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Medical Forum / Diseases and Disorders / Sinusitis / February 2005Getting sinus surgery - REALLY important questions pls read!
Ok I have been bouncing in and out of here for about a year now or so reading about stuff. I finally got a ct scan and it came out horrible. I have tryed baxin, zithromax and few times, ciffender or how ever you spell it, and now that new one tequin or something like that? Nothing works, it kinda helps the infection a bit but either comes back or just bottom line doesnt go away. Now I find out Ive been dealing w/ a pollup on my right side for some time now it seems. Its too the point were I can't get air in or out anymore on the right side. CT scan showed a deveated septum and a pollup on the right side completely blocking the right side. My upper sinuses are about completely blocked and my right cheek sinus is about completely blocked too. He said they are going to use a tool the has blades at the end that is suction too and it will cut the polup up and clear it out. He also said he will have to break the middle part of my nose inside to be able to get up past the crooked septum to do whatever. Now ok that sounds ok to me so far but heres were he freaked me out a bit. He said normally that the fluids drain out the top sinuses in the forehead during the surgery but he said it may be mucus or fluid or it could be a thick peanut butter like paste and that is bad which is fungus. He said if he finds that he has to cut 2 little cuts were the eyebrow starts and drill a 4mm hole in my fore head and suck out everything in the frontal sinuses because thats the only way. It sounds logical but im thinking that is kind of wierd and scary. Have any of you ever heard of that? The doctors name is Marmol and in port charlotte, fl and is board certified. Is there a way I can find out anything about the guy before I do anything? I have heard good things about him but haven't talked to anyone in town that had sinus surgery w/ him. My surgery is scheduled in less than 2 weeks. O I haven't really tryed too much of sinus sprays, they seem to do nothing for the side w/ the pollup. Sinofresh messed me up royally and triggered some kinda attack that cause me to fight another infection for 3 weeks. I tryed afrin, man that stuff works perty good to open up my left side, but didn't do much on the side w/ a pollup. So if he douches everything out, how can I help the fungus from not comming back. I mean were the hell did it come from? >He said normally that the fluids drain out the top sinuses in the forehead >during the surgery but he said it may be mucus or fluid or it could be a [quoted text clipped - 7 lines] >good things about him but haven't talked to anyone in town that had sinus >surgery w/ him. My surgery is scheduled in less than 2 weeks. Frontal recess surgery it is indeed tricky. I think techniques have changed in recent years and more is possible now. Sinus surgery is never a cut and dried thing. There are different approaches and techniques. Only some sinus surgeons have much experience with frontal recess surgey. So, to my view, going with the first sinus surgeon you happen to come across is actually not the best approach. It is just very unlikely that he is the best one. He may have obsolete techniques. Plus frontal recess surgery is very difficult and shouldperhaps not even be performed except by those with extensive experience. Personally I would cancel the frontal surgery until I had got 2 or 3 expert opinions from true experts in frontal surgery. I would not be at all surprised if you found some who could do it without the external cuts. >O I haven't really tryed too much of sinus sprays, they seem to do nothing >for the side w/ the pollup. Sinofresh messed me up royally and triggered [quoted text clipped - 4 lines] >So if he douches everything out, how can I help the fungus from not >comming back. I mean were the hell did it come from? You don't know that it is fungus yet, right? No I don't know if its fungus jet yet. I read for a few more hours on here last night and read about fungus and candida. Well if he sees there is fungus up there I think I would want it done. I was on some hospitals website in tx and saw some pictures of the frontal sinus cavity eaten away and exposing the brain to the sinus cavity and getting meningitis or however you spell it. He's not saying its being done for sure on if when he gets up into there and sees or tests it and its fungus will he doit. There is no trick to doing the Frontal Sinus surgery via endocopy. An honest doctor will realize if he hasn't been totally successful at surger in clearing the pathology and will then resort to the external approach. Despite the best CT scan, anatomy is higly variable and the Frontal Sinus has the most tortuous drainage route. I complement your doctor on being prepared to do the external approach if it is indicated. Murray Grossan, M.D. http://www.ent-consult.com I am just trying to reply to the person who might need the external approach to the frontal sinuses. Sometimes the surgeon just can't get in endoscopically . Has it been tried? I did have the frontal extenal approach.The secretion were so thickened and gelatinous that they couldn't be cleaned from below anyway. It sounds kind of horrible but it is really is just two little slits and they heal up quickly and you will hardly notice. Might not hurt to get a second opinion jut to make sure you feel comfortable. Carol