Having a nose job

No… I’m not a celebrity. There’ll be no before and after pics although somewhere in the annals of medical literature, Steph’s skull will be recorded in 3D. Many people choose to undergo “a nose job” to enhance their looks. I’m about to have a nose job with a difference! 

The nasal septum is the vertical wall in the middle of the nose that separates the right and left nasal cavities. This wall extends back to the end of the nasal cavity and is made up of cartilage at the front and thin bone at the back. The main functions of the nasal septum are structural support for the nose and regulation of air flow in the nasal passages.

When I had the graft surgery in Nottingham last year, one side of my nasal septum was harvested and used to cover an area of bone within my skull which had been left exposed following previous surgery. The graft tissue healed well in it’s new location but unfortunately, the donor site (my septum) has failed to heal properly and continues to be symptomatic. This failure to heal is rarely seen and is thought to be due to the fact that I’ve an underlying connective tissue disorder, called Ehlers-Danlos syndrome (EDS). My surgeon in Notts has been scratching his head to find a solution to the problem.

Nasal splinting has already been tried and failed. Topical antibiotic ointment has failed. Daily hypertonic sinus rinse-outs (with the addition of baby shampoo) have failed. We even tried occluding the air flow on that side of my nose, using a prosthetic ‘bung’ but nothing has succeeded in getting my septum to heal. I travelled over to Notts recently to discuss what options are left… if any.

At the consultation, it was quickly spelt out to me that we are now in ground-breaking territory in terms of finding a solution. The first surgical option proposed by my surgeon, sounded too invasive for my liking so I asked him to think again. We discussed various other options all of which were ruled out because of my failure to heal. It was then that my surgeon had the brainwave to adapt another tried and tested surgical procedure, to suit my needs.

There is a condition known as a perforated nasal septum. This is basically a hole in the nasal septum which can be caused by nasal surgery, cautery, physical injury or cocaine use. Now, I’m not a cocaine snorter but I do have a large perforation (surgical opening) in the bony posterior area of my septum as a result of previous surgery to improve the drainage from my frontal sinuses. Sometimes, a nasal septal button is used to close an anterior septal perforation. While my perforation is asymptomatic, my surgeon has come up with the novel idea of adapting the button procedure to suit my unique anatomy and thereby solve the problem with my anterior septum.

He’s going to have a nasal septal prosthesis custom-made to fit through the surgical opening at the top of my septum and which will completely encase both sides of my septum with silicone. A 3D model of my skull will first be made from recent scans so that the prosthesis can be made-to-measure in advance of surgery. All that’s required of me, is to turn up and have the thing fitted under general anaesthetic.

I told you I was having a nose job!

Patients are a nuisance

Whatever savings and cutbacks are having to be made in these harsher economic times, curtailments in the treatment of sick children are not something that most of us are prepared to tolerate. As the HSE continues to push for efficiencies in the public system, many children in this country are being denied treatment and more and more problems are arising in terms of patient care.

Our hospital system is breaking down as the basics simply aren’t happening. The embargo on staff recruitment has resulted in operating lists (elective surgery) being cancelled without warning, out-patient appointments being cancelled and phones not being answered in many departments. Frontline staff are fed-up and disillusioned and many of the consultants are no longer advocating for their patients. The bottom line is… patients are suffering and it seems that even sick children, don’t count anymore.

If you think I’m exaggerating, have a listen to this interview with Professor Michael O’Keeffe, Consultant Ophthalmic Surgeon in Temple Street Hospital (a children’s hospital in Dublin). Thankfully, he’s not afraid to speak out.

Interview Credit:  ‘Today with Pat Kenny’ on RTE Radio 1.

Photo: Steph’s theatre gown, captured on mobile phone.

Any Ideas?

On tidying out my sock drawer the other day, I found this souvenir.

NO, it’s not my age! Any guesses what it is?

A Real Milestone

Last March, I was fascinated to read an article about groundbreaking surgery to rebuild the windpipe of an 11-year-old boy from Northern Ireland, from his own stem cells. The operation, lasting almost nine hours, took place at London’s Great Ormond Street children’s hospital. Stem cells taken from the boy’s bone marrow, were injected into the fibrous collagen ‘scaffold’ of a donor trachea, or windpipe. The organ, which had first been stripped of it’s own cells, was then implanted into the boy.

I was really delighted to read last week that this pioneering surgery has been hailed a success and doctors now believe it could lead to a revolution in regenerative medicine. What an amazing breakthrough!

