Publication Soon

I am pleased to announce that I have submitted the book, Having Nasal Surgery? Don’t You Become an Empty Nose Victim!, for publication. Cold Tree Press (http://www.coldtreepress.com) has notified me that it takes on average 90 days from the date of submission until publication, as they strive to make their books in the best possible condition for the market. That means this book will be published sometime in the summer, perhaps by August 11th. I will keep you posted as this date approaches.

Cold Tree Press is one of the top self-publishers in America and this company is selective regarding the manuscripts they publish. I feel fortunate to be working with such a talented publishing company. As you can see above, they have already created a great cover design for this book and I look forward to continued working with them on it.

Empty Nose Sufferers on the ENS Book

Although the book will not be out until August 11, I have been communicating with a patietn who had a nose surgery just 3 months ago and is now experiencing full-blown ENS symptoms. I knew she was suffering quite a bit, so I shared my adobe pdf of the book with her. Below is what she wrote after she read the the book:

I have read through the book and have found it really helpful. Chris' story is inspiring.. how he has suffered with ENS for so long and manages to still have a positive outlook. I think it covers a lot of important information, both technical and emotional. It is a book that many people could read -- sufferers of ENS, friends and family, people thinking about getting surgery. It has helped me to gain a better understanding of what to expect, what turbinates are, their functions in the body, and how to better live with this serious condition. Oh! I wish I was informed like this before the surgery. I would definitely suggest this book to my friends and family so that they have a better understanding of what ENS is and what it entails. There are so many people every year who get butchered by doctors who for one reason or another do not inform their patients properly of the procedure and possible side effects. This is a problem in many areas of medicine. Chris' book is a reminder not to go blindly into surgery but also to live bravely with things one cannot change.

I wish to thank this patient for her kind comments. I really hope her condition improves and her prognosis is good. And I hope the readers of this blog will find her comments useful.

The interest from members of the empty nose syndrome forum at (http://www.emptynosesyndrome.org/) is encouraging to me. This is a great website for ENS patients to come together and support each other. (I read posts on the ENS forum on a daily basis.) This website contains a lively discussion forum, a section where Dr. Houser answers questions, and a tutorial on the nose and turbinates. A half-hour audio tape of Dr. Eugene Kern’s lecture on empty nose syndrome is also available.

I thought it would be helpful to post some of their thoughts they have publicly posted on the ENS forum in support of this book:

Forum Member "3":

Very impressive! You should get the 21st century genius award.

Forum Member "TT":

I think it’s great to put a face on ENS. I'll keep a close eye on your blog. I wish you the best of luck. Your children are adorable.

Great work on the site!!

Excellent job! The fact that there is now a book written entirely about this disorder really legitimizes the cause. Otherwise it remains just a footnote in a technical journal.

I love the name of your book. "Nasal Surgery?" Really windens up the audience to anyone having nasal surgery over just people that found out they have ENS. I hope you're able to get a wide distribution into mainstream stores across the country. It is important to get the word out.

Forum Member "Simon81":

Wow, looks good Chris. Nice Job.

Forum Member "Sp1d3rdan":

Chris, Great work! You should give them away at Medical Schools so that the latest group of ENTs are aware of this.

Forum Member "Andrew":

Looks great. Best of luck and thank you for doing this!!

Forum Member "Tom":

Great cover, looks very nice. I can't wait to read it.

Forum Member "Matt":

Howdy Chris, Thanks for all the effort. I look forward to reading it! Best, Matt

Forum Member "MF":

Chris, You really have to be commended. Working this hard on a book that can not really help your self that much, yet can save hundreds or thousands of people the distress we all experience, is a noble and selfless act. Bravo!

Forum Member "Jdog":

Looking forward to the book Chris!!

....I'm excited for the book! It should be pre-requsite reading by the doctor before you agree to surgery.