www.naturalsinushealth.com Carol... Did the external operation cure your sinusitis? Did the operation open up the interior frontal drainage route? ..It seems just about every operation I read about on this group, become the first of a long string of many that never really cure the problem. ..I would love to hear from someone --anyone-- that says: " I've had XX operation for sinusitis, and now my sinuses are perfect." ...Jon >..I would love to hear from someone --anyone-- that says: " I've had XX >operation for sinusitis, and now my sinuses are perfect." ...Jon All sinus surgery does is clear away past damage. The process of thickening is going to start up all over again unless the underlying allergic or other cause is remedied also. Hi Don... I'm thinking in terms of the damage caused by the operation itself. You'd think that if the ENT could simply clean the sinuses out, something like flonase should suffice to keep an allergy in check. ....However...It appears (more often than not) that the operations have a higher success towards opening up a whole new can of worms as opposed to curing the initial infection. ...Is there anyone here who has had only a single operation? --Probably very few. .... From what I've read, one operation basically guarantees 2 or 3 more down the road. ... And ironically, the patient is still no better off, for now the sinuses only available cleaning system, is gone with auger. ...I'm a firm believer that the body will do whatever it takes to cure itself. ...I'm thankful now, I didn't have the operation I was slated for nearly 5 years ago. ...Jon >Hi Don... I'm thinking in terms of the damage caused by the operation >itself. You'd think that if the ENT could simply clean the sinuses out, >something like flonase should suffice to keep an allergy in check. Flonase only penetrates so far. >....However...It appears (more often than not) that the operations have >a higher success towards opening up a whole new can of worms as opposed >to curing the initial infection. I hope your statistics are wrong and I think they are. There certainly are such cases, but I do not tink they are in the majority. > ...Is there anyone here who has had >only a single operation? --Probably very few. . Yes - I have. >... From what I've read, >one operation basically guarantees 2 or 3 more down the road. ... And [quoted text clipped - 3 lines] > ...I'm a firm believer that the body will do whatever it takes to cure >itself Well the problem is that it eventually tries to wall in the infection - which works to a degree, but may leave a risk of the infection's eventully spreading to bone and occasionally other earby organs. >. ...I'm thankful now, I didn't have the operation I was slated >for nearly 5 years ago. ...Jon It depends on the circumstances. Some people cure their sinusitis on their own, say by allergen avoidance. But some people have closed-off blocked sinuses full of infected pus that are beyond the point of being likely to heal heal on their own.... All sinus surgery isn't successful because there may be so much disease, bone erosion, etc that all the doctor can do is remove the diseased tissue and extablish drainage. There is often a reasn why the doctor wants to do surgery NOW - because delaying it will only advance the disease further and make a complete cure impossible. Every case is diffetent. And patients can choose options. I am currently treathing a lady where I have explained that the chance of a medical cure is only 10% vs 85% for a surgical cure. She chooses to try the medical route. I hope she is right. Murray Grossan, M.D. http://www.ent-consult.com ..The question is: When should one decide to have an operation? Irrigation and flonase has stopped those God-awful headaches I used to get on a daily basis 5+ years ago (when I was slated for an operation); however, since that time, and because of steady irrigation and flonase, my sinuses have felt great -- at least 80% of the time.. ..A cat scan (5 years ago) showed I had ethmoid involvement, a polyp in my left maxillary, and some activity in the lower end of my frontals. ..So am I doing damage by not having an operation? ...Could my sinuses be actually getting worse, even without my knowledge -- IE: despite a showing of incapacitating symptoms? ...Right now, my sinuses feel clear as a bell, although last night I was congested and flushed out some thick white coloured mucus. ...I know my sinus problem is still there, but should one wait until there is a definite indication that the current regimen is completely ineffectve towards holding the infection at bay? (I've gone almost 2 years without the need of an antibiotic.) ...Jon If I wasn't getting infections I wouldn't be having surgery. My doc goes for medical management for at LEAST a year before the knife....I had surgery for the last time after I had a recurring infection for almost 5 years - and for almost 1 year w/ this doc. ok well I am getting it done and mainly because I can't get ANY air through the right side. It is starting to blockoff the drainage and I can feel some going to my ear. I believe I am at a point of no return on the polyp. This isn't a little polyp id have to say its brob. the thickness of a AA batt. so imagine a plug in your nose. Plus I have a deviated septum, there isn't a nose spray, nasal wash, or some witchcraft potion for that. I think the main reason why people hear all bad on here is because your only hearing the bad stories. People come here when they have