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| Pre-op pictures |
February 17, 2017
Initial consultation
I asked Dr. Smith if he would use a laser. He said he'd use a cutting instrument with a curved blade (or loop?) that cauterized as it cut. (This may be what's called a wire loop, circular cautery device.) Dr. Smith said he would do just the nodules on the sides of my nose and not the central portion. He explained that the surgery could either be done under local anesthetic or under general anesthetic. The estimated costs were $1500 and $3000 respectively. He said the worst part of having it done under local anesthetic was the smoke and smell of burning flesh. He didn't know whether Medicare would cover the procedure, but that they certainly would not cover "cosmetic" surgery. I explained that as the nodules have grown, my nares have shrunk. When I play tennis, I find I can't breathe through my nose and have to open my mouth to breathe. He said that might make a difference and that he'd include it in the submission for payment approval to Medicare. The doctor said he'd treated a patient with nodules very similar to mine 17 hears prior. That man's rhinophyma had not returned. A nurse took photographs of my nose.
A couple of days later, someone from the doctor's office called. Medicare apparently does not pre-approve any procedure. You have to have it done and then see whether or not they will cover it. I was asked whether I wanted to do local or general anesthesia. I chose local due to the difference in cost.
Someone from Dr. Smith's office called me a few days later with the dates for the surgery and for a pre-op appointment.
Friday, March 31, 2017
Pre-op appointment
Dr. Smith had to attend an unexpected but mandatory workshop, so one of his nurses went over the pre-op questions and instructions. She asked me many questions concerning my medical, surgical, and familial history. I was to stop eating and drinking at midnight the night before the surgery. Nothing at all that morning. I was to shower with antibiotic soap the night before or morning of the surgery. No deoderant, cologne, or makeup after the shower. I was to stop taking baby aspirin and multi-vitamins a week before the surgery. I could take my blood pressure medication the day before and should take it after the surgery the next day. No aspirin or multi-vitamins for two weeks after surgery. I was to keep the wound unbandaged but covered with Aquaphor (a petroleum-based cream) for about a week or until the tube ran out. She gave me a new tube. Thereafter, I'll keep the wound covered with a diaper rash ointment that contains vitamins A and E. These products are to keep the wound moist and prevent scabbing. Scabbing leads to scarring. (I later bought a tube of Desitin. I also bought a package of Assurance brand disposable, absorbent underpads to keep my bedding somewhat clean.) The nurse said my nose would be a "bloody, weepy mess" for a few days following the surgery. (She was correct, but it wasn't constant.) I'm not to expose my nose to the sun for three months post-op.
Monday, April 10, 2017
The day of surgery
A friend drove me to the hospital and they took his name and phone information to call him when I was ready to be picked up.
I spent a while in the surgery prep room, mostly, I think, waiting for the doctor to arrive. A nurse started an IV in my left wrist after I had taken off all my clothes and put on a hospital gown and socks. A couple of nurses that would participate in my surgery came in and asked several questions (allergies, sleep apnea, past medical procedures and conditions). My anesthesiologist came in and asked mostly the same questions. He attached leads on my torso to monitor my heart, etc. I asked him what drugs would be used and he told me Propofol and another drug, the name of which I didn't catch. I'd recently had a colonoscopy in which Propofol was used. In contrast to previous "conscious sedation" drugs, I hadn't awakened feeling "drunk" or "loopy".
When the doctor came in to see me prior to the surgery, he again asked about the central portion of my nose, which was enlarged due to the rhinophyma. He asked about sculpting that too, and I told him to go for it--to reduce the bulbousness.
Eventually, they wheeled me in to the OR and I scooted from the gurney to the operating table. They extended arm rests on both sides of the table where my arms rested at a comfortable angle. Momentarily, the anesthesiologist started the drug(s), and after a few seconds, I felt a tingly sensation and was out. I awoke in the recovery room.
