeamish.

There's still a bit of swelling and odd puffiness in my throat, I'm sure it will take a while for that to subside. I know the front of my throat may look different when healing is complete because of the paratracheal dissection; the doctor removed some muscles from the front of my neck. He informs me that as a result I will no longer be able to sing vibrato, but I assured him that was no loss.

I haven't really tried to sing since the surgery -- just a few notes here and there, and it did feel weird but then again everything throat-related, including speaking and swallowing, feels weird now.

As DH was cleaning the drain site last night I said, I feel like something from a science fiction movie.

He didn't miss a beat: You mean like The Borg?



Yeah, well, at least I don't have a tube coming out of my skull.

out, about, and going home soon

Somehow I still can't believe it actually happened, even though I now have this huge incision around my neck. I also have a drain, which is kind of icky, but DH is a total trooper and is taking good care of both me and it. (I suppose that's kind of the same thing.)

Surgery took about 4-and-a-half hours. Since I had to repeat the procedure names about 12 times pre-op, I now know them by heart. I had: a complete right neck dissection, a central compartment dissection, a superior mediastinal dissection, and a bilateral paratracheal dissection. Doesn't that sound creepy? Now that it's done I can handle rattling that off a lot better. Anyway, the dr said he found a lot more cancer than he expected even from the ultrasound and the CT scan, so it is a very good thing I had this surgery now. I don't really like to think about the alternatives so I will just move right along...

I woke up in recovery feeling pretty OK and able to talk right away. I couldn't move my right shoulder or upper arm, but my hand and forearm were OK. Later that evening I could move both my shoulder and upper arm. Now the only numbness I have is along my right jawline, and my right ear. It's weird. I do have swelling on the right side of my neck, and I'm sure that has a lot to do with the numbness. Plus the poor nerves have been shocked all to pieces, I'm sure.

The staff kept a watchful eye on my calcium levels and my parathyroids seem to have come through OK. Even so the endo has bumped up my calcium to 3 grams/day. I had thought that I was only doing 1g/day before surgery but then I looked at the bottle and realized I was taking 2g/day, so no wonder I was low post-op -- I missed my 2g dose on surgery day.

Now I will tell you something you probably won't believe, but the food at MDA is quite good. There is a "room service" menu and you can order anything you want (depending on what diet you're on per dr's orders, of course -- but I was on "normal diet as tolerated"), so I had some pretty decent meals. One of the drinks they offered was peach nectar, which is a favorite so I had that more than once. Hey, if you can't indulge post-op, when can you? I also had some really amazing homemade granola with plain yogurt, which I think may be one of my all-time favorite breakfasts.

The nurses were terrific. I probably had 10 different people working with me between recovery and my room, and they were all very kind and helpful. And especially good about keeping the good pain management drugs flowing. Speaking of which, I am doing well there with minimal pain and only taking Celebrex for now. I have some hydrocodone (heavy duty stuff) to take if it gets worse, but it does make me feel very loopy. I don't sleep right on that stuff either -- I took one last night and drifted in and out until it wore off, when I finally fell properly asleep.

The physical therapist came in to see me and gave me my shoulder-strengthening exercises, and was amazed at my range of motion. I knew there was a reason for taking up yoga and swimming this fall. I have been a good girl and already done one rep of my exercises this morning.

So we had a late breakfast and now DH is seeing about our transportation to the airport tonight (our flight leaves after 8PM) and also about getting a duffel bag or something, because we have a lot of stuff we didn't anticipate getting -- both paperwork and supplies for caring for my drain. We need another bag! But all will be OK.

I am tired and my right arm feels like I played tennis all day with it. My incision around my neck is probably 9 inches long but doesn't hurt (yet) as the nerves are still shot, I'm sure. The surgeon placed the steri-strips perpendicular to the incision so the effect is one of a fringed collar. It would be funny if it weren't so freaky looking. I hope it doesn't scare the kids!

DH says he doesn't notice the swelling in my face but I do. All in all I don't look too bad considering what I went through, and I certainly feel better than I expected to. I am still nervous about the flight home but really looking forward to getting there. I know with DH I will be all right even if I have a little more pain or discomfort, it will only be for a short time.

