November 16: went to work, had pain in my left eye. It felt like it was swollen.
November 17: woke up with my left eye swollen. It looked like angioedema so I was popping 50 mg of Benadryl every four hours. Swelling went down.
November 18: woke up with my left eye swollen even more, tilted down and to the left, with double vision.
November 19: went to the ED. Had post-septal cellulitis, cranial nerve III palsy, vertical diplopia, dilated pupil, proptosis and ptosis. Labs were normal. MRI with contrast done, revealed a retrobulbar mass, approximately 3 cm in diameter. Loaded with Ativan...Transferred to Johns Hopkins for further eval. CT scan done with contrast. Seen by ophthalmology and ENT...why ENT? Had the most thorough eye exam EVER. They measured the actual degree of double vision. ENT resident came to see me...they said they thought it was a mucocele...WTF is that...started in my left ethmoid sinus, broke through the bone and started growing behind and over my eye. Started on steroids (I had been saying I needed steroids since the 17th)...eye swelling went down after a few days and double vision resolved by the day after Thanksgiving.
November 27: saw the head of sinus surgery at Hopkins. They asked about how all this came about. I told them I woke up one morning with my eye swollen, took a pic and sent it to a nurse I work with who showed it to a PA. They were like "You have pictures of it?" Me: "Of course I have pictures" (they obviously don't know people in EMS). Scoped me in the office and explained the surgery...they would cut it, remove what they could of the outer covering (not all because part of it had attached to the bone between the eye and the brain and they didn't want to risk a CSF leak). They said they may have to do a septoplasty as well. Me? I was like "Whatever, just get this thing outta my face."
December 5: Surgery bright and early at Hopkins. Had a sit-down with the anesthesiology resident...
Me: What size tube are you using?
Doc: 7.5
Me: Are you using the Glidescope or laryngoscope?
Doc: (laughing) laryngoscope
Me: Don't click my teeth.
Doc: (more laughing) OK
Me: Don't give me Dilaudid after surgery unless you want them to clean up the mess. They gave me Dilaudid before, then Zofran, Compazine, Reglan, Phenergan, and put a scopolamine patch on me and I was still heaving.
Doc: OK (laughing)
Me: Oh yeah...I get pretty bad post-op nausea, so you need to medicate. And I have a high pain tolerance, so no need to go overboard with the stuff.
Doc: Gotcha. Anything else?
Me: Nah...that's it.
My surgeon was awesome. They wheeled me in to the OR, I moved over to the table. I'm bsing with the OR staff. My nurse is giving me hell...I'm joking around with them all. They strap my arms in..."This is Fentanyl" they said...and the room started spinning. I started giggling and said "Woah." They said "This is Propofol" and I said "Ah! Milk of amnesia!" The whole room started laughing and my nurse says "Oh, you know this one?" I said "Yep! Night night." And I was out.
I woke up...feeling like I got punched in the face a bunch of times. Fentanyl is an amazing drug...I got two doses in PACU, as well as a lot of Zofran and the scopolamine patch...again lol. I felt like I got an uppercut to the nose and punched in the mouth...the resident, in his humor, had taped the tube down on my lower lip, leaving me with a fat lip. Ha. Ha. They had to do the septoplasty too, so I had sutures inside my nose. I saw my mom and asked for a Slurpee. My throat was so sore from the tube...turns out when they pulled the tube I didn't want to start breathing on my own again...whoops. I told the anesthesiologist I was a little tired..I'd been up for three days before the surgery. :)
When I was finally cleared to leave, I made the mistake of leaning forward to grab my bag of clothes and get dressed. Hello epistaxis!! "Ahh!" I yelled. My nurse was next door and hollered "What?" I yelled back "I sprung a leak!" She comes in laughing at me and said it was common, so she taped a gauze pad under my nose and let me get dressed. Four hour surgery, two to three hours in PACU and I was on my way to the hotel....with a couple of stops first.
7-eleven to get a Slurpee. My mother has a great sense of humor. I'm in the store, with a gauze pad taped under my nose, trying to buy an extra-large strawberry Slurpee with cash...post-op, post-anesthesia, and post-Fentanyl. Hilarious I tell ya. LMAO...Love her :)
I slept sitting up for the first few nights. The saline rinses SUCKED. Post-op instructions said not to blow my nose. Hardest thing ever. Back to Baltimore after a couple days recovering.
Now...here's the kicker. No pain meds after leaving the hospital. Not even Tylenol. I felt fine. I wasn't even bruised. A little swollen, but no bruising. My nose only hurt if I touched it...so I didn't touch it. Not rocket science here.
First post-op visit included scope and debridement. Lemme tell ya...debridements SUCK. Pulling the sutures out of my septum was the worst...because they can't numb it with Tertracaine. So here's the scope...
Doc turns the screen toward me
Doc: Can you see that? (with the scope up my nose)
Me: Yep.
Doc: You see that big white thing there?
Me: Yep.
Doc: That's your eye.
Me: That's so cool!
The doc also told me that when I was under they pressed on my eye from the outside and could see it move on the inside once they removed the mass. I told him that's something I would do too, so it's all good. Second post-op visit was a week later...that debridement was the worst. The doc couldn't get the scabbing with suction and had to use forceps. I told him "you know my pain tolerance" and he said "I know but I don't want to push it." Final measurement...3.5 cm mucocele, extending from the ethmoid air cells to behind the globe of the eye. Kinda big for something in the face.
I was back to work the next day, two weeks after surgery.
Had my last appointment last week. The surgeon said that the bone won't grow back. My question was..."Doc, just tell me...I'm not going to have snot behind my eye, right?" He laughed..."No, there is a membrane there separating it. You don't need to come back unless your eye starts swelling again." "Sweet."
Yes, I know my sense of humor is sick and twisted...but really, what else do you expect from me? Want me to lie down all "woe is me" and crap? Hell no. Ain't in my nature.
So that's it...the joke, according to my brother, was I was "all Quasimodo-ing it up" for a few weeks. I have anisocoria...but I've had that for a while. No more proptosis or CN III palsy. I'm as normal as I was before...if you could even call it that.
So now you know. Fun times, right? The thing that sucked is everyone was looking at me like "Oh shit." I never get sick, complain, etc. I handle it on my own, and I handle things for everyone else. Everyone looks to me...as my aunt said, I'm the family's "rock." I couldn't be out of commission for that long. So here I am :)
Now...sleep.
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