Dr. Tichenor on the ENS Book

I am very happy to announce support from Dr. Wellington Tichenor. Dr. Tichenor wrote the Introduction to the book. He is a medical specialist in sinusitis who does not perform surgery, but primarily treats patients who have not responded well to surgery, such as ENS patients. Dr. Tichenor is a leader in both prevention and treatment of ENS. His website, http://www.sinuses.com, has won numerous awards for outstanding content.

Here is Dr. Tichenor’s back cover endorsement:

“I applaud Chris’ attempt to bring this critically important issue to the public’s attention. If one person can be saved from the devastation this surgery can cause, he will have performed a great service.”

April 2007 Reflections on Writing the ENS book

Writing a book is a lengthy, time-consuming process but it is also very rewarding, and I cannot wait to craft this ENS book into a finished product. Not only do I hope the book will help others, I also find writing to be a therapeutic process for myself as I have come to understand ENS on a deep level which,in turn, has enabled me to better understand and treat my own condition.

My primary hours of working on this book have been between 9 PM and 2 AM so I can spend time with family during the day. In the meantime, I also work a full-time job as a school psychologist.

I recall reading that the average author of a non-fiction book spends about 480 hours, or 2 years, writing it and I believe it. There is more to writing a book than just writing itself. In my book experiences, I have come upon various challenges and opportunities: researching and fully understanding scientific issues (particularly unfamiliar ones), securing copyrights for quotes of more than one word, having artists develop quality sketches, researching publishing options, numerous phone conversations, and then having it reviewed from medical and lay edit perspectives; and the book is revised numerous times to incorporate this ongoing feedback. In retrospect, I think the hardest part of writing this book was explaining the medical details, which took NUMEROUS revisions. I found myself even late in the editing stages revising medical details. In addition to being a layperson, which I made clear in the disclaimer, compounding the issue is explaining a medical topic like ENS that is complex and not well-understood. Thankfully, feedback from various doctors has helped me write a book that I believe is medically accurate. I have certainly strived for the highest level of accuracy, and patience has been to this book’s benefit.

I have had ENS for 10 years now. I first thought about writing this book 3 years ago, when I first discovered I had ENS. I started to write, but little came out as I still didn’t understand my condition that well. It was not until the past year, through the help of Dr. Houser, the empty nose website and discussions with fellow ENS sufferers, when I finally put A-B-C-D together and was able to write the book from start-to-finish. When all is said and done, this book will have been a 1-year project. It is 41,581 words in length, which means it will likely be between 150-200 pages. It will come in paperback form.

As much as I am going to work hard to promote it once it is out -- and I have been assured it will be listed on numerous high-traffic websites (Dr. Grossan believes sales are assured)-- I am also thankful to be bringing it to a close so I can focus on family and friends more.

Thus far, I have had my book reviewed by 4 ear, nose and throat (ENT) specialists and 3 lay persons. My chief editor, a good friend of mine with an English degree, spent nearly 2 months editing it to a "t" and he did an amazing job; his efforts will significantly enhance the finished product.

*Dr. Eugene Kern, Past President of the American Rhinologic Society and International Rhinologic Society who coined the term "empty nose syndrome," read my book and was quite positive about it. He remarked that my story was "compelling." Like the other doctors, he gave me many ideas on how I could improve the medical aspect of it and considerations to address.

*Dr. Murray Grossan also offered numerous ideas on how to enhance the book and his contribution has been invaluable. He is a true champion of the ENS cause and it has been a great pleasure corresponding with him regularly about the book. He also has a great sense of humor. His revised and updated version of The Sinus Cure just came out on April 10. Page 269 has a nice summary of empty nose syndrome.

*And of course, Dr. Steven Houser was the doctor who gave me the ambition to write it and has offered immense support as well.