problems, they aren't going to come here for nothing unless your a ENT. Mainly I was concerned about the front external approach because it frightened me a bit to hear what he may have to do. As someone noted they had it done because the mucus was so thick and jelly like which is exactly what my doc said. That makes me feel better to hear that. Anyways, Im going in tomm. morning early. I hate G/A, I don't wanna be poked w/ a needle and put to sleep but o well its for a good cause. I will leave some feedback about how it went and thanks for all the replys. Frank Hope everything goes well - you're probably gonna feel a LOT better when you're all healed up! Ah thank you entconsult it sounds like you agree with my doctor which makes me feel quite better about the decision to step forward. I was going to get a second opinion which he offered me to do but I think there is enough evidence to support what he is saying. I know I need all the other stuff for sure besides the frontal so I am not questioning that. The odd thing is, if my frontal sinuses have been clogged up I never have known it because I have never really had any pain from sinuses. Even the sinus in my cheek has only hert me 1 time during an infection. I very rarely have enough pain in my head anywere to cause a headache. I guess im just lucky or have a high tolerance for pain. Ok heres a few more things, were can I search on more info about the external frontal procedure so I can know what to expect afterwards and just to learn more about it in general. Also what is the name of the procedure so I can seach better on google or whatever. I want to make a phone call to the doctor on monday to ask some inteligent questions. When he was telling me the news my jaw was just kinda open and I was like duhhhhh, holy crap and wasn't really in a thinking position. Boy the internet sure does make situations like this helpful were would we be without it today! One common Frontal Sinus approach is called the Lynch Procedure. Murray Grossan, M.D. http://www.ent-consult.com Have you tried Cipro, Levaquin or Zetek ? They're considered the "big guns" when it comes to a pesky bacterial infection. Tony yo dude I got royally screwed and now my life is changed forever! Don't get surgery unless you really really really really really have to! The ENTS will clean you out alright but then your nose won't even work anymore! Don't worry too much about the severe complications as long as you're near an emergency room and have insurance then try and clear the infection and if you never had that much sinus discomfort your probably suffering from a severe bout of acute sinusitus. The damn doctors are so mathematical that they think that they can define sinusitus in weeks or simple terms like acute subacute and chronic well guess what? They convinced me that my eight week infection was chronic because my cat scan showed mucosal swelling 4-5 weeks after the third antibiotic cleared me up and they also worried me with the deviated septum and concha bullosa which they say contributed to it BUT if you go to ENTLINX there is no coorelation between these common anatomical deviations and sinusitus! Guess what dude I figured a lot out during my suffering,(SUFFERING YOU DON"T HAVE TO GO THROUGH!) stay away from ENT's all they want to do is operate otherwise all they do is look at snotty noses and prescribe drugs! most of the time! you think there wasn't enough cancer of the throat to go around and other really deadly conditions that merit surgery. Well dude you say you haven't used any nasal sprays and you should because the same tiny little nasal and sinus passages that you need to feel and function normally are easy to get swollen and then its sometimes almost impossible to unclog your sinuses and if they are clogged then antibiotics will only hold the infection at bay but you won't get rid of it! So get a regular doctor who isn't interested in doing a modern abstract sculpture inside your nose and get a combination of antibiotic like biaxin or augmentin or levaquin or tequin and an antifungicide like diflucan and also get a prescription for a nasal steroid like aquacort you should get at least 14 days worth. the tiny red 4 hour sudafeds help too but you have to use them sparingly, I think early predawn and afternoon is the best times because it gives you couple of hours to decongest before flushing. The other thing you must do is flush so go to a surgical supply and get a bulb syringe and get some kosher salt, arm and hammer baking soda and a few gallons of distilled water! flushing must be done without irritating the interior of the nose so temperature must not be too hot or cold exactly bodytemperature is best , use the distilled water and mix in a level teaspoon or just under of salt and about half a teaspoon of baking soda in a large 12-14 ounce coffee mug that you have scrubbed clean and rinsed thoroughly microwave for about 25 - 35 seconds it will take some practice to get your cup and microwave time exact, if it a little warm then let it sit or suck it into the syringe and squirt it back several times until it cools. when its cool the squirt it gently but with a little force up your nose! then blow out gently and do it several times. If you can twist your head almost upside down and then squirt it may work a little better! you should do this 2-3 times a day but may have to do it up to a half dozen time s a day until the sinuses open up! its tricky to integrate with the nasal steroid