“A boy from Northern Ireland was released from hospital yesterday after pioneering surgery to rebuild his windpipe using his stem cells.

Ciaran Finn-Lynch, who in March this year became the first child to undergo a trachea transplant, is set to return home today.

The 11-year-old underwent the operation which involved the removal of his trachea and its replacement with a donor windpipe at Great Ormond Street Hospital in London.

Doctors used stem cells from the boy’s bone marrow to build up the donor windpipe and ensure the organ was not rejected. Four weeks ago, they were able to describe the transplant as a success after proving blood supply had returned to the trachea.

His parents, Colleen and Paul, described the last few months as a “rollercoaster” and paid tribute to the surgeons. “We’re just so grateful. We are delighted they could give Ciaran a chance.”

Ciaran was born with a condition called long segment tracheal stenosis, which leaves sufferers with a very narrow windpipe, making breathing difficult.

He underwent major surgery to reconstruct his airways but, at the age of 2½, a metal stent used to hold his airway open eroded. When a second stent eroded, the idea of a transplant was raised.

The boy’s parents said: “When they first suggested the procedure, we agreed to it, though we knew it would be the first time it had been tried in a child. We had 100 per cent faith in them.”

The surgery had been tried in Spain in 2008 on a mother of two.

Ciaran’s transplant took place four weeks after a donor trachea was found. The surgical team was led by Prof Martin Elliott, who said, “Ciaran is a wonderful boy and a great friend to us all. His treatment offers hope to many whose major airways were previously considered untreatable.”

Source: The Irish Times

More news BBC News HEALTH

Improving Patient Safety

In recent years a primary concern for patients being admitted to hospital has been the risk of contracting methicillin-resistant Staphylococcus aureus, commonly known as MRSA.

Many cases of MRSA arise from the transfer of germs from patient to patient due to lack of good hygiene. To address this, hospitals have revised their hygiene practice. Measures have included the introduction of hand-sanitising kits and tougher visitor regulations to reduce the risk of infections being brought in from outside. However, the concern over post-operative infections lingers.

The Royal College of Surgeons Ireland (RCSI) is introducing a Surgical Development Initiative for trainee surgeons which will focus on maximising patient safety and preventing infections following surgery. The RCSI initiative is being launched this month to the new group of surgical trainees who commence their basic surgical training in July. It has been developed specifically for trainees to improve practice in the areas of hand hygiene, the optimal use of antimicrobial prophylaxis, the care of wound sites after surgery and the prevention of bloodstream infection that can result from infected intravascular devices.

The RCSI’s new project is in line with the World Health Organisation’s (WHO) recent prioritisation of patient safety, to prevent healthcare-associated infection (HCAI) and its ‘Safe Surgery Saves Lives‘ initiative which is endorsed by RCSI.

In tackling post-operative infections, WHO has recently published it’s WHO Surgical Safety checklist. The 19-point checklist has shown improved compliance with standards and a decrease in complications from surgery in the eight pilot hospitals where it was used for evaluation. It demonstrated a decrease in mortality from 1.5 per cent to 0.8 per cent and a drop in surgical site infection (SSI) rates from 6.2 per cent to 3.4 per cent.

As someone who has battled against serious post-operative infections (MRSA, cellulitis and osteomyelitis), I welcome any initiative which will reduce the risk of surgical site and healthcare-associated infections.

The WHO surgical safety checklist is an essential aide to patient safety. This video demonstrates how the checklist is used at Great Ormond Street Hospital…

Information Source:  The Irish Times

Where did you get that hat?

In March 2007, I underwent an extremely rare operation in a specialist surgical unit in Nottingham. A Riedel’s procedure is an operation of last resort and is only used in patients where all other surgical treatments have failed. The procedure causes a cosmetic defect in the forehead but reconstruction can be done at a later stage if necessary.

This first picture was taken to mark my safe return from the operating theatre. During the surgery my head was opened from ear to ear via a zig-zag coronal incision and my ‘face’ was peeled back to the bridge of my nose, to expose the front of my skull. The diseased anterior wall and floor of both frontal sinuses was cut away leaving behind a large hollow in my forehead. The edges of this bony hollow were then ‘chamfered’ (planed) to make a gentle curve so that the soft tissue of my face could fall in and line the hollow area.

My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in place to minimise haematoma formation. Ten days later, the staples (all 59 of them) were removed from my scalp and I was well on the way to making a good recovery. I’ll never forget how good it felt to be able to wash my hair again.