In attempt to raise awareness for the ENS book, Walt Ballenberger, founder of the Postnasal Drip Website, has offered book commentary on the following links (interestingly, my book managed to get onto "women's fitness" links);

www.postnasaldrip.net/Blog/

ezinearticles.com/?Pulsatile-Irrigation,-ENS,-and-Other-Sinus-Issues--A-Discussion--Part-1&id=466841">

articles411.com/article.php?id=44414&act=print

abc.eznettools.net/.../bbtopic.cgi?

SUID=X305810&&topic=Empty_Nose_Syndrome&&category=3

www.womens-interests.com/health-and-fitness/page_18.html

www.refinance-mortgage-search.info/walt.htm

www.thepharmaweb.com/healthcare/Pulsatile%20Irrigation,%20ENS,%20and%20Other%20Sinus%20Ossies-%20A%20Disc...

bobbie.lovestoblog.info/index.php/archives/date/2007/02/26/

Walt has not read the book yet, but he plans to buy it once it is out. In these comments, he remarked I am a "driving force" behind the ENS symposium at http://www.emptynosesyndrome.org, but I have informed him I am not, just an ENS sufferer who wants to help others suffering from the same condition. I just do not wish to take credit where it is not due.

Dr. Houser on the ENS book

Chris is addressing a tremendously important issue in otolaryngology. Empty nose syndrome is a real entity that requires further investigation. It is fully preventable if the otolaryngology community will embrace it and work to understand it. Furthermore, it is not a hopeless situation; there is hope for improvement and recovery. Although Chris' book is written for the general public, I truly hope my colleagues in ENT will read this book and take it to heart.

-- Steven M. Houser, M.D.
http://www.geocities.com/shouser144/index.html

Dr. Grossan on the ENS book

Chris has done a fine job of presenting empty nose syndrome (ENS). Remarkably this subject is practically unknown by the medical profession. Patients present with I can't breathe through my nose, not getting enough air, I am constantly sick, loss of sense of smell, not sleeping at night. The doctor sees a wide open nose that you can drive a truck through and can't understand the complaints.

But it is like a garden hose - if it is narrow it reaches the far wall, the opening is wide open, the water drips at your feet. The symptoms of ENS are serious and Chris does a fine job explaining what to do.

-- Murray Grossan, M.D.
http://www.ent-consult.com
http://www.grossan.com
http://www.hydromedonline.com/presentingthehydropulse

The ENS book: a closer look

You will notice the photo above is of myself (Chris Martin), my wife Colleen, and our two daughters, Faith, age three, and Abigail, age one.

The purpose of this blog is to raise awareness about a book I am writing on empty nose syndrome (ENS).

This book explores my personal experiences while offering practical treatment ideas. My goal is to have it published by summer 2007. I will provide details about how you can order when the time comes (please stay posted). I am a school psychologist who suffers from ENS, and I believe this condition has not received adequate medical attention from ear, nose and throat doctors or plastic surgeons.

In brief, ENS is an iatrogenic medical condition that is caused when too much turbinate tissue is removed. ENS sufferers experience a variety of symptoms, including the hallmark sign of paradoxical congestion, which means having a sensation of shortness of air despite the nasal cavity being wide open. Other symptoms include difficulty concentrating, weakened ventilation of the lungs, shallow sleep, frequent headaches, a dry nose, sometimes nasal crusting (i.e., dried mucus), thick mucus, sometimes recurrent infections, all of which lead to high rates of anxiety and depression. ENS is clearly a tough problem.

Endorsed by well-known ear, nose and throat specialists familiar with ENS, I strive to offer a genuine message to the reader and hope for the injured patient through:

1. My personal triumph in coping with ENS.
2. A critique of turbinate surgeries for anyone considering nasal surgery.
3. An inside look at the politics of ENS.
4. Best treatments for ENS, many of which also apply to sinusitis, allergic rhinitis and postnasal drip.

As just noted, the treatment ideas are not only applicable to ENS, but also to sinusitis, allergic rhinitis and postnasal drip. Better yet, these treatment ideas come straight from an ENS sufferer. I have received back cover endorsements from Dr. Murray Grossan of Los Angeles, California, and Dr. Wellington Tichenor of New York, NY; along with a foreword from Dr. Steven Houser of Cleveland, Ohio. These are well-known doctors.

