Saturday, December 4, 2010
Christmas Card 2010
What Warmbrods can do with a roll of 24 exposure film, a tripod, time delay setting, and the promise of ice cream if everyone smiles...
Wednesday, October 13, 2010
While We're Stuck on a Baking Theme...Birthday Baking
Catching up on posting some summer pictures - these with a baking birthday theme...
Blaine's Baