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The Doctors Lounge - Primary Care Answers

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Forum Name: Ear Nose and Throat

Question: Septo 12 days post-op


acreature - Sat Dec 02, 2006 9:00 pm

36yo male diagnosed with chronic sinusitis, no prior surgeries except this one. No family history to speak of, only current med is Tylenol.

I recently had Endoscopic Sinus Surgery which included everything from Maxillary polyp removal to Frontal and Ethmoid sinus opening and cleaning, Septum straightening, and diseased tissue removal.

My inquiry deals with the recovery stage. I irrigate 4-5 times daily, with the distilled water/salt/baking soda solution. Sometimes I wake gagging and have to irrigate in the middle of the night. Mild Headaches sometimes follow the irrigation.

It seems the drainage is a continuous Pink/Peachy color with an occassional stream of blood; 12 days Post-Op?

I am not scheduled another ENT appt until Dec 28th, and would just like to verify this is within the norm. I had planned to return to work after 10 days or so, but as Law Enforcement, I would be better served not to return until the drainage, especially the bloody and pinkish drainage ceases.

Thanks for any time, and welcome any questions that may assist.
Theresa Jones, RN - Sun Dec 03, 2006 1:58 pm

Hi acreature,
The type of drainage that you describe is to be expected in the first few days post op, however 12 days is a more considerable amount of time. I would suggest that even though you do not have a follow up appointment until the end of December that you go ahead and call the specialists office and inform them of your symptoms. If you have any signs or symptoms of an infection, ie., Fever, chills, etc. that would be warning signs of an underlying problem and require treatment with a course of Antibiotic therapy. Best wishes.
Sincerely,
Theresa Jones, RN
acreature - Sun Dec 03, 2006 2:14 pm

Thank you for the reply.

Is it possible to Irrigate too often, and have a negative effect of healing?
Theresa Jones, RN - Sun Dec 03, 2006 2:32 pm

Hi acreature,
If you are following the post op instructions given after the procedure was completed then you are doing correctly. There of course, is a possibility that the substances added to the distilled water have not completely dissolved and that could certainly cause additional irritation. When you call your physician's office, inquire about using the distilled water, salt, and omitting the baking soda to see if this helps.
By the way, sincere appreciation is sent to you for putting yourself at risk to serve and protect the lives of others.
Hopefully you will have a speedy, uneventful, recovery.
Sincerely,
Theresa Jones, RN
acreature - Sun Dec 03, 2006 3:12 pm

Thank you very much. That means a great deal. But, back at you with the same appreciation. Your profession has helped me a few times from duty injuries.

As far as post op instructions, I was advised to irrigate 3 times daily; Morning noon and night. I am irrigating more than that because I can feel the discharge building up and want to clear it out. This is why I asked about irrigating too much.

I'll call my Surgeon first thing in the morning though, and thanks agin.
acreature - Sun Dec 03, 2006 6:55 pm

Is pink with some white streaks a discharge color I should be concerned with, considering the type surgery?
acreature - Mon Dec 04, 2006 7:50 pm

Made the call to my ENT this morning. Assistant stated that all was normal, including color.

Still have my concerns, but that what the Doc said ;)
Theresa Jones, RN - Tue Dec 05, 2006 10:18 am

Hi acreature,
My expectations on the color of discharge would be pink to clear. As long as the color doesn't change to yellow, green, etc. then most likely you will progress normally. I am glad to hear that you called your specialist and may you have a speedy recovery :)
Sincerely,
Theresa Jones, RN
acreature - Tue Dec 05, 2006 3:27 pm

Still a lot of drainage... Headaches, mostly on the right side, (eye-ear cheek areas) no Fevers or other symptoms.

Irrigated, then felt clogged up again 30 minutes later and was able to catch the following. (One pic with flash, one without)



Minus any Fever, would this color be of concern? I was put on a 5 day regimine of Levaquin after surgery... but no more Antibiotic.
acreature - Tue Dec 05, 2006 11:31 pm

Well, called the Doc again. They called in another regimine of Levaquin, "Just in case"

Was stated that because of the amount of work they did, and with the drainage tubes in my frontal sinuses, it is expected to have such an amount of drainage for a longer period of time.
Theresa Jones, RN - Sat Dec 09, 2006 11:59 am

Hi acreature,
In the second photo it appears that the drainage from what I can view is a slight green in color which would indicate a probable infection. It could possibly be related to the procedure itself or just the particular time of year that is prone to cause illness in general. Regardless of the causative factor, I'm glad to hear that you have been provided with a course of Antibiotic therapy which should eliminate the possibility of an underlying infection.
Best wishes.
Sincerely,
Theresa Jones, RN
Dr. Tino Anthony Solomon - Wed Dec 13, 2006 6:33 pm

Hi Acreature,

I have been following your case with great interest. Please keep us updated on your condition and follow up with your ENT surgeon.

