Your guide to FESS (functional endoscopic sinus surgery)

My problem started last November (or perhaps earlier and i just didnt realize it)
I'd get occasional blocked noses which were more of a nuisance. Then i started noticing, i only got blocked noses in low temp areas for example: air conditioned, when it rains, or when I go to japan.

From simple blocked noses, it became more serious when it started giving me headaches (the effort of breathing through mouth), and even numbness in my extremities. We call this resdung or sinusitis. i had this controlled using afrin ( a spray that provided instant relief where it reduces the swelling of my sinus so I can breathe normally). However having afrin was only a temporary solution. I'd have very rare good days where my sinuses would discharge clear fluid and I'd be fine on that day but these days were far & between.

When I realized my colleagues Eva and Jeff had done FESS, I looked it up more online. Then I booked an appt with an ENT in SDMC. I saw him twice in a period of 3 months before deciding to have the surgery. Prior to that, I tried some resdung pil given by another friend, but it didnt work too well.

The ENT wanted to have surgery ASAP, the current weekend which I was not prepared for. So i requested for it to be done after raya (the next week). Upon pre-admission, I had difficulty reaching SDMC (they said their system was down) when I wanted to reschedule my appt date. Reason why I had to reschedule because I had a fight coming on the 25th and I wanted to compete before going for surgery. But seeing how difficult it was to reschedule, I decided to go ahead for the surgery.

I checked in for admission (I'd already done pre-admission - this is where they verified my insurance) at 3pm. There was still a wait as they couldnt find my records. Even after going to my ward, a nurse informed me that they had already canceled my surgery as per requested by me (HUH?). However they manged to sort everything out in the end and my surgery was scheduled for next day 930am.

Useful things to pack for 1-2 nights stay in hospital:
1. Wet tissues (good to freshen you up)
2. 4 changes of underwear
3. 2-3 Tshirts
4. A jacket
5. Long pants (I don't have nice legs)
6. Water, your fav beverage
7. Ipad + charger
8. A book (for when your ipad runs out of batt)
9. My contact lens solution and spare contacts. My glasses



SDMC was air conditioned and it was hell on my sinus. My insurance covered a RM150 room so I had a room mate who had a slipped disc and was there for rehab. By the time they wheeled me for CT scans and blood tests, my nose was completely blocked. Interesting note: SDMC does not use pneumatic tubes but concierges (mostly banglas) who shuttle patients via on foot or wheelchair and carry the medical records/scans manually. I think this was a good idea, humanizing the boring part of being hospitalized. Most concierges were chatty and pleasant and ALL the nurses had very good bedside manner. I was comparing this based on my experience in HUKM, although not being govt owned, had scary nurses and doctors who did not give a shit (I talked to my doctor once only and he basically tore my incision off). To be fair, I was in a common ward at the time, perhaps the level of treatment is dependent on the grade of my room?

So my nose was blocked the night before the surgery and I saw the ENT in his clinic, and he said it was ok to use Afrin. So I had a good night's sleep and set the alarm for 730am the next day.

13th Aug 2013 - I woke up, took a shower using this pre-surgery shower gel they gave me. They gave me a painkiller pill to swallow. Then waited until 915am where they pushed me in my bed to operating floor. I fasted from 10pm the night before. First time I saw a scrub nurse (which was strange as I've done ACL reconstruction before), I thought of Gray's Anatomy and wondered when their next season would be out. So they wheeled me to a big room filled with pre and post op patients. I think I saw the guy who was supposed to have the same surgery as me waking up. Everything was blurry as they don't allow glasses so I can see for shit. I think he panicked when he woke up as his nose was stuffed and he was supposed to breathe thru his mouth. This was in fact the main reason I hesitated for this surgery as I know the experience of breathing thru mouth was unpleasant and if you panicked, you hyperventilate and it just made matters worse. So there were nurses there to calm him down and asked him to breathe thru his mouth. I listened kay poh-ly to somebody chewing somebody out about not knowing how to do so-so and so (intern?). After a short wait they wheeled me in.

The operating table is so narrow. How do they fit fat people I wonder? It looked like a butcher's slab, easier to hose the blood off, I guess. And it was cold. I wasn't scared, dammit, it was cold. The anesthesiologist was a nice lady (I didnt know bius ppl were doctors also, in fact I just found out radiologists were also MDs) who put me at ease. She injected me with somthing cold which gave me tingles but worked really quickly. A mask over my face and I was knocked out. Don't fight the anesthesia, you'd lose anyway. My only regret was my bad vision so I couldnt see a damn thing.