The pictures below document my recovery following this operation. My return home from hospital in April of that year happily coincided with the early arrival of summer so I got to enjoy a whole month of lazing around in the sunshine. The sun proved to be a perfect tonic and quickly dried up the pressure sores on my forehead.

In the last year, I’ve had two further operations on my head in Nottingham plus extensive IV antibiotic therapy to eradicate a bone infection. The final photograph shows how my face looks today now that all the swelling has finally subsided. Reconstructive surgery is available to improve the contours of my forehead but having recently discussed the options with my surgeon, I’ve decided not to proceed.

I’m more than happy to leave well alone.

Up close and personal

I was asked recently if I’d ever posted any pictures on this blog to document the problems I’ve had with my head over the years. The answer is, no but it started me thinking that perhaps it’s time I should. Words can only convey so much of a story whereas pictures say so much more. So, thank you Alhi for giving me the push that was needed!

My story goes back a long way as I’ve had multiple surgeries on my head as a result of having chronic sinus infections for most of my adult life. About 5 years ago, a decision was taken to insert a stent close to the base of my brain, to drain a recurring abscess in the right frontal sinus. It was at this stage that my husband decided to record my surgical journey with a series of ‘up close and personal’ photographs. Little did we know then of the battle that lay ahead.

This first photograph was taken in 2005, several days after the operation to have the stent inserted in my head. The incision follows the contour of my eye socket and is continued through the eyebrow for maximum disguise. This operation was actually the fifth time this incision had been used to access the right side of my forehead. All previous access had been gained through my nose or upper jaw.

The second photograph was taken 3 weeks later while I was still recuperating from the surgery. I was actually on a sailing holiday at the time when I developed severe headaches and my eyes and forehead started to swell. I knew something serious was going on but I didn’t know what so we made haste back to the hospital. This photograph marks the beginning of my journey with MRSA.

This last photograph was taken following my treatment for the orbital cellulitis. Once the MRSA wound infection had been diagnosed, the stent had to be removed from my head and it took several courses of intensive IV antibiotic treatment, administered over a 3 month period before I was finally discharged from the hospital. I’ve included this picture as it shows how well the incision healed despite the setback.

Less than a year later, the MRSA infection recurred and resulted in the development of chronic osteomyelitis in the frontal bone of my head. Further extensive surgery and treatment has been required in the meantime but I’m going to save those pictures for another day.

Third Time Lucky?

Well… I finally got to Nottingham to see the surgeon having had my two previous attempts foiled by that damn volcano. As a result of the enforced delay, I had emailed the surgeon in advance, to alert him to the fact that my head still hadn’t healed properly. While his reply was reassuring, I wasn’t convinced that all was well. I’m sorry to have to report that my concern was justified.

When the surgeon looked inside my head, he groaned. He asked me to remind him of how many weeks I was now post-op and his face fell at my reply of three months.  “I’ve never, ever seen this happen before”, the surgeon said. Now it was my turn to groan. Those words have become increasingly familiar over the years as things have gone wrong with my health. Delayed healing has now been added to that list of peculiarities.

It wasn’t all bad news though as the graft has actually healed well. However, the surgeon echoed the words of my surgeon at home when he said that “in solving one problem, another has been created”. In other words, the small area of bone which was chronically infected, has healed perfectly thanks to the graft but the donor site for the graft, is now refusing to heal. That’s when I heard the MRSA word mentioned again. A swab was taken for analysis. Personally, I think it’s more likely that the problem is linked to my connective tissue disorder, Ehlers-Danlos syndrome (EDS), but who am I to know?

When the surgeon first heard of my problem with delayed healing (via my email), he was of the opinion that repeat internal splinting of my airway might be required. However, having seen the situation for himself, he changed his mind and decided that one side of my nose should be temporarily sealed off. Apparently, exposure to air (breathing) can dry out the airway to such an extent that it delays the healing process following certain types of surgery. With this in mind, I was subsequently dispatched to another department of the hospital to begin the next stage of treatment.

The ‘expert’ in making facial moulds greeted me on arrival in the maxillofacial department. This department deals with diseases, injuries and deformities of the oral and maxillofacial region and my visit provided a fascinating glimpse into the world of facial reconstruction using prosthetics. I was there to have a simple mould made of the inside of my nose so that a prosthesis could be made to seal off one side of the airway. However, the ‘bomb crater’ left in my forehead following previous surgery, was also of interest to my new friend. I was shown the photographs which were taken of my face at the hospital last year, to record the cosmetic disfigurement. During my earlier consultation with the surgeon, I’d already ruled out going down the road of re-constructive surgery as it’s fraught with possible complications*. I’d no hesitation in telling the maxillofacial expert “thanks but, no thanks!”

