My Sinus Surgery--Progress Report

[Steven D. Litvintchouk]

Well, I had my revision sinus surgery yesterday, 22 September.

The closest thing to a "smoking gun" yet was a pus-filled mucocele in
the one ethmoid on my left side that had not been operated on in my
prior surgery. My surgeon removed it and cleaned away all the swollen
tissue around it. That ethmoid is separated from my brain by only a 1
mm wide layer of bone, so I'm glad that it's gone.

I also had a big fluid-filled cyst removed from my left maxillary and a
widening of that maxillary ostium (duct).

Once again, I turned out to be right, and the doctors turned out to be
wrong. I had predicted in advance that the most interesting problem
would turn out to be in that ethmoid, not the big maxillary cyst that
the surgeon said was a likely cause of infection.

I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).

Otherwise, so far, so good. Now we'll see how healing progresses.

[iamthezookeeper]

Steve...glad everything is going okay. Did you get the lab back yet on your
mucocele? They can be quite the nasty buggers as they wear away bone and
can come back with a vengence so keep that is check. Sorry about the
painkiller reaction...did they find something else that works instead?
Trudy.

[Steven D. Litvintchouk]

Post by iamthezookeeper
Steve...glad everything is going okay. Did you get the lab back yet on your
mucocele? They can be quite the nasty buggers as they wear away bone and
can come back with a vengence so keep that is check.

And my mucocele was separated from my brain by only 1 mm of bone. The
good news is that it may have been a major contributor to my symptoms,
so maybe now that it's gone my symptoms will improve.

The lab work hasn't been completed yet on anything. I will be seeing my
ENT for a followup next week and hopefully the lab results will be done
by then.

Post by iamthezookeeper
Sorry about the
painkiller reaction...did they find something else that works instead?

Fortunately, the pain subsided so quickly that after just 5-6 hours, I
didn't need any painkillers at all. I haven't even needed to take Tylenol.

[Tony Banana]

Were you awake during surgery ?

Were you able to drive yourself home?

Just wondering in case I ever need endoscopic surgery.

Thanks,

Tony

[Steven D. Litvintchouk]

Post by Tony Banana
Were you awake during surgery ?

No, both my surgeries were done under general anesthesia.

Post by Tony Banana
Were you able to drive yourself home?

No way! You're much too groggy and dizzy from the anesthesia to be
allowed to drive yourself!

Hospital policy is that you must have a friend or relative take you
home, and it is recommended that the friend or neighbor stay with you
overnight to be sure you don't have any problems the first night. They
won't even let you take a taxi home the first night.

If that's not possible (and this time for me, it wasn't), they let me
stay overnight at the hospital in case there were any problems. And in
both my surgeries, there were problems. In my first surgery, I had an
unexpectedly large amount of post-op bleeding. In this latest revision
surgery I just had, I had some unfortunate reactions to the
medications--including an inability to urinate. So I stayed overnight,
and then they let me take a taxi home the next morning.

As it is, I wish there were someone living with me, just to keep
changing these godawful "moustache bandages." You wear a "moustache
bandage" of gauze stuck under your nose to catch the bloody drainage
that keeps oozing out of your nose. It's not easy to change the bandage
yourself, believe me.

But I live alone, so I'll just have to fend for myself.

You also need to keep your head elevated at night, so the bloody crap
doesn't ooze down the back of your throat and get into your airway to
make you cough. I own a recliner and I'm going to try sleeping on that
tonite instead of my usual bed.

[CanDo]

Steve, best of luck and success for the outcome of your surgery. Hopefully
this will be the end to your sinus misery.

You must have had much misery with those problems in your ethmoid and
maxillary. Do you know why the pus-filled mucocele didn't show up on xrays
or why your doctors were unable to diagnose an ethmoid obstruction?

[iamthezookeeper]

CanDo...with my first CT Scan that showed the mucocele under my left
eye...poking up through the orbit floor...they missed seeing one on the
right in the lower maxillary. I wonder why they are so hard to spot...I
can see them clearly in the film when I hold it up to the light.
Anyway...now they do CT with contrast and that shows every little problem
quite well. Mine are filled with epithelial cells so they are careful to
keep them under control. Hope Steve's don't come back at all and he
recovers quickly. Trudy.

[Steven D. Litvintchouk]

Post by iamthezookeeper
CanDo...with my first CT Scan that showed the mucocele under my left
eye...poking up through the orbit floor...they missed seeing one on the
right in the lower maxillary. I wonder why they are so hard to spot...I
can see them clearly in the film when I hold it up to the light.

In my case, much of the entire ethmoid sinus was filled with swollen
tissue anyway--the mucocele was sort of buried inside there--and maybe
that made it harder to spot?

