Tuesday, June 29, 2010

one month post-op lateral wall implant

It is a little over one month post-op and my feelings on the implant are pretty consistent with my previous comments.

There definitely has been improvement from this surgery with respect to my breathing, and I accredit this improvement from having the lower septal implant removed. It's overall less obstructive in my right nostril, but it still sometimes feels as though my breathing is pushed to the left or somewhat obstructive (while other times it feels fine). Prior to the lateral wall implant, I did not have this sense that my breathing was pushed to the left, but I did have an even greater sense of obstructiveness (due to the lower septal implant). Consistent with how it was before this most recent surgery, however, this sense of obstructiveness seems largely related to my stress level or level of fatigue; the more fatigued I feel, the more obstructive the implant feels. This sense of obstructiveness also relates to air quality such as being in a car with dry, recirculated air (when I would put in a max air nose cone or nasivent tube to help with getting enough air in my right nostril). All said, I do think there is a neuromuscular component to my symptoms, which is perhaps why I responded so well to craniosacral therapy. I am also going to a chiropracter in the near future, and anticipate that will help as well.

All factors considered, though, there does seem to be small improvements in my breathing from day-to-day. Sometimes, like right now after a 3 mile run this morning, my breathing feels totally fine.

Getting my lower septal implant removed was a good decision for me and strengthens my belief that that is not the best place for an implant for those missing their inferior turbinates. Thankfully, Dr. Houser's trend is to do the lateral wall as well. I do think that is the correct physiological location for an implant, and I would caution anyone reading my posts and interpreting the effectiveness of the lateral wall implant to recognize that I changed two variables at once (took out lower septal implant [while leaving the upper septal implant in place] while putting in lateral wall implant). So unlike me, just proceed scientifically with the implants and you should be fine.

Should the lateral wall implant continue to resorb, then I will be happy and let it be. Should I continue to still experience some mild obstructiveness in my right side and a sense that my breathing is pushed too much to the left, then I may proceed to get the lateral wall impant reduced in the office. I will have to give it a good half year at this point before I can make any further decision, if at all, as it takes many months for the lateral wall implant to resorb. I don't think I would get it removed because of its already small size. It was a good decision that only 2/5 of a 2 x4 cm sheet was used.

Friday, June 18, 2010

12 day post-op update

An anonymous writer asked me to provide an update on my nose. I wrote the following at emptynosesyndrome.org at 12 days post-op. (At present, I am 20 days post-op, and I am feeling better every day!).....Below is what I wrote:

I am about 12 days post-op from my lateral wall implant surgery.
Thankfully, I seemed to have healed well from the surgery, with only minor throat pain that quickly resolved itself within days after surgery.

This early post-op, I cannot gauge the long-term benefit. Overall, it feels OK and improved from before the surgery, but a primary issue I have had is that my breathing sometimes feels like it is pushed "to the left" as a result of the lateral wall implant, making breathing uneven. (Remember, now I have both a lateral wall implant and an upper septal implant.) My breathing was uneven before this implant surgery as well, and the nasal cycle contributes to this uneveness in breathing. And of course, my lateral wall implant will likely resorb by around 50% over time, so I anticipate my breathing will feel closer to normal and more even as times goes by. I noticed an improvement in eveness today over recent days, and I am thinking my allergy shots yesterday might have played a role in this respect. According to Dr. Houser, it takes 9 months for the lateral wall implant to reach its permanent size.

But this much I do know: a) the lateral wall implant is a much more natural place for an implant and physiologically correct and b) a lower septal implant can be obstructive and un-natural, so I am very confident that removal of my lower septal implant was also a correct decision. Do note: some people can tolerate the obstruction caused by the lower septal implant, as it still represents improvement over their previous symptoms. I am also well-aware that implants are not a cure. As expected, I can clearly tell that my right nostril will never function as perfectly as my left. I just won't have the level of humidity, nasal sensations, degree of comfort in breathing, etc. because my right inferior turbinate was significantly removed, whereas my left inferior turbinate was left more intact. What the implants will likely do for me in the long-term, if they have not done this to some extent already, is prevent erosion of my mucosa by acting to preserve my remaining mucosa. As tissue loss can lead to turbulent airflow which, over time, can lead to erosion/atrophy of the mucosa, resulting in lost nerve endings as the mucosa breaks down and becomes increasingly metaplastic, I can be thankful my implants will help protect against that. If you do not have an implant, then I strongly encourage you to do techniques to preserve the mucosa so your nose does not become atrophic.