+Dr. Grossan is author of the popular book The Sinus Cure and is inventor of the Grossan Hyro Pulse Irrigator, which is an influential product for treating sinuses and allergies.

+Dr. Houser is both a practicing ENT doctor and professor at Case Western Reserve and he published the article, Empty Nose Syndrome Associated with Middle Turbinate Resection, which appeared in the December 2006 edition of Otolaryngology-Head and Neck Journal. He is the primary doctor in the United States who attempts to treat ENS patients through surgical implantation of alloderm.

+Dr. Tichenor is a medical specialist in sinusitis who does not perform surgery, but primarily treats patients who have not responded well to surgery, such as ENS patients. Dr. Tichenor is a leader in both prevention and treatment of ENS. His website, http://www.sinuses.com, has won numerous awards for outstanding content.

Dr. Grossan's back cover endorsement

"...A must-read for anyone with nasal problems so they, too, can understand about ENS and avoid becoming an ENS patient. The up-to-date information can empower the patient to best therapies."

Part of Dr. Houser's foreword

"Chris' story is a compelling one. He tells a very personal tale to help inspire others. He also explores the science behind ENS to really inform others with similar difficulties. His advice to ENS patients is right on. I hope this book will get the attention it deserves. I will certainly recommend it to the ENS patients I treat."

Below are four quotes taken directly from the book:

In spring 2003, a grateful lady traveled 75 miles to personally thank Dr. Murray Grossan of Los Angeles, California, a well-known ear, nose and throat doctor. The reason: her son, then age twelve, was scheduled for a bilateral turbinectomy, a surgery where inner nasal tissue known as turbinates is removed. But she read a 2001 Los Angeles Times article, Sniffing at Empty Nose Idea by Aaron Zitner, in which Dr. Grossan was cited as opposing such procedures because of potential complications such as empty nose syndrome (ENS). Consequently, she cancelled the surgery, visited an allergist, and her son’s nasal problems cleared. He was spared from becoming an ENS patient for life.

*********************************************************************************

The 1997 partial turbinectomy and septoplasty left me in the following condition:

I was missing 90% of my middle and inferior turbinates, except for 40% of the left inferior turbinate; I had a hole high on my septum; I had a hole in my maxillary sinus; and my ethmoid sinuses were partly removed.

Clearly, far more was removed than stated by the procedures, partial turbinectomy and septoplasty.

*********************************************************************************

A good question to ask is, “How much of the nasal mucosa, the organ of the nose, can one remove before contributing to ENS symptoms?” We do not know. It appears that we can remove some of the turbinates and the nose works fine. But if too much tissue is removed, results are disastrous. In that sense it appears the more aggressive the turbinectomy, the greater likelihood of ENS.

**************************************************************************
Also consider that according to Dr. Grossan, when the concept of ENS was presented at the Triologic meeting about 5 years ago, the response was reported to be a deafening silence. The response at the 2006 annual convention of the American Rhinologic Society was even worse: there was not a single presentation on ENS.

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Table of Contents

Disclaimer...

Table of Contents...

Acknowledgements...

Foreword...

Introduction…

By Wellington S. Tichenor, M.D…

Chapter 1. Empty Nose Syndrome…

a) Brief background of empty nose syndrome…
b) Relationship between sinusitis, allergic rhinitis, asthma and ENS…
c) Mucociliary clearance (MCC)…
d) My own approach to ENS…
e) Plight of the ENS sufferer…
f) Who is this book written for?...
g) Rationale…
h) Four reasons for this book…

Chapter 2. My story: prior to the partial turbinectomy…

a) A deteriorating nasal health…
b) The ‘quick fix’ but a lifetime of regret…
c) Shortly after the partial turbinectomy…
d) I just could not blow my nose…

