septo turb

[waker]

I just had this yesterday and have had packing out just splints left. Very congested can I use flonase? How often should I saline rinse? Dr suggested affrin for excessive bleeding does this sound right? Any help appreciated

[Billinseattle]

Hi,

If confused about basic instructions, don't be afraid to call & ask your surgeon...that is what he/she is paid for.

Nasal saline rinses, typically 4 times a day in large volumes. This can get messy, I did mine in the shower. It prevents clot accumulation and early scarring. It will also help somewhat with the congestion...and the mucous build up.

Congestion will get better after a few days...this is common at this time. It will get even better when the splints come out.

Flonase will have little or no impact on your congestion. This is post-op swelling and congestion...not allergies which flonase is designed to treat. Using Afrin will help the congestion. Talk to your surgeon about how much and how often. Some surgeons don't mind if you use a ton; some hate it because it can do things like elevate your blood pressure (usually only an issue if you already have high blood pressure).

This is typically the most fustrating and uncomfortable time. It'll get a lot better.

Hang in there,

Bill

[waker]

The surgeon wont return my calls already tried and since I was so out of it today I don't remember exactly. His tip sheet says to use affrin to stop bleeding by soaking a cotton ball and placing it in the nostril, but i didn't know if I could use it by spraying it into the nostril. So you are saying it wont hurt the healing process? Im couhing up big clots of blood also is that normal at this stage?

[Billinseattle]

Waker,

Sorry you seem to be having a rough go of it. I think things would be alot smoother if you had been in contact with your surgeon. Many of these things are typical and/or variants and can be talked through.

Afrin (oxymetolazone) works on bleeding and swelling by constricting blood vessels locally in your nose. To alleviate congestion you can spray several blasts in your nose up to but not more than 4-6 times per day. Saline rinses will also help you clear your congestion and the mucous (snot). Keep doing those religiously...you may regret it later if you don't .

The downside to Afrin are that it may elevate your blood pressure (up 10-30 points). This is usually not a big deal since you are using this for a week or two. It is only a big deal if you have baseline high blood pressure. The other major downside to Afrin is there will be a rebound state of congestion that'll be pretty annoying for 3-4 days when you stop using it...and you must stop. After the post op period, when the swelling goes down and the splints come out you will be less congested...and able to then tolerate the comparatively lesser congestion of the Afrin rebound.

So, the saline and Afrin are good things at this stage , and for 1-2 weeks post-op.

Now, bleeding...some oozing is normal. Residual clots (tablespoon size) from the back of your throat (dribbling down) is typical...but should not persist. This is probably why you were packed when normally he says he doesn't. Bright red blood, or copious bleeding sends you to the ER...and definitely more packing.

Things will stir up some non-worrisome oozing may include heavy straining or bearing down...so don't lift heavy things, have your head upside down, exert yourself, or get constipated. Minor oozing can be stirred up by the saline flushes. This should stop quickly and get better the more you irrigate. If you are worried, Afrin sprays or cottonball soaks may help...but remember the clot that forms needs to come out at some point.

Do not take medicines or herbs that will thin your blood at this point. Specifically, aspirin, ibuprofen, naprosyn, ginko (herbs that start with "G" are blood thinners) ,plavix (a specific blood thinner that some people are prescribed for heart issues), ticlid (another one of those), etc... Tylenol and narcotics are ok and won't contribute to any oozing.

Generally, unless you have bright red blood continuously, bleeding after this surgery is usually not significant (meaning not enough to require transfusions, IVs , or put you in the hospital)...and will subside just like a normal playground nosebleed. If continue to spit out clots (spoon size) for several days, you should see your surgeon. Smaller pea sized clots or blood streaked sputum are less worrisome, more typical, and will subside.

More proactive measures. Hydrate, hydrate, hydrate. Keeps the tissues moist. Drying out of nasal tissues makes it easier for them to bleed and harder to heal. Take your pain meds (if this is painful) on a scheduled basis (ie every 4 hours or 6 hours depending on the drug and instructions). Don't wait for pain. This way you'll get on top of the pain cycle...and soon you'll have less pain and use less drugs. If you are taking alot of pain meds, eat some Benefiber, and take stool softener. Constipation from pain meds is common...and straining will lead to a build up in intra-cranial venous pressure leading to more oozing (and maybe congestion) in your nose.

Finally, after getting the stents out, and getting the all clear from your surgeon, FIRE HIM ! He should return your calls (for any reason or question)...that is his (or his on-call partner's) job ! IF THE DOCTOR (surgeon or sleep doc) IS NOT RESPONSIVE, HE SHOULDN"T GET YOUR BUSINESS !

Hope this helps. Post more questions or concerns if you have them, I'll check tomorrow,

Bill

[waker]

Bill
Thank you so much for your help.