I am going to wait about a month or more before providing another update, at which point I can hopefully provide an update that might in fact closer reflect the long-term impact of my lateral wall implant. So expect an update around July 10th, give or take a few days.

Thursday, June 3, 2010

One week post-op update of lateral wall implant

It is only one week post-op so I am still not in a position to judge the long-term benefit, but I do feel more and more confident each passing day that I made the right decision and will not need further implant surgery - to remove or add Alloderm. This does not mean that my right nostril is perfect or nearing 100% improvement. I have lost nerve cells in my right nostril from my 1997 turbinectomy, and having so much removed inferior turbinate means this nostril will always have some degree of dysfunction. But at least with more orderly airflow, thanks to the lateral wall implant, I can be overall more comfortable in my breathing - and that's the point where I can accept it for what it is and move on in my life.

I think I made a good decision with removing the lower septal implant. It feels much more natural when I breathe to have the lower septal implant removed, which convinces me this was the right decision for me. (I actually think I have been breathing better, too, in my sleep. I am not waking up tired despite not using the CPAP since the surgery, as I need to allow my nose to heal.) The lower septal implant was sort of like breathing against a large bump for me - and it was obstructive at times.

I do think the upper septal implant, which compensates for my middle turbinates, is fine now, and might be a good option for people missing their middle turbinates. Dr. Houser noted there is even air space in this location of my nose on both sides.

Re: the lateral wall implant, I also believe this was a good decision. There's still crusting and I am sure it is swollen and will resorb over time, but I am not sensing any of the obstruction I felt with the lower septal implant. It feels a bit like it has pushed all my breathing to the left, but then again, there is still some major crusting in my nose, so I expect this to go down as time passes. If anything, this lateral wall implant does seem to offer some airflow resistance as it is in the airway (but not too much like the septal implant) and it seems to direct airflow in a much more orderly and natural way than the septal implant does. In fact, there were times today when I felt like my nasal breathing was fairly normal in my right nostril. Now, Dr. Houser only put in 2/5 of a 2 x 4 cm sheet in my lateral wall, so this is a small implant. So I do think the lateral wall is best positioned for directing airflow in a natural way; I noted to Dr. Houser at the office visit prior to surgery that my right nasal breathing is more comfortable if I put my finger near the base of the right nasal vestibule toward the lateral wall where my nose would conceivably feel most empty (I say 'would' because I was saying this when I had my lower septal implant in, which made my nose feel pretty full), along the same line as the lateral wall....so the lateral wall implant made sense for me. The septal implant is more into the airway, so it is easy to see how that could help with issues of dryness, volume, and airflow resistance, but I think there is also a risk of a sense of obstruction in this location - at least there was for me and most people with whom I have corresponded. If you can accept some degree of obstruction, then its benefits may outweigh its risks for you. My initial thoughts are the lateral wall implant might not address the issues of dryness and volume as well as the septal implant can because the septal implant protrudes more into the airway, even if the septal implant isn't in the most natural location. But, for me, the sense of obstruction was too much of a trade off to gain from the moisture and volume it offered. Of course, a smaller, more conservative septal implant would lead to less obstruction. According to Dr. Houser, my lower septal implant was equivalent to 1.5 2 x 4 cm alloderm sheets.

But Dr. Houser indicated to me that his trend is to do the lateral wall more and the septal implant less, and perhaps this is because people find it a more natural location....I'll plan to post again in a week or sometime later to update on my progress with this implant.