spray because you want a clean nose that the water has mostly drained from before spraying the aquacort. Also with the Aquacort instead of twice morning and night do it four times the first couple of days then go to three times for several days and afte about a week go to the normal two squirts twice a day! Drink a lot of tea dude and don't use warm compresses use cold compresses to reduce the swelling and try and get a little exercise even if its walking half a mile or going up 4-5 flights of stairs to get the adrenalin pumping but don't tire yourself out with prolonged exercise until you are better! Guess what dude you're gonna get better and don't smoke if you do cause that'll screw you up again. guess what dude I had surgery and I'm worse and have to go through all that sh.t I told you about regularly and if I would of known before the surgery than I wouldn't have got it cause if you search a wall street journal article from a couple of years ago they'll tell you that often scarring clogs you up again sometimes worse and you're better off without surgery! most people willeventually get over it and guess what else the ENT ain't telling you! When you get to be 45years old your nasal mucosa will begin to gradually shrink and you'll have less problems! guess what else he ain't telling you? He' gonna chop on your turbinates and rip open your sinuses and grind away the eggshell thi partitions that make up the complex honeycomb structure of your natural anatomy dude and then when you're all dry and still getting infections he'll say to you "You have Chronic sinusitus and we have to work together to keep you symptom free"Meanwhile syptomfree means dryness discomfort , thick gagging mucous drainage more and worse infections, he'll say "Keep Flushing" and you'll begin to wish you were deaed and he was dead and wonder how it ever happened thet you must now nurse and flush your dysfunctional nose for the rest of your life!!! when all you have to do is nurse it back to health and you'll feel 100% recovered! The important thing is the steroid nasal spray it really helps get the swellinmg down but you should even ask your doctor to give you a short cousre of oral prednisone to reduce the swelling! once the swelling inside the nose goes down and you start to drain then you're on the way to recovery! good luck dude! oh yeah I NEVER had any frontal sinus pain discomfort or anything because all I had was unilateral maxillary sinusitus but the ENT's usually peform Bilateral procedures and also do ethmoidectomies that can cause scarring and block you're frontal recess! !! Don't mess with that frontal recess dude ! Time, nature and patience are the best medicine! well im alive! My nose doesn't hert as much as i thought it would. Good news, no fungus! So no frontal surgery. He straightened my septum and removed a little polyps on my left side but he said there was ALOT of polyps on the right side. He said once he removed the polyps everything just drained out. He said there was enough polyps on the right side hat it was pushing over to the left. As soon as I was aware I felt under my eyebrows to see if it hert and it didn't! My nose bleeding is a pita. The stupid nurses left me sitting back a little in recovery and I swallowed a bunch of blood and I threw it up all over one of them. I don't remember throwing up but I remember a nurse saying, "he just threw up on me, it was projectile" When they moved me from the bed to a chair to keep me forward I looked back at the bed sheets, yuck. Anyways, the first hour or so the nurse and my gf were changing the pad on my nose every 5 minutes it seemed like. Each hour it is slowing down. So also another tip, as soon as you are aware sit forward so the blood can drain out. The G/A wasn't bad this time, it didn't completely shut everything down like I thought, they said I could eat anything I wanted but didn't recommend anything hot or spicy because it would make the bleeding worse. A word of advise also, brush your teeth and mouth out as soon as you get home because I had dryed blood in there and was making my stomache kinda upset. I didn't notice it till the next morning when I looked in the mirror. Everyone at the hospital was very nice, the nurses, the doctor, the guy that put me to sleep was very nice too they were all joking with me in the surgery room. Ive got a pain killer and I think amoxicillan it must be for weeks that I have to take it. I cant wait till this is over. I will keep you guys updated. Hopefully this will help someone out there in the future. Sounds as if it went very well - good news! They usually recommend leaning you head back to stop bleeding. That worked for me when nothing else did..... the bleeding is slowing down considerably from yesterday. i have to change it about every 3-4 hours now which is ALOT better than yesterday. I read somewere someones story that they started using saline solution the next day to clear some it up. Yesterday air was moving through the left side now its clogged it just makes it feel wierd when i swallow like theres a pressure buildup when i swallow. The pressure under the middle of my nose from the pad taped to my face is annoying and gives a dull pain. Also if you guys have a mustache, shave it before you go in, it will seal better. I didn't i shaved it this morning wasn't too fun. My doc is telling me i need the same sinus surgery as you did you have the surgery and did it help? |
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