I should have mentioned that: my ENT not only removed the mucocele but
he had to scrape away all that swollen tissue around it.

[iamthezookeeper]

Steve...you are lucky it could be removed all the way. Mine can't and
therein lies the problem. It keeps filling up and encroaches into my orbit
within weeks of surgery. They are thinking of putting a drainage tube into
the mucocele but that has it's own problems with infections. Sigh. One day
they will find out how to fix me. Soon I hope. Trudy.

[Steven D. Litvintchouk]

Post by iamthezookeeper
Steve...you are lucky it could be removed all the way. Mine can't and
therein lies the problem.

Why can't yours be removed? Has it invaded the bone?

Post by iamthezookeeper
It keeps filling up and encroaches into my orbit
within weeks of surgery. They are thinking of putting a drainage tube into
the mucocele but that has it's own problems with infections. Sigh. One day
they will find out how to fix me. Soon I hope. Trudy.

I've seen a zillion ENTs and the one who did my surgery is the best I've
seen--better than the Cleveland Clinic.

If you're ever in Massachusetts, please stop by and see him.

[iamthezookeeper]

Thank you. Who is your ENT? One of my first surgeries was done at the New
England Medical Center and for the life of me I can't remember the ENT's
name. He was wonderful and caring...very good. I have been literally from
Coast to Coast and been treated everywhere. (Military) The reason I was at
Cleveland Clinic was Dr. Don Lanza was recommended as the second best
surgeon in the country...Dr. David Kennedy being the first...but as we
know that is a matter of opinion depending on who you ask! Lanza now runs
the Sinus and Nasal Institute in Florida so I was switched to Ann Arbor
with Dr. Jeffery Terrel who seems quite competent so far. Yes, the
mucocele has gotten into the bone...specifically creating a huge hole in
my orbit floor. My eye is stable and sight not affected yet so they are
waiting to create a new eye socket for me as it is quite dangerous. In the
meantime they remove what they can of the mucocele along with taking the
chronic disease out of the other sinuses. Lanza said he had never seen
such severe disease which was pretty depressing. I am being treated now
with high doses of prednisone, sprays, inhalers, antibiotic nasal wash,
painkillers, etc. and have some relief though the meds are making me
"crazy". I fear that 23 years off and on this stuff has damaged my immune
system totally and now have to deal with chronic pain in my joints,
tendons, muscles until they figure out what to do. I am babbling. Sorry.
Make a good day! Trudy...Me You've Seen, Don't Be A Putz, Go See The
World.

[Steven D. Litvintchouk]

Post by iamthezookeeper
Thank you. Who is your ENT? One of my first surgeries was done at the New
England Medical Center and for the life of me I can't remember the ENT's
name. He was wonderful and caring...very good. I have been literally from
Coast to Coast and been treated everywhere. (Military) The reason I was at
Cleveland Clinic was Dr. Don Lanza was recommended as the second best
surgeon in the country...Dr. David Kennedy being the first...but as we
know that is a matter of opinion depending on who you ask!

I saw Dr. Lanza. He swore that there was nothing in my ethmoid sinus
that needed surgical repair, and sent me on a wild goose chase to find
evidence of recirculation phenomena. He was wrong.

The surgeon who did my surgery was Dr. Eric Stein. He's got a practice
in Chelmsford MA.

Post by iamthezookeeper
Lanza now runs
the Sinus and Nasal Institute in Florida so I was switched to Ann Arbor
with Dr. Jeffery Terrel who seems quite competent so far. Yes, the
mucocele has gotten into the bone...specifically creating a huge hole in
my orbit floor. My eye is stable and sight not affected yet so they are
waiting to create a new eye socket for me as it is quite dangerous. In the
meantime they remove what they can of the mucocele along with taking the
chronic disease out of the other sinuses. Lanza said he had never seen
such severe disease which was pretty depressing.

Any idea how this happened? I assume you had been treated for sinusitis
all these years. How do the doctors explain it progressing to this
stage despite treatment?

[Don Brady]

On Sat, 25 Sep 2004 15:45:39 GMT, "Steven D. Litvintchouk"

Post by Steven D. Litvintchouk

Post by iamthezookeeper
Thank you. Who is your ENT? One of my first surgeries was done at the New
England Medical Center and for the life of me I can't remember the ENT's
name. He was wonderful and caring...very good. I have been literally from
Coast to Coast and been treated everywhere. (Military) The reason I was at
Cleveland Clinic was Dr. Don Lanza was recommended as the second best
surgeon in the country...Dr. David Kennedy being the first...but as we
know that is a matter of opinion depending on who you ask!

