The surgeries

The first surgery was in May 1992.
The second surgery was in April 1995.
The third surgery was in January 1996.
The fourth surgery was in October 1997.
The fifth surgery was in October 2004.
The sixth surgery was in January 2017.
In addition, we've learned that Wes needs regular nose maintenance.


The First Surgery

In May 1992, Wes got pneumonia and was hospitalized. He'd been told before that he needed to have his sinuses operated on, but it was never a pressing issue. So, since he was already in the hospital -- and a sinus infection had helped cause the pneumonia -- it seemed like a good time to finally have the operation. Plus, the infection was getting dangerously close to Le Brain. Little did he know... It hurt like hell. In this operation, he had his septum straightened and his maxillary sinuses (underneath the cheeks) bored out to hopefully keep things flowing. So, he was stuffed with packing to stop the bleeding after surgery. The next day, an evil nurse came in and just yanked the packing out. THAT really hurt like hell. He cried. He also ratted on her to the surgeon AND found himself a new surgeon. He wasn't putting up with that insensitive crap.

Here is what came out the next month. The reason Wes is so happy in this picture is that, once something this large comes out, suddenly he could breathe!
Nose 6/92 (51kb)

But did that surgery solve the problem? No. He had another infection raging when we went on a SCUBA diving trip to Cozumel, Mexico, in August. It became obvious that something was impacted in the sinuses when Wes couldn't dive without pain. So, once again, here he is elated that something came out: We could dive now! (Note: The picture is dark, but the blob in the handkerchief is what came out. Look at the size of Wes' mouth for some perspective on how big this thing is.)
Nose 8/92 (40kb)


The Second Surgery

In April 1995, Wes had another sinus infection that wouldn't go away. This one was way up in the ethmoids and sphenoids, between and above the eyebrows. Once again, this was an infection that didn't respond to monthsof antibiotics. So, we had to operate again. But, unlike last time, the infection was too high up to go through the ol' nostrils. (It would endanger the optic nerve.) Yes, this time the surgeon would drill a hole through his eyebrow, and keep going about 3" back. He would then scrape out the two sinuses and remove the "folds" in them to help prevent infection from setting back in. PLUS, as an added bonus ["...Wait, NOW how much would you pay..."] he would go in and re-whack Wes' septum to fix what the previous surgeon didn't do right. When he was done, he would leave a drain tube sticking out the eyebrow so that he could flush out the sinuses after surgery. Yes, our dear Wes became a temporary Cyborg.

Here is the only picture that shows the drain tube. Note the red blood blob on Wes' eyebrow. That's the end of the tube. Also see the expression of joy on Wes' face.
Nose 4/95, #1 (21kb)

In this picture we see the Cyborg Tube politely covered with fresh gauze, but the nostrils uncovered for a full show. Yes, Dear Readers, when they pack your sinuses after surgery your nostrils wind up looking like Michael Jackson's old ones for a while.
Nose 4/95, #2 (31kb)

And here we have the whole pretty post-surgery picture, bloody nose "diaper" and all.
Nose 4/95, #3 (27kb)

Despite how trashed Wes looks in these pictures, we do have one very good thing to pass along: When they remove packing from your nose it doesn't have to hurt. Yes, after Wes' encounter with his previous surgeon's evil nurse, he was really wary the day the new surgeon was to remove the packing. So, he took two codeine and went in for his appointment. When it came time, he asked for a shot of Demerol. The surgeon looked at him and asked "Why do you need that?" Wes relayed the story about the previous packing removal and the intense pain it caused. The surgeon got a look of consternation about him and said "It doesn't have to hurt." So, with that said, the doctor had Wes lay down and then he dripped Lidocaine into his nostrils. This not only numbed the nose, but also loosened the packing from the dried blood. The surgeon let it soak in for about 10 minutes, then came back. "Now hold my hand while I remove the packing. If it hurts, squeeze my hand and I will stop." With that, he gently eased the packing out. NO PAIN! Yes, Dear Fans, this is one of our favorite doctors!


The Third Surgery

Well, toward the end of '95, Wes started getting an infection in his left maxillary sinus. We tried washing it out. Pulling it out (this involves an instrument resembling a dentist's tooth cleaning tool). And, of course, the requisite months of antibiotics. Still, it wouldn't budge. It turns out the infection had encrusted itself along the sinus wall and wasn't going anywhere without major intervention. So, we decided to go in and scrape the sinus wall down to the bone. This time, like the last, the surgeon would use a unique access method: He would drill up through Wes' gumline, above his eye tooth, directly into the sinus cavity under the cheek. Despite how it sounds, he said it would actually hurt less than Wes' previous surgeries -- and he was right! (Yay!) We don't have any pictures, as this was done in the mouth and the stitches afterward prevented us from prying Wes' mouth open to take some. But, we do have a picture of the kind of thing that was coming out before the surgery.
Nose 11/95 (23kb)


The Fourth Surgery

Just like before the third surgery, Wes got an infection in his left maxillary sinus. This one was harder to identify as an infection, though. Twice during the summer of '97, Wes thought he had an infection starting. He began antibiotics, went in for a visual inspection, and there was nothing there.