In recovery, I felt somewhat weak and a bit disoriented. The disorientation passed fairly quickly. My monitor alarmed and my recovery room nurse told me to take deep breaths. The monitor alarmed a couple more times, and I concentrated on breathing fully and frequently to turn off the alarm. I later asked her if the alarm was for oxygen saturation and she said that it was. I asked her what the alarm setting was. She said it alarmed below 90%. I was soon more lucid and was breathing with less mindfulness and she said my O2 saturation was 97%. (The hospital is near 5000 feet above sea level.) My throat was sore and I asked about that. I was told they had inserted an oropharyngeal airway. My forehead bore a couple of small lesions that hadn't been there prior to the surgery. There was another lesion near the outside corner of my left eye. At the time, I didn't think to ask the recovery room nurse about them. (My friend later offered the suggestion that they'd probably dropped a tray of scalpels on my face! But actually, I later realized that the doctor had removed some skin lesions from my forehead and from next to my left eye.) In recovery, my right eye also hurt, as if something had brushed across it while it was open. It was fine the next day. I think the nurse brought me a mirror at some point, but I'm not completely certain. My nose was raw flesh down the front and on both sides. It was covered by what looked like a thin sheet of plastic-like gauze that had yellowish "goop" on the wound side. That might have been some type of antibiotic ointment. I didn't think to ask about it. The nurse asked if I was thirsty (I was VERY thirsty), and gave the choice of cranberry juice, apple juice, or Sprite. I opted for apple juice. It was delicious. She later brought me another cup--also delicious.
It would have been nice if the Dr. Smith had stopped by my recovery room to tell me how the procedure went. He may have had another surgery, or something else, but no one who was in the operating room came to recovery to talk to me.
I was given privacy and I got dressed. She brought a wheelchair and wheeled me to a nearby room where my friend was waiting. He's a doctor and he'd been reading the instruction packet regarding my post-op care. He asked the nurse about a discrepancy between two of the sheets regarding the level of fever that should generate concern. The nurse didn't seem to know which of the temperatures was actually correct and "winged" a response.
The nurse wheeled me out to my friend's car and we left the hospital. Though the instructions said to eat lightly and blandly at first, I was feeling pretty good and was starving. We went to Twister's and got breakfast burritos. I got a large diet soda as well. My friend told me to be sure to warn him and to open the door if I felt I needed to vomit. I had no problems either enjoying the burrito or keeping it down.
We got back to his house and he made me comfortable in an easy chair. I played on my phone for about an hour and was feeling pretty good. After a while, we sat out in my friend's garage and smoked a cigar.
My nose didn't really hurt, and my top lip was pretty numb--no doubt from the lidocaine or other local anesthetic that was injected into my nose. This numbness seemed to persist to some degree well into the next day. Even on Friday following the surgery, my upper lip still felt somewhat "different". I'm guessing this numbness of my nose is the reason it didn't hurt or ache much until Friday.
Though the instructions stated I was not to drive for 24 hours, I felt good and later drove to my ex-wife's house. It was only a few blocks away and I could stay on side streets to get there. I texted my friend when I arrived safely. She was at work but had left a key for me to get in. She'd made me a bed on the living room floor using a pair of tri-fold bed mats. I'd slept on them before and they're very comfortable. I turned on some of my favorite music and draped a chux pad (a 2-foot by 3-foot, disposable, absorbent underpad) over my pillow and over the sheet under the pillow to absorb the bloody ooze that was coming from my nose. This wasn't constant, but I had to wipe it off my moustache every 15 minutes or so. The next day, this oozing was a little less, and it gradually decreased every day thereafter.
I called Dr. Smith's office and asked one of his nurses two questions: Would it be a problem if I took a nap? No, not at all. And second, what should I do with the "bandage" over my nose? I should remove it that evening or the following morning. The easiest method would be to get in the shower and run warm water on my nose and under the bandage as I slowly and gently peeled it off. (That's exactly what I did later that evening and it came off painlessly.) Then I was to apply Aquaphor.
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| After removal of the "bandage" |
My face (but not so much my nose) was swollen and aching and I took a couple of Percosets that I'd had from some years back. They helped. I tried unsuccessfully to nap, but rested for a couple of hours. When my ex got there, she had calzones for us that she'd picked up on her way home. They were also delicious. We watched the season premiere of "Better Call Saul". Following that, I got in the shower, removed the bandage, and applied Aquaphor. I took another Percoset before bed. I didn't sleep very well that first night, mostly, I think, due to the oozing from my nose that I'd have to wipe away from time to time. I had a box of facial tissues next to the bed along with a cardboard box to use as a trash can.
Tuesday, April 11, 2017
Day 1 post op
When I woke up, my face felt quite swollen--primarily my cheeks near my nose. Over the course of the day, the swelling diminished. That morning, I called the doctor's office and asked for a Percoset prescription should I need it. It was ready soon thereafter, I picked it up, filled it, and drove to my house in the mountains east of Albuquerque. When I was at the office, I asked to speak to the doctor or a nurse. He wasn't available, but I asked a nurse about cleaning procedures. She said I was to clean the wound twice a day and reapply the Aquaphor right after cleaning. Apparently, I'd missed the "cleaning" portion during the pre-op visit.