When I woke up, I had a splitting headache. Nobody was there to tell me to breathe thru mouth, but I did (since I'm already so experienced from all the blocked noses). They wheeled me back to my ward after determining I was fine. So that was 1130am. When I reached my ward, there was an uncomfortable feeling in the middle of my chest and I gave the nurse the 'I'm gonna puke go get something for me since I cant get out of bed yet' sign. The contents of my stomach promptly made its way up to my mouth. I contained it since I didnt want to mess up the bed. But here's my dilemma, I needed my mouth to breathe and my mouth was closed to keep the vomit from spilling out. I was practically holding my breath while she did the sprint from supply closet to my ward which was at the end of the hall. The nurse made it back in record time and I dislodged all the puke into the vomit tray. Mostly dried blood and bile. And since I had operation on my nose, the force of my vomit caused blood to seep out thru the nostrils.  Now I know why they want you to fast. Less puke to clean up. Then I was handed souvenir from the surgery (my removed tissue) and a DVD of the operation (WTF). The cut off tissue looked like foreskin :D. ENT came to tell me everything went well and my sinuses were really swollen.

After puking, the headache was immediately gone to my relief. Dee showed up with food (he & his mcD porridge) but I didnt eat yet. Which was an unconscious, but wise decision. At around 2pm, after making small chat, I got this familiar uncomfortable feeling in the middle of chest, sat up and vomited again onto a fresh vomit tray.

Dee left around 5pm, and they gave me dinner (porridge also) around 6pm, I ate dinner, breathed a sigh of relief when it stayed down for an hour. That uncomfortable feeling again (this time I was ready, vomit tray and a few steps to the bathroom). Almost didnt make it in time to toilet bowl, felt like the Exorcist where there was projectile vomiting. Out came the McD bubur, McD nuggets and Milo. Nose bled again (well, it's mostly mucus mixed with thin blood). Slowly flushed the toilet bowl and floor. Refused to eat now in fear of vomiting. Just had small sips of water, like a dainty lady.

That night, I snored like hell. And that put my room mate in hell. She couldnt sleep and tossed and turned. She even complained to the nurse that I was snoring too loud and told her to turn me on my side. The nurse kindly explained that my nose was packed with gauze and I had no choice but to sleep with my mouth open. The next day she shot me murderous looks (but look who's discharged first, biatch)

In the morning, the ENT came, talked talked talked then gripped the 2 black thread that was holding my gauze (if you looked up into the nostril, they looked like 2 tiny balls) then proceeded to pull it out. They should've filmed my reaction. I'm sure it was comical. I thought the gauze went up to the bridge of my nose to absorb blood. The sensation when he pulled it out was equiv to disembowelment thru the nostrils. You know the length and width of bottle cleaners? It was that big! To see that thing expanding as it came out, holy shit.

Everything felt so unblocked and free after he did that. Nurse taped a horizontal gauze (like a gauze mustache) to catch any stray blood. Took my lunch apprehensively, thinking I might vomit again, but finally, the anesthetics have worn off. It was some sort of macaroni soup (I've always loved these as recovery food) but it was difficult to aim for my mouth with the gauze mustache.

When they wheeled me to the noon clinic to see the ENT, I was happy, thinking I was gonna be discharged, but he was busy so they wheeled me back. Around 5pm, I asked the nurse if I could remove the gauze as I felt ridiculous in it. Finally I'm almost back to normal, although still leaking mucous-y red thru my right nostril. Advice from ENT: cannot blow your nose yet. Started pestering the nurses if I can be discharged. Mainly cos I didnt want to spend the night snoring and being complained again. How humiliating.

So they sent me to clinic at 830pm and ENT said I could be discharged. Also first experience in air conditioned room where my noses did not clog up.

Yeahoo. Took 2 hours for them to process my paperwork. SDMC staff are all great, but their administration really really needs work. So I signed the necessary, collected my drugs (antibiotics & painkillers, plus afrin and saline) and walked back home (yeah, I stayed behind the hospital)

Spent the night at home with air cond on with no clogged nose. So happy.

15th Aug 2013 - There's a lot of crusted blood and nose poop in my nostrils at the moment, not sure if I'm allowed to dig em out. When my nose was just unblocked, my left nostril was really clear and when I breathed there was this tunnel-y echo. But this sound dissipated today. Spent the wee hours of the morning doing some work from the office. FML.

So that's my experience with FESS. I did not have a good experience in the beginning when I was trying to reschedule the surgery but the ENT and SDMC staff made up for this many times over. When I was in HUKM, I barely saw the doc but this ENT followed up and I saw him multiple times a day (its a bit of a hike from tower A to tower B but he came anyways) which put me at ease and my stay a comfortable one.

For those with sinus problems, give him a try.
Dr Puravi (his picture on the website does not do him justice. In there he looks like a short, old man. But he's actually quite young and very tall)

http://noseearthroatspecialist.com/

And don't give busy as excuse. He has night clinics on Mondays & Wednes at SDMC.




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