(Visual verification of an infection is easier to do with Wes than a regular sinus X-ray. This is because the scar tissue from his previous surgeries looks on film about the same as an infection does -- a white-gray area. The main way to get a good diagnostic reading that doesn't falsely identify scar tissue as an infection is to run an MRI. But, at about $1,000+ a pop, it is much cheaper and simpler to ask Dr. Kosoy to look into the sinus cavities directly and tell us what he sees.)

So Wes had two false alarms. Then ragweed season (September) started and Wes' nose was running and running and running. He felt cruddy. He went to his main doctor and she didn't find anything. We started antibiotics. After his visit to San Francisco for Folsom Street Fair at the end of September, we knew it was time for action. Turns out he had walking pneumonia and... an encrusted infection in his left maxillary sinus. The sinus (with its resulting drip) had to be taken care of or the pneumonia would not resolve.

As before, we tried washing it out, pulling it out, cutting it out, suctioning it out. We got maybe half. We couldn't get the rest because the hole into that sinus simply wasn't big enough to treat the hidden area in it, even with bent instruments and moderately hard force.

It was time to cut a BIG "window" into that sinus. The infection would get scraped out during the operation. And the resulting big window would allow for more significant periodic maintenance in that pesky maxillary sinus.

Just like the last time, Dr. Kosoy would drill up through Wes' gumline, above his eye tooth, directly into the sinus cavity under the cheek. Having gone through this entranceway twice now, I must tell you it is the least painful type of invasive sinus surgery I've had.

And here we have entire process documented for you!
Wes' October 1997 sinus surgery


The Fifth Surgery

Well, it was time. The fourth surgery opened up my sinuses and kept them largely open for seven years. After four surgeries in five years, that was a big change. But throughout 2004 the sinuses kept getting infected. I was sick half the time. A CT scan (299kb) showed exactly where the blockages were. We went in and Roto-Rooter'ed the drains out.

One huge difference this time was the surgeon was able to use no packing. And he put in nostril splints, to keep them really open. Sinus packing forces breathing through the mouth, which dries out the throat and is generally uncomfortable. But if there's enough bleeding, it's needed. It was wonderfully weird to be able to breathe through the nose on the same day as surgery.

Until... a week after the surgery the sinus started bleeding just out of the blue around lunchtime. I lay in the recliner and pinched my nose. I iced my head. It wasn't stopping. I went and got nasal pinchers to squeeze the nostrils closed. The splints prevented them from closing. Blood, blood and more blood. My nostrils were pinched, but I was swallowing blood. This thing was running freely. I dialed 911. They asked if it seemed like I was losing a lot of blood, to which I said yes. After the paramedics arrived, blood started even oozing out my right eye socket and down my cheek. The paramedics were incredibly nice. I was dressed only in boxers and they wanted to take me to the hospital. One helped put some pants on me while I still used one hand to keep my nostrils pinched. He got flip-flop sandals out of the closet. Plus he gathered real shoes, socks, and a black shirt -- so any blood (which did indeed get on it despite my best efforts) wouldn't matter. I grabbed one critical thing: My cell phone. From inside the ambulance I called the condo and left a message for Tom on the answering machine. Then they took me to the hospital emergency room. After signing in I called the ENT's office -- praise be to the cell phone -- and told them what was going on. They said I was at the right place, and that the hospital staff would likely cauterize the bleed or pack it. About 3pm I got hold of Tom. He asked if he could bring anything. Yes: Water, lip ointment for my dry lips, a protein drink with a straw to make it easier to sip, and a sandwich cut into tiny pieces to eat. Around 5pm I was admitted to an emergency care room. Tom went back home and made more bite-size sandwiches. There they soaked cotton balls with Afrin and gently slid then in my sinuses with forceps to see if that would constrict the blood vessels enough. It didn't. They also started an IV for fluids, as I was getting dizzy. The high blood pressure and pulse confirmed I seemed to be dehydrating. (I really couldn't drink water all afternoon, as each swallow created a vacuum to my pinched nostrils. It was more of a nag to the blood situation than painful.) The hospital ENT came shortly afterward. He had me blow my nose as hard as I could to clear out the muck, injected lidocaine with epinephrine in to the right sinus -- which seemed to be the most problematic -- to both numb it and constrict the blood vessels. Then he packed the sinus with an inflatable packing, injected saline into it to make it expand, which created pressure inside the sinus. and left the inflate tube hanging out. (Notice the blood from where I'd been bleeding out my right eye socket when the paramedics had arrived.) The bleeding seemed to stop. He gave me a head's up that pain would be in my future once the lidocaine wore off. After some seven+ hours of holding my nostrils closed, it was utterly thrilling to be able to rest my arm. And I no longer felt fresh blood running down my throat. They kept me for observation for a while, during which I could finally really drank water, then discharged me about 8:30pm. It had been a long, long day.


The Sixth Surgery

Wes had an infection off and on for over a year. It would go away. It would come back. Finally, when one of the cultures came back Enterobacter cloacae he was referred to an infectious disease doctor. She suggested considering surgery. Wes' ENT laid out his plan: The surgery would be primarily scoping with cultures; scraping out leftover crusted or swollen areas from these infections; washing -- and opening anything that needs to be.


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