Interesting anesthesiologist encounter

[ghmerrill]

Back story:

So yesterday I had my sinus and nose areas reconstructed: a very large polyp removed, bilateral turbinate resection, septum repair, ... The brief summary of the procedure goes for two paragraphs. The operative report is almost an entire page of pretty terse description. The procedure took a bit over 3 hours from OR entry to exit. This was done by a sub-specialist in allergic rhinitis I've taken to seeing recently.

It's amazing how good they've gotten at this stuff. Huge improvements in technology, medication, and surgical techniques. Also huge advances in anesthesia. Now it's just like a switch. You blink out. You blink back on. I always used to have nausea coming out of the anesthesia, but the last couple of times, none at all.

Post surgery I had one Tylenol/Codeine (which I don't think I needed). Went home after spending about an hour and a half in recovery. No grogginess. No pain. Took a Tylenol (no Codeine) later, and then one late at bedtime. Just pro forma. None this morning. No pain. Bleeding yesterday, but seems to have stopped today. About to start the flushing and home care regimen.

Anesthesiologist:

The "performing anesthesiologist" was a resident under the hawk-like attention of a senior anesthesiologist. The young guy was great. Once I was on the table he put a full face oxygen mask on me to increase oxygen prior to the anesthesia. He apologized for significant pressure I was having to breathe against and said I should just do my best -- that the O2 level was very high. Then he said "Actually, you're breathing much better with this mask than I've seen before. You must exercise pretty well." I said "I do. I also play euphonium, bass trombone and tuba regularly." He said "Yeah. That would do it."

I can't play for about a week, but expect that I'll be able to go full bore after that. Really looking forward to the improvements this should result in.

[Kingfan]

Best wishes for a quick and full recovery, Gary! Let us know how it goes.

[Mr412]

I recently had abdominal surgery for a direct inguinal hernia. I took all of the narcotic pain meds my Doc gave me. Not for the pain b/c it was well under my radar. I took them 1/2 tab at a time, every four hours during the day to keep me sedated so I wouldn't get feisty and retard the healing process. It worked and I got myself through the first week. Then I allowed myself to slowly begin low-level activities again - like going for three-mile walks outside and playing my bass a bit. It's a process.

Best wishes.

[Kbiggs]

I had similar surgery about 20 years ago. Despite having a fairly large oropharyngeal cavity, per the anesthesiologist (a former college football player who looked the part), my uvula was smashed when I was intubated. Lots of blood, nausea, vomiting, complications, etc. It took me quite a while to get back to playing.

I hope your recovery continues quickly.

[Bach5G]

Best of luck on your recovery. I’m interested in hearing if you find improvements in your playing.

[ghmerrill]

I'm not sure about improvements in my playing. I'm mostly looking for improvements in sleeping and constant problems of a rhinitis nature (congestion, allergy, frequent sinus infections, etc.). I will note that some years ago I actually used to be able to do circular breathing, but seem to have lost that capability. I'm not sure whether that's just practice related, age related, or related to my sinus issues. We'll see. I also really want to dump this CPAP, and move to one of the new dental appliances that my wife and son have adopted so successfully. So this surgery was the first step in those directions -- not to mention that the ENT guy was focused on the statistics of cancer developing from the giant polyp.

[Kingfan]

What dental appliance are you looking at? I would love to dump my CPAP.

[AndrewMeronek]

I have a friend who went through some major oral surgery last year. As she's recovering, I think she's actually gotten better with her health improved, and she says she is having to do a lot of work re-learning how to play.

[ghmerrill]

What dental appliance are you looking at? I would love to dump my CPAP.

First, the history of these is full of suspicion and skepticism. Their "mechanism of action" is so different from CPAP that medical doctors were very down on them for some time. Also, there are simply some apnea conditions that they can't treat (and would be dangerous to use in attempting to treat them). My wife and I have the same primary care doctor, and she is great. But she was initially quite skeptical. However, she provided all the information and support necessary for my wife to get one when she was diagnosed with mild obstructive sleep apnea. I'm still a bit skeptical myself, but I'm going to try. Dealing with DME suppliers over the years has just become too much (like dealing with pirates who don't even honor their agreements after you've paid them the extortion fee).

That being said, there are now a number of these devices being made, and providers will normally choose/recommend one for you based on your particular case and needs. They are often supplied by dentists (specially trained and certified) and my wife got hers from our dentist we've been seeing for 30 years. We decided that my wife would be the lab rat in this drama, and she's been doing an excellent job of it. Of course, she is the one with the degree in biology. (I'll note in passing that at this point Duke Health as adopted "oral devices" as obstructive sleep apnea treatments, saying that "Specialized dentists and maxillofacial surgeons offer dental appliances to help people sleep better. These appliances are customized for each person and need to be expertly adjusted over time. ")

My son got his from an MD sleep specialist group in Seattle, and I don't know the details of that. He tried CPAP, and was using it, but didn't like it (who does?). He finds the appliance effective and easy to use. Several years ago he paid out of pocket for it, and it wasn't cheap. Now insurance companies (and Medicare) cover the costs.