My nose cleaning apparatus was as follows. I rigged up short length of flexible hose inside one of my sink faucets with a short length of old oxygen tubing inserted into the other end of that. With the hot water turned on about half, enough flow went into the hose to result in a gentle stream of warm water from the oxygen tubing. I washed my hands well with a bar of Dial antibacterial soap. I irrigated my nose with the water stream. This did little to nothing. The layer of Aquaphor is pretty impervious to a mere stream of water. I rubbed the tip of my index finger on the bar of Dial soap and gently rubbed and wiped my nose from top to bottom. This also did little to remove the Aquaphor. I later found that I could use a very soft, well-cleaned (rinsed several times in isopropyl alcohol before each use) toothbrush to lightly brush much or most of the Aquaphor from my nose. Bits of clots and small scabs would come off too. I rubbed the toothbrush on the bar of soap and then on my nose, wiping gently downward. I'd then smack the toothbrush on the edge of the sink to rid it of the ooze and Aquaphor that it had collected. Rinse the toothbrush off, reapply soap, and continue the process. I used the inside surfaces of good-quality napkins to blot my nose dry after cleaning. They left little to no residue stuck to my nose as facial tissues would have. Washcloths or hand towels would have worked fine too for drying, but I wanted to avoid having to wash them. There was still a fair amount of ooze and Aquaphor remaining on my nose after washing. Much of that ends up on the napkins. When my nose was dry, I reapplied Aquaphor. I'd use about a third of an inch on my index fingertip for the central portion and a similar amount for each of the two sides of my nose.
I use reading glasses for reading, computer use, and for looking at my phone. I found that I had to wear the glasses upside down to avoid having them rest on the lesions and to avoid wiping the Aquaphor off.
Sleeping was an issue. I always sleep on my stomach with my face just off the edge of the right side of my pillow. This would inevitably result in rubbing all of the Aquaphor off my nose during the night. Though I'd attached chux pads to my pillow and to the sheet under it, I didn't want to elimate the Aquaphor and allow my nose to dry out and scab over during the night. So I've slept in my recliner for the first week. There, for some reason, I can go to sleep on my back--something I'm unable to do in my bed. I sometimes roll to one side or the other in the recliner, but my nose doesn't touch the chair.
Wednesday, April 12, 2017
Day 2 post op
I made a nose shield for my sunglasses from an aluminum Diet Coke can. I covered the front of the shield with masking tape so it would blend in somewhat with my skin tone. It doesn't really. It's for use mostly after my nose heals but I'm still not supposed to expose my nose to sunlight for three months. Since I play tennis, golf, and fly model sailplanes, I'm in the sun a lot. I left the inside surface of the shield bare aluminum so I can clean it off with an alcohol wipe.
I found I had to change the way I blow my nose. I've always been a relatively violent nose-blower, smashing one nostril closed and honking the other pretty loudly and forcefully. Now I cover one nostril with a thumb and gently blow the other into a tissue. After blowing both, I can't really wipe well, so I twist up a small section of the tissue and insert it into a nostril, twirling it to collect the residue. Another twist for the other side. Repeat until they both feel clear.
Thursday, April 13, 2017
Day 3 post op
Friday, April 14, 2017
Day 4 post op
My nose is oozing much, much less today, but it's feeling much more achy. I'd say it's almost, but not quite, painful. I didn't take a Percocet, but I was a bit tempted. Washing it didn't hurt any more than it had previously. My nose is itching more, but I've mostly avoided scratching it so as to not disturb or remove the Aquaphor.
Saturday, April 15, 2017
Day 5 post op
Sunday, April 16, 2017
Day 6 post op
Monday, April 17, 2017
Day 7 post op
I had been working on a sun shade for my nose. I wanted something that would attach to a pair of sunglasses that would be comfortable and that would keep my nose in full shade for the three months that were needed for full healing and conditioning of the new skin that would form. I tried the plastic cover of a term-paper binder. I tried fashioning them out of soft drink cans that I'd cut and shape using scissors. After several iterations, I came up with one that shielded my nose and that was relatively comfortable. It's made from a trimmed soft drink can and is covered with masking tape. The interior surface is bare aluminum so it's easy to clean off the inevitable goop that transfers to it when my nose makes incidental contact with it.