Chapter 3. My story: the ENS journey…

a) When my sinus problems persisted…
b) An allergy solution…
c) Seeking answers to the stuffy sensation…
d) The unhelpful answer: further surgery…
e) The bittersweet discovery of ENS…
f) Delaying real help while getting little…
g) Temperature extremes and ENS…
h) Battling thick mucus and recurrent infections…
i) Psychological effects of coping with ENS…
j) Why I will not give up…
k) A fortuitous, but never-ending turn of events…
l) Seeking help through Dr. Houser…
m) The office visit…
n) The good surgery…
o) After the surgery…

Chapter 4. What exactly is empty nose syndrome? …

a) The turbinates: how form fits function…
b) Physical symptoms of ENS…
c) Psychological symptoms of ENS…
d) Proposed classification system for ENS: IT, MT, and Both…
e) Empty nose syndrome or atrophic rhinitis?.…

Chapter 5. Commentary on turbinate surgeries…

a) Introductory statement…
b) Submucous resection…
c) Submucous resection with outfracture…
d) Electrocautery…
e) Radiofrequency…
f) Total, subtotal, and partial inferior turbinectomy…
g) Injection corticosteroids…
h) Cryosurgery….
i) Laser surgery…
j) Middle turbinate resection…
k) The multiple surgery experience among ENS patients….
l) My ratings of turbinate surgeries…
m) Future thoughts on turbinate surgeries…

Chapter 6. Politics of empty nose…

a) Some doctors remain stuck on deceiving logic…
b) Logic leads some to believe removing even more turbinate tissue is best…
c) ENTs and plastic surgeons notice positive benefits to some patients…
d) ENS is less likely to be identified because of its iatrogenic origin…
e) Doctors (mistakenly) consider ENS rare…
f) Turbinate surgeries are financially ‘sanctioned’…
g) There is a failure to adequately address ENS…

Chapter 7. ENS: the difficult diagnosis…

a) There is a lack of knowledge on ENS among ENTs and plastic surgeons…
b) There is no objective test to determine ENS…
c) The ENS patient is in denial of his or her symptoms….
d) The suffering experienced by the patient is in relation to how he or she felt before surgery…
e) Severe dryness and atrophy might not occur until years after surgery…

Chapter 8. What ENS is not: postnasal drip

a) Tips for treating postnasal drip…
b) ENS versus PND….
c) What postnasal drip is not: GERD
d) Tips for treating GERD.

Chapter 9. Non-surgical treatments for empty nose syndrome…

1) What to do if you suspect empty nose…
2) Step-by-step approach…

Principle 1: Keep the nose moist while keeping mucus moving…

Natural remedies...
a) Saline irrigation…
b) Nasal sprays…
c) Nasal gels…
d) Nasal oils…

Medical remedies…
e) Irrigation with antibiotics…
f) Guaifenesin…
g) Zinc lozenges…
h) Allergy shots…
i) Antihistamines…
j) Three vaccines…
k) Decongestants…
l) Anti-inflammatories…

Dietary remedies…
m) Drink plenty of fluids…
n) Hot tea with lemon and honey…
o) Chicken soup…
p) Vitamins (particularly A and D)…
q) Dietary considerations…

Environmental remedies…
r) Environmental considerations…
s) Humidifier…
t) Good hygiene

Principle 2: Maintain blood supply to the nose by stimulating residual tissue in the nose…

a) Exercise…
b) Swimming…
c) Warm Packs…
d) Other methods for increasing blood flow…
-Acupuncture…
-Biofeedback…
-Inversion technique…

Principle 3: Relax…

a) Sleep…
b) Reduce stress…

Chapter 10. Surgical treatment options…

Chapter 11. Concluding thoughts…

Appendix A: Glossary…

Appendix B: Websites of interest…

Appendix C: Dr. Houser’s replies to FAQs…

Appendix D: Books of interest…

Appendix E: Index…

About the Author…