Kind regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery
acreature - Thu Dec 14, 2006 5:41 am

Thanks for the interest Doctor.

The yellow discharge is back... very bright, almost lime green. I have to call my ENT back again, in hopes a stronger Antibiotic maybe?

I can sleep more now, 4-5 hours before I have to get up and irrigate.

Headaches are mild, and no Fevers. An occassional cold sweat episode in the middle of the night, and am back to work, though I have to bring a small kit with me to irrigate twice during my 10hr shift.
acreature - Thu Dec 21, 2006 8:16 pm

30 days post-op

Irrigated last night, and it started to bleed...


Then it really started to bleed; for 20 minutes.

Then I felt a huge mass creeping down the back of my throat... which fell out of my mouth. It was the size of a busted egg and all blood.

But, it stopped bleeding.
acreature - Sun Dec 24, 2006 5:49 am

Dec 23rd, about 10pm


On a traffic stop and my nose starts bleeding. Uncontrollable. Have another Dep finish my stop for me because after 20 minutes, it would still not cease. I drove myself to the closest EMS station, and they insisted on transport to the ER

Doc thinks he sees the bleed from a turbinate and uses Silver Nitrate to cartorize (sp)

Still bleeds.

45 minutes after the bleed starts, the Doc "SHOVES" what feels like a large tongue depressor into my right nostril, then starts dripping saline onto it. Felt like the thing was touching the back of my throat.

Now, I have packing in my nose, again.

Placed on more Levaquin 500mg (7day prescrip), and was told to get to my ENT Surgeon first thing Tues.

Just when I thought I was finally improving.... this happens. Kind of reinforces my opinion that the surgery that was supposed improve my quality of life, has only deteriorated it.

Any opinion as to why the turbinate would bleed so profusely, so long after the surgery? There was no trauma to my nose that could have caused it.
acreature - Thu Dec 28, 2006 5:09 pm

Called my ENT Surgeon the day after Xmas, and was advised to leave the packing in until Thurs (today) and come in for removal and a regular post surgery check.

Reckon maybe I'll find out why the bugger started bleeding so bad.
Dr. Tino Anthony Solomon - Tue Jan 02, 2007 9:31 pm

Hello there,

You've been through quite an awful time these past few weeks. Your symptoms may have been as a result of an infection in the sinuses post-op or simply a concurrent flu or cold virus. However it is important to consider the possibility that your symptoms are simply your original chronic sinusitis symptoms returning. Unfortunately the type of surgery you had, despite being the best option is not always curative and in many cases symptoms return. The nasal bleeding may have been due to irritation from constant irrigation or dry air creating a friable nasal mucosa, in other words the skin on the inside of the nose is delicate and the combination of recent surgery, local friction and possible infection may have broken down the skin. You describe what sounds like a nasal pack in your nose. This is the standard initial treatment for uncontrollable nose bleeds. It is placed up one or two nostrils and expands on contact with liquids such as the saline you were given. Do not worry too much about this, but I recommend you go back to your surgeon and explain to him what happened so that he can thoroughly examine the wound sites and perhaps suggest alternative symptom control.

Kind Regards,

Dr Tino Solomon
BSc(Hons) MBBS
Senior House Officer in Surgery
acreature - Mon Mar 12, 2007 11:45 am

Where to begin...........

The stents were to be removed last monday, the 5th of March. Removed one, but could not locate the other. After several minutes of poking and prodding, the Doc stated that it must have come out.

I, after seeing the one that was removed, think that I would have noticed that coming out. But, he did try to find it. Some bleeding involved as he attempted.

CT scan done a few days later revealed that the stent indeed was still intact. CT also revealed more polyps. I go back to my Surgeon on the 19th hopefully to remove the remaining stent and seek advice on the new Polyps.

Frustated as hell now.

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