Thank you everyone for all your thoughts and prayers. It has really been a tremendous help. This will probably be the longest update for a while since I know my mom will not let me sit at the computer for this long at home (hee!). That's OK, I'll pop in with little updates when I can. I'm doing well and going to be fine, both dr and physical therapist say back to normal activities after 4 weeks. That'll go by very quickly.

lunacy

Today was a typical crazy day -- ref. the title of this blog!

Managed to get up a little before 8, dragged DS2 out of bed and dressed him and fed him breakfast then took him to Atrium, then went to the grocery store, got home put groceries away then dashed out to pick up DS2. Came home for about 30 minutes and then went out to pick up DS1.

Since it was a cold and rainy day (the first official day of our second season here, aka Not Summer), traffic picking DS1 up was worse than it has been lately with the road construction right in front of the school... I was stuck for literally 25 minutes. It's just stupid. The DOT has totally mismanaged this road construction project from my perspective, but what do I know? Why couldn't they have prioritized this stretch of road for the summer when the school was closed? It's the only school on the road, for heaven's sake! OK, enough of that pointless rant...

Got home with DS1, had about 20 minutes before I had to go pick up DH, who drove me up to my surgeon's office. I wasn't sure how the intense highway driving would affect my neck, plus I wasn't sure what the news would be regarding the stuff they took out, and I wanted him there for moral support.

We got up there pretty early and walked across the street to the hospital's Starbucks to get me a humongous mocha. (mmmmmmm) It was perfect in the drizzly damp chill. Then we walked back through the maze of hospital corridors and across the street, making sure the parking lot security guard saw us return -- he had vetted us for a quick trip for the coffee, no more. Apparently, they have a huge problem with people taking their parking spaces for trips to the hospital. How rude. However, we were legit customers of the building, the coffee thing was just a detour.

Everything went well with the surgeon. As I expected, he took off the steri-strips. He did a nice slow even peel, and it didn't hurt. I have a cool scar now:

The swelling should go down over the next few days and the bruising I hope will disappear entirely, and there won't be much to see there at all. Cool.

The biopsy report, while not good (tons and tons of cancer), was good in one respect: all the cancer was well-differentiated papillary thyroid cancer, which means anything that's left will be knocked off by the RAI. That was a huge relief.

After that, DH and I drove back to his office, and then I went to Toys'R'Us and shopped for DD (My Little Pony Palace! Barbie Princess & the Pauper! DVDs galore!), then Sam's Club (*sob* they don't carry the grated parmesan I like anymore!) and then to Joanne's for a costume for DS1: he wants to be the Grim Reaper, and I found this awesome pattern and cool fabric. It's going to be incredible but I can't believe I volunteered myself for it... What was I thinking?

Finding the pattern and picking out the fabric took forever, so I didn't get home until 5? 5:30? I don't know, but I was flattened by that time. Mom made dinner, it was awesome, and I have been basically useless since then this evening, bouncing from one thing to another and accomplishing nothing.

But I'm happy anyway:

This is the kind of goofy picture that results when idiots like me take self-portraits at arm's length with their digital cameras. But I like this picture because I can see my resemblance to my Dad in it. Plus I think you can see some of the relief I'm feeling after today's post-op follow up.

Rosie is doing a lot better today, she even climbed up to one of her favorite perches, the top of the old CPU. She moved slowly while getting there, but she made it. She still has weakness and uncoordination of her hind legs, but not as bad as before. We are all encouraged by her improvement.

back home

The surgery went well although it was a bit difficult. There was cancer (papillary, as was suspected), but there was also lymph node involvement. The lymph nodes were as big as my thyroid... and the mass had grown right under the nerve leading to(from?) my vocal chords, so the surgeon had to work around it to get everything out. I couldn't talk last night but this morning my voice is back but hoarse, which is common after any surgery requiring intubation.

I never get to sleep in the hospital. Too much noise, too many interruptions. I'm glad to be home.

My endo popped in to see my last night, she just happened to be visiting another patient and noticed my name on the board. That was very nice of her to come by and tell me what the scoop is. Namely, I have to wait for my TSH to get up to 40, and then I'll get the RAI and a full-body scan to see if there are any distant metastises, which the RAI will also eliminate. Then I can go back on the thyroid hormones and get my life back. Here's hoping it happens sooner rather than later.

The surgeon was funny this morning, we reviewed all this stuff plus wound care,etc. He said, "You're perfect," inspecting the incision (no swelling, looks good.) I laughed. I am far from perfect, but I am as well as can be expected. I have no complaints.