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S's painful nose

Posted Oct 16 2010 12:00am
Since I met S he's been complaining about his deviated septum causing problems during sleep. When he was a child his nose was broken and now the septum moves and blocks off his sinuses causing him to snore and not get a good night's rest. One day I mentioned to him that he could go to his family doctor and get a referral to an Ear, Nose and Throat doctor to see if the problem could be solved. We looked online and found that the surgery to fix the septum involves having his nose packed for a few days which would be very unpleasant, but possibly worth it. He got the referral appointment and found that surgery wasn't necessary yet.

What the doctor did was use a spray up his nostrils to open up the sinuses and stick a camera up there. S tells me that was extremely unpleasant and weird feeling. I imagine he was screaming in his head for the ordeal, I know I would be. The doctor was amazed at how tiny S's sinuses are and in fact couldn't even get the camera up into the cavities above his right eye at all. He asked S if S had post nasal drip and for how long. S said yes and as long as he could remember. It turns out that it isn't his deviated septum causing snoring and pain, it's his sinuses are red and raw from being too dry so they create extra moisture to solve the problem, causing inflammation and post nasal drip. Surgery to fix the septum is an option for aesthetics, but not necessary for the problems he's having. He is to use a nose spray once a day and a nasal rinse once a day. The nasal rinse is like a neti pot but with the pot the water just flows in and out, the rinse fills all the sinus cavities before draining. S likened it to drowning. Unpleasant, but it worked. Until his nose started bleeding.

He's always had nosebleeds. Sometimes when he blows his nose, sometimes for no reason at all. He called the doctor and they moved his follow-up appointment to check it out. Another inspection of his nose (just...ew) revealed a huge vein that had grown around the deviated septum and was now too close to the surface of the skin, causing bleeding. So he cauterized the vein with silver nitrate and gave him a prescription for antibiotics.

S started using the antibiotic cream on Wednesday. That night he was up every hour and a half with pain. By Thursday he had to leave work early because of the blinding pain in his nose and he had taken more than the maximum daily dosage of Advil to cut the pain and was taking Tylenol about every hour and a half. He called the doctor and the doctor said the pain would be worse before better. That night his teeth started to hurt as well. When I got up for work on Friday morning at 4am S was on the couch rocking in pain. The whole side of his face was excruciatingly painful. He hadn't barely slept all night and was trying to decide if he should wake me up. So instead of me going to work right away I took him to the emergency room in hopes of getting something stronger for the pain.

Luckily (I thought) the emergency room was basically empty. A couple of children were there but they see a pediatrics doctor, S was the only adult waiting for treatment. We got in very quickly. Unfortunately the doctor on duty was going to be off duty in 20 minutes so he didn't see S. Instead he wrapped up his paperwork and finished with his last patient. I was listening to the two nurses talking and I've been in hospitals enough to get the gist of the 12 hour shift changes. I thought the change was 8, but that's when the nurses change. Doctors come on shift at 6, the other doctor ends shift at 7 so there is an overlap. S was caught in the overlap sitting on a hard plastic chair rocking in pain. They offered him a bed but he felt better upright. The old doctor didn't want to take S on at the end of his shift so he left S for the new doctor. The new doctor didn't begin her examinations until 7, after she'd started her on-shift routine. So we ended up sitting there for an hour and twenty minutes. I was not impressed.

The nurse was kind enough to seek out the new doctor and ask for some pain relief for S, which she brought him and he refused. It was percocet. He'd tried that once before and the day after it felt like he had a huge block of ice moving through his intestines along with the shakes, sweats and nausea. When the doctor finally saw him she was going to give him codeine but he has a bad reaction to that as well. She also looked up his nose and found the area that was burned with the silver nitrate was huge and deep. Larger than she would have recommended and no doubt the cause of excruciating pain. At this point S was willing to accept the percocet but I stepped in and told him he's not getting a one-time dose, he's probably getting a prescription for as-needed doses and if one percocet hurt, can he imagine how much several would hurt? He nodded and the doctor gave him something I've never heard of - Tramacet - saying it's a step below percocet and a step above Advil.

At this point I couldn't do much for S, the pharmacy we go to opened at 9am and it was just after 7, so I took him home and I went to work. S took two Tramacets as soon as he got them, then one six hours later as directed, then one five hours later. He was tired, warm, and feeling a bit icky when I left for an Adult Party I'd been invited to (more on that later). Just as I was leaving the party I got a call from T, apparently S was in the bathroom vomiting blood. I got home and found S on the couch, pale and sweaty. According to doctor's advice he should have only had three Tramacets in that time, not four, and six hours in between them. I asked if I should get him in the car to go back to emergency and he said no, he's ok now, it was only a little blood and mostly the food he ate. I helped him have a bath and then get to bed and told him to absolutely not take any more Tramacet until after six hours had passed. He waited seven, took one and hasn't had any since. Instead he just had Advil this morning.

He's better this morning, just tired and worn out. The pain is manageable, he's not screaming in agony any more. There's been no more vomiting - that would have resulted in a visit to the emergency room against his will if there'd been more. He's also decided that fixing the deviated septum just isn't worth it, thank you very much. He's found that pain in his nose is intolerable and surgery would be more than just unpleasant. I had no idea there would be this much pain when I suggested he get his sinuses checked out. At least he will be able to breathe easier when all is said and done. Hopefully sooner rather than later.

ps - the remaining 51 doses of Tramacet are going right back to the pharmacy for proper disposal.
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