I saw Dr. Lanza. He swore that there was nothing in my ethmoid sinus
that needed surgical repair, and sent me on a wild goose chase to find
evidence of recirculation phenomena. He was wrong.
The surgeon who did my surgery was Dr. Eric Stein. He's got a practice
in Chelmsford MA.

I hope this really reinforces to people that they need to get multiple
opinions, especially if the case is difficult, and not choose hastily among
them...

[iamthezookeeper]

"Any idea how this happened? I assume you had been treated for sinusitis
all these years. How do the doctors explain it progressing to this stage
despite treatment?"

That is a good question and one I have never had totally answered by the
experts. They tell me it is from having hypoplastic sinus with no
landmarks resulting from and accident I was in when I was 13 that crushed
the left side of my face and damaged the right. I was put back together
back on the outside but the internal damage was another story. I ended up
with sinusitis/samters triad/asthma when I was 23 and have been treated
since. I had another sinus infection a few years back and went to my
family physician. She was out so they gave me the Nurse Practioner. She
said I was fine even though I had a fever, ached, epithelial cells in my
urine and told her something was wrong. She said I had the flu, go home
and rest. The next day my face started hurting pretty badly and she put me
on a Z-Pack which didn't help. The next day my face was red, hot, swollen.
She said give it time. My doctor was back the next day and when I called
she said get in here. I went and she took one look at me and sent me to
the opthomologist who sent me directly to the hospital. I had periorbital
cellulitis that was 1/2 inch from my brain stem and they put me on IV
Tequin. They did a CT scan and came back in the room, my ENT, Optho,
Infectious Disease...all said you need to go to Ann Arbor right now. The
mucocele had broken the orbit floor and came up through it...which hurt
like hell. Dr. Harris performed the surgery to remove the mucocele along
with polyp disease in all sinuses and I did pretty well until it came back
about six months later. That started a cycle of surgeries that is ongoing.
They can't get all the cells of the mucocele as it grew into the bone and
keeps coming back. They won't repair the orbit floor until we run into
trouble as my eye is stable and my sight not affected. I have to be very
careful about infection as it likes to travel down my optic nerve, so I
try to take care of myself and stay relatively healthy, which lately is
hard as something has happended to my immune system from all of this...but
that is another story.

Trudy...What if the Hokey Pokey really is what it's all about?

[iJah]

On Sun, 26 Sep 2004 09:15:11 -0400, "iamthezookeeper"
<***@aol.com> wrote:

<snip>

Post by iamthezookeeper
They won't repair the orbit floor until we run into
trouble as my eye is stable and my sight not affected. I have to be very
careful about infection as it likes to travel down my optic nerve, so I
try to take care of myself and stay relatively healthy, which lately is
hard as something has happended to my immune system from all of this...but
that is another story.
Trudy...What if the Hokey Pokey really is what it's all about?

i'm sure you well know that steroids (prednisone) can suppress your
immune system - maybe you've been using a lot of these? also, no doubt
just the stress and worry caused by the illness itself further
supresses your immune system - it's a vicious circle, no?

[iamthezookeeper]

iJah...I have been on/off prednisone, prednisolone, medrol for 23 years
now. That is what most likely caused the damage to my immune system along
with the multiple surgeries and stress. The cycle is vicious as you say
but to be alive and breath is better than the alternative...at times.
Trudy.

[DreamHarp7]

Post by Steven D. Litvintchouk
I've seen a zillion ENTs and the one who did my surgery is the best I've
seen--better than the Cleveland Clinic.
If you're ever in Massachusetts, please stop by and see him.
Steven D. Litvintchouk
Remove the NOSPAM before replying to me.

I didn't catch the doctor's name-what
is the doctor's name? Thanks

[s.n.]

Post by Steven D. Litvintchouk
I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).
Steven D. Litvintchouk
Remove the NOSPAM before replying to me.

I am happy u r feeling better Steven, I have a surgery myself for a sphenoidal mucocele ...

what can u tell us about the allergies (morphine...) ?
Do they make tests for that before giving us morphine?

Did you know what may cause mucoceles ( because I never get a surgery before ... but I devitalized 3 teeth/year 2011-2012 and the fill was bad , the paste on my 15 tooth exceeds... )

I discovered this mucocele (symptoms are normally silent) when the plane started landing until it reached the land (almost 30 minutes)... horrible pain,cephalalgia, headache, couldn't move or speak, I had to calm down the blood pressure by forcing with my fingers over my head ... two days later the pain increased and I can't move my head from one position to another ... fortunately I insisted on having a scanner, (whithout knowing that scannner is the only way to discover the silent mucoceles)...
This landing headache was good in a way, at least I discovered what 's wrong ...

