In Your Shoes!! - Part 1

As a doctor, it is very easy to give advice about post-operative care regarding ways to manage pain and precautions to be taken. The real problems and difficulties are best judged by the patient. Fortunately or unfortunately, I have undergone a few common ENT / Otorhinolaryngology surgeries myself. This experience indeed was an eye-opener to me in many ways to understand the problems and difficulties faced by the patient. In this blog, I will share with you my experience on Septoplasty or Nasal Bridge Correction surgery as a patient.

My first obstacle or challenge was to understand the surgery. As an MBBS graduate although I was aware of the theory aspect but not very enlightened about the practical aspects of the surgery. Luckily for me, I was going to be operated by one of my teachers. He had an excellent way of describing the surgery to me using simple diagrams and paper cut-outs. A clear explanation was given to me about the types of deviations or bends that are commonly seen in the nasal septum or bridge. The doctor also went on to explain that septal deviation was a common condition in 80% of the population. That statement was a big sigh of relief for my wife, as she had already fixated in her mind from the word surgery that her husband has a major nose deformity.

Thereafter a clear explanation was given on why I require surgery and the various surgical techniques or options that were available. Similarly, a clear understanding was made regarding the outcome and aim of the surgery to ensure that doctor and patient (myself) are on the same page.

The main indications for a Septal Correction / Septoplasty surgery are:

• Nasal airway obstruction

• Septal spur causing headache

• Uncontrollable nosebleeds

• Nasal septal deformity obstructing access for other intranasal surgery

Immediately the first question that was fired at my doctor was," Will my nasal block disappear for good immediately after my surgery?". My teacher taught me a few important lessons at that very moment. The success of any surgery is not only in the anatomical outcome of the procedure but also giving the patient an exact picture or idea on what to look forward to post-surgery.

The postoperative period was divided into 3 time periods for me to get a better understanding of the outcome. He divided the postsurgical period into the 'Healing Time', 'Honeymoon time' and 'Reality time'. It might not be a scientific way of dividing the postoperative period but it definitely was the best way to explain the outcome to a patient.

During the 'Healing Time', the first thought that will cross your mind as a patient will be 'Why did I agree to this surgery? Is it worth all this irritation and pain?'. To be honest that was the exact thought process I had for the first 2 weeks after surgery. The most difficult day was the first postoperative day with nasal packs and splints in both my nostril forcing me to breathe through the mouth. Mouth breathing was causing dryness of my mouth and thirst resulting in a very disturbed sleep. Overcoming the first night was like winning half the battle, the next morning nasal packs were removed and it was a big sigh of relief as I could inhale some air through my nose. Maybe we can use the new coined urban word 'Airgasm' that has come out during this COVID-19 pandemic to help you understand that feeling. Once the packs were removed, started the process of washing/douching your nose. This definitely was not the most pleasant thing to do as you will be washing out all the stagnated mucous and blood clots from your nose. This process indeed helps your nose to heal faster as you are reducing the workload and letting the nose take a postoperative rest. Like any other patient, I got lazy as the oozing from my nose reduced after the first 3 days of surgery. On the 7th day, it was my first postoperative visit to the doctor for cleaning and removal of the splint. As soon as he inserted the endoscope into my nose, he glared at me and said "Sachin you have not washed your nose as advised, now you pay the price!". Luckily for me, he was extremely patient and took a lot of time to carefully suction out all the dried clots without causing much pain. I realized at that point, nasal douching will make my post-operative healing faster and better. During the first two weeks, I was not feeling a drastic improvement in my nasal block. With regard to postoperative pain, it was very well within the tolerable limit with minimal pain killers for the first 3 days.

*SPLINT is a silicon plate kept in the nose to avoid sticking between two raw surfaces

'Honeymoon time' started for me from around the 3rd post-operative week. I could feel a significant difference in my nasal obstruction. There was absolutely no pain from the 10th postoperative day. My nasal douching was now reduced to once in the morning and night. Finally, it was all worth it feeling started kicking into me. My doctor had clearly told me, never to forget my surgeon once the feeling good quotient kicks in. At the end of 1 month, I visited my doctor again to do a final endoscopy to ensure everything has healed well and to stop the douching process completely. He recorded the endoscopic procedure and showed me the erect nasal septum which has been slouching for the past 26 years. During this visit, he once again reminded me about the 'Reality Time'.

'Reality Time' refers to the period where nasal obstruction can recur due to causes other than nasal septum or bridge deviation. My teacher had given the highest emphasis on this period prior to the surgery as he clearly explained clearly other factors like allergy can cause resistance in the nasal airway/space. Therefore it is also essential as a patient to understand that septoplasty or septal correction is not going to resolve the allergic problems related to the nose.

To sum up the whole experience, Septoplasty is not a very painful procedure but definitely there is an uncomfortable quotient involved postoperatively for around 2 to 3 weeks. The whole process involves around 3 to 4 weeks visits to your doctor for cleaning and endoscopy to ensure full healing of the nasal septum. The surgery only corrects the physical obstructions created by the nasal septum therefore treatment for allergy and other nasal problems will be required. The key to fast healing is douching of the nose as frequently as possible during the first two weeks. I was able to return to work after the first 7 days but for the gym enthusiasts, it will take at least 3 to 4 weeks before you can hit the weights again.

Shall share my experience with Adenotonsillectomy Surgery in the next blog. Please feel free to comment and subscribe to my blog if you find it useful.