The box my wife's is in says: Myerson EMA ... Sleep Better appliance / Custom Fabricated by Glidewell Laboratories / www.glidewelldental.com. That's all I know about it. I have a consultation with the dentist in another couple of weeks to kick off the process of my getting one. It's a fairly lengthy process over time of analysis and fitting and adjusting -- and conforming to various diagnostic, treatment, and insurance requirements.

[BGuttman]

He tried CPAP, and was using it, but didn't like it (who does?)

I do. Been using one for some 33 years now. If I hadn't learned to deal with it I'd most likely be dead now.

[ghmerrill]

I've been using it for about 20 years, and the CPAP itself doesn't bother me. I can live with the CPAP (I use it religiously every night), but I HATE to travel with it (especially by plane). But the worst part is just getting the supplies for it. That is SUCH an unfixable mess of incompetence and greed (apparently independent of which supplier you may choose -- and I've been through half a dozen). So I'll take pretty much any reasonable alternative -- and factor into this that the last three CPAP units I've got, I have bought out of pocket because it was actually cheaper than going through Medicare/Insurance and having other people's taxes contribute to the outrageous "negotiated" prices and weird payment plans that are imposed.

A pox on all their houses.

[Kingfan]

Thanks for the info. The website doesn't specify which one. I look forward to hearing about your personal experience.

[BrassSection]

I second great improvements! Many years ago I was having cataract surgery. I was supposed to be awake for the surgery, but put out before for the blocker shot in the eye. While the blocker was being injected into my eye area I looked at the guy and said “That hurts!” He replied You’re supposed to be asleep!” I answered “Obviously I’m not and that hurts!”

Year later back for second eye, surgeon asked how first one went. I replied ok except for feeling the blocker. He said WHAT??? He said he’ll make sure it doesn’t happen this time! It didn’t. Slept thru whole surgery. Fast forward to mid 90s and rotator surgery. Trying to put me out with no effort. Alphabet forwards and backwards, didn’t feel anything 0 to 100 and back, still wide awake. Counted the ceiling tiles, still wide awake. Anesthesiologist said “You’ll feel this” and cranked the valve open enough I could feel the stuff running into my arm. Surgery was at 7:30 in the morning, therapy scheduled for noon. 5:30 I finally came to. Healing went quick though, was supposed to be in sling for 6 weeks, which wound up being ten days. Got back to trombone in about 4 weeks. Loaner Bach horn, King was out for reconditioning. Horn took a full year to get back.

Fast forward to 2020 and total knee replacement surgery. Anesthesiologist came in to talk to me before my surgery, asked if I had ever been put under. Related previous experiences and he replied “Things are completely different now, you’ll be fine”. Surgery at 7, discharged at 11 and walked up my sidewalk unassisted. 10 days later out shoveling snow off of said sidewalk. 8 weeks later 2nd knee replaced, basically a repeat other than shoveling snow 2 days after surgery. Extra strength Tylenol was all I took, best decision I ever made was to get the new knees. I was to the point I had to use a tall stool to lean against to play. I couldn’t really sit too good in a regular chair and couldn’t stand too good either.

[ghmerrill]

... Surgery at 7, discharged at 11 and walked up my sidewalk unassisted. ... Extra strength Tylenol was all I took

Sounds like the "minimally invasive" lumbar disk neurosurgery I had a few years ago. It was just astonishing. You could hardly see the "access point" in my back. I got up and walked home in early afternoon after morning surgery. And they have this whiz-bang stuff now (brandname = "Zynrelef") that's an extended-release topical analgesic (so applied to the site) that lasts for 72 hours (3 days!). It really works. Originally introduced for orthopedic cases, but being more widely used. It does indeed "redefine postoperative pain management".

[BrassSection]

Not quite “minimally invasive", 30 staples in one leg, 31 in the other. I must be a rapid healer. Ten years after shoulder surgery I happened to pass the physical therapist I had in a store one day. Couldn’t remember my name but he said, “Right shoulder, trombone player, right?” He said he has still never seen anybody recover from my type of shoulder surgery that fast. He didn’t believe me on day 10 when I showed up without my sling, he asked where it was and I said surgeon said I could lose it. He called the surgeon and hung up with a sheepish look on his face.

[ghmerrill]

Not quite “minimally invasive", 30 staples in one leg, 31 in the other.

Staples aren't invasive -- they're just surface irritation.

I empathize with your knee experience. My first knee surgery (right knee, smashed when I tripped over a motorcycle stand in the garage and broke the kneecap into 3 pieces) was botched by an ortho guy at UNC. He did put the patella back together (with three screws that looked a lot like decking screws on the x-ray), but had neglected to pay attention to my allergies -- such as a minor one to nickel. Alas, he did not use titanium screws. After my "recovery" period I had to spend about a week hobbling around the Paris Metro system, and after I came home he removed the screws -- saying he'd hoped to be able to leave them in longer. I later got that knee replaced (not at UNC), but that wasn't helped by the situation that had been caused by the original treatment.

[2bobone]

Gary : I truly feel for what you went through with the knee surgery, but it reminds me of that old conversation : "What do you call the guy who graduates LAST in his class at medical school ? ----------------- "Doctor" !