I have otite since childhood and white secretion from my left eye daily since 10 years (6 ophtalmologues didn't heal it, no antibiotics did !) ... this white secretion was accompanied with an increasing exophtalmos ..

I will keep u informed about my case

[s.n.]

does anyone think mucoceles come from devitalization ?

[s.n.]

does anyone think there is a relation between devitalizing teeth and sinusite infection and/or mucocele ?

[Susan]

x-no-archive: yes

Post by s.n.
does anyone think there is a relation between devitalizing teeth and sinusite infection and/or mucocele ?

I don't think it, I know it, particularly in the case of rear molars.

Very common yet overlooked cause of sinus infections.

Susan

[Steven L.]

Post by s.n.
does anyone think there is a relation between devitalizing teeth and sinusite infection and/or mucocele ?

I know it for a fact, based on my own experience. (I got a lot of sinus
relief for the first time *after* I had most of my upper molars removed.)

[Susan]

x-no-archive: yes

Post by Steven D. Litvintchouk
I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).

I never saw the original of this post, sorry if I missed it somehow.

It's possible that rather than a true allergy, you may have had a
reaction to the severe sdrenal suppressive effects of morphine, many of
which can trigger allergies due to lowered steroids systemically, or
allergy like reactions, like itching all over, etc.

In any case, I hope you're better now.

Susan

[asdfasdf]

Post by Susan
x-no-archive: yes

Post by Steven D. Litvintchouk
I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).

I never saw the original of this post, sorry if I missed it somehow.

That's because Steven posted it on 9/23/2004!

[Susan]

x-no-archive: yes

Post by asdfasdf

Post by Susan
x-no-archive: yes

I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).

I never saw the original of this post, sorry if I missed it somehow.

That's because Steven posted it on 9/23/2004!

OOPS!

Susan

[Steven L.]

Post by Susan
x-no-archive: yes

Post by Steven D. Litvintchouk
I had a couple of interesting after-effects: an allergic reaction to
the morphine painkilller, and inability to urinate caused by the
anesthesia numbing my bladder (which may be worse in my case because of
my enlarged prostate).

I never saw the original of this post, sorry if I missed it somehow.
It's possible that rather than a true allergy, you may have had a
reaction to the severe sdrenal suppressive effects of morphine, many of
which can trigger allergies due to lowered steroids systemically, or
allergy like reactions, like itching all over, etc.

I shouldn't have called it an allergy.

It's more properly called a "histamine reaction."

Relatively high doses of certain opiates (such as morphine) can trigger
the release of histamine. It's not a true immune system-mediated
reaction though.

The treatment is simple: Antihistamines like Benadryl until the
reaction subsides. When I started getting hives under morphine, the
nurses just pushed in some IV Benadryl and the hives subsided quickly.

Just google for "opiates histamine"

[Susan]

x-no-archive: yes

Post by Steven L.
Just google for "opiates histamine"

I don't need to google it to know that morphine, more than any other
opiate (though all of them do it to a degree) lowers cortisol so much
that it's not performing its function of suppressing immune reactions
and inflammations, either.

Xanax makes my back itch, Ativan doesn't. Xanax has a strong cortisol
lowering effect, Ativan has a much milder one.

Susan

[Steven L.]

Post by Susan
x-no-archive: yes

Post by Steven L.
Just google for "opiates histamine"

I don't need to google it to know that morphine, more than any other
opiate (though all of them do it to a degree) lowers cortisol so much
that it's not performing its function of suppressing immune reactions
and inflammations, either.
Xanax makes my back itch, Ativan doesn't. Xanax has a strong cortisol
lowering effect, Ativan has a much milder one.

Xanax is not an opiate.

[Susan]

x-no-archive: yes

Post by Steven L.
Xanax is not an opiate.

Right, but in a class (benzodiazapenes) that also acts by lowering
cortisol, though I haven't heard of anything doing it as much as
morphine. Maybe heroin?

Susan

[Steven L.]

Post by Susan
x-no-archive: yes

Post by Steven L.
Xanax is not an opiate.

Right, but in a class (benzodiazapenes) that also acts by lowering
cortisol, though I haven't heard of anything doing it as much as
morphine. Maybe heroin?

I'm sure that the prednisone I now take daily also does it. :-)

[Susan]

x-no-archive: yes

I'm sure that the prednisone I now take daily also does it. :-)

Sure, it suppresses your adrenals, but you don't get the same effects
due to replacement. Not that it's without its down side, too.

Did you get a xplanted kidney, is that why you're on it?

Susan