My new ‘nose’ will arrive in the post in due course and my surgeon in Ireland will oversee the healing process. I’ve been warned that the prosthetic ‘bung’ will be visible and will give my voice a nasal intonation but it’s only a temporary arrangement and I’ll happily settle for it as long as I’m spared another battle with MRSA. Fingers crossed please that the swab result turns out negative!

* I’m pretty sure this blogging friend would agree with my decision.

A hard graft

I’d another appointment at the hospital yesterday. Almost 10 weeks have passed since the graft surgery and I’m still not out of the woods. It’s been a hard graft in more ways than one.

I’m still waiting to be reviewed by the surgeon in Nottingham. If you remember, volcanic ash caused the postponement of my post-op appointment 2 weeks ago. The surgeon who oversees my care here, was kind enough to see me again while I await returning to the UK. I’ve now had five sessions of treatment with him since the operation.

The good news from yesterday was that the graft has healed perfectly, covering up the area of bone left exposed by previous surgery. The not-so-good news was that the donor site from which the graft was harvested, has failed to heal properly. Having fixed the problem in one place, it seems another problem has now been created. Will it ever end? 😦

I knew something wasn’t quite right as my head hasn’t followed the usual pattern of healing following surgery. The sympathetic look on my doctor’s face when he said, “I hope it heals for you”, was distinctly unnerving.

Fingers crossed the news from Nottingham in a few week’s time, will be more positive. They say time is a great healer.

I Know Him So Well

I traipsed into the hospital again this week as the recurring symptoms in my head had begun to wear me down. I was in need of reassurance and I knew that the surgeon would put me straight. After years of dealing with the infections in my head, we’ve got to know and respect each other well.

On entering the examination room, the surgeon asked if I would mind having two young medical students present while he examined my head. I was perfectly happy to agree to this, in fact I positively welcomed it. I knew from previous experience that it was likely to add an interesting dimension to the consultation.

While the surgeon was preparing the endoscope, I chatted to the two female students to put them at ease. I asked them what they thought of the new HPAT (Health Professionals Admission Test)* which was introduced last year as part of the entry exam for medicine. They reckoned the test had evened out the ratio of male/female students that succeeded in getting into medical school last year. In recent years, the percentage of students studying medicine has been 70/30 in favour of females. This would suggest that an aptitude test suits the male psyche better, while swotting for exams is more of a female forte. The surgeon then piped up and declared that if he or any of his colleagues were asked to sit the HPAT today, he reckoned they’d all fail. We all laughed at this concept.

The room went silent while the surgeon delved deep inside my head with the endoscope. Shortly afterwards, he emerged with a large lump of something horrible and announced triumphantly “that’s some bogey”. I’m beyond mortification at this stage so I just grinned over at the two girls who looked horrified on my behalf. The students looked on in silence as the surgeon and I continued to banter about the state of my head. The many years of treatment have left us both comfortable enough in each other’s presence, to be able to employ banter as a coping mechanism. The girls were not aware of my previous medical/surgical history and therefore had no idea that I knew this surgeon so well. The look of disbelief on their faces, was priceless.

When the surgeon had finished his task, he took photographs of the inside of my head and used these to reassure me about the cause of my present symptoms. It appears that the donor site used for the recent graft surgery, is slow to heal and is causing irritation to surrounding structures. My post-operative check-up in Nottingham next week, should elicit more information on this. The good news is that the graft continues to heal well.

Before I exited the room, the surgeon gave me a big grin as he explained to the students that I was no ordinary patient. “This is a very rare case”, they were told.  I grinned back and left him to explain.

*The HPAT allows all Leaving Cert students with over 480 points to apply for medicine. Entry is decided by a combination of CAO points and HPAT results, which examines spacial and logical reasoning, problem-solving and interpersonal skills.

With thanks to the Amateur Transplants for the parody.

In case you didn’t know… the ABC used in the above video, is a well-known mnemonic for AIRWAY, BREATHING and CIRCULATION. The ABC protocol exists to remind rescuers delivering emergency treatment to an unconscious or unresponsive patient, of the importance of airway, breathing, and circulation to the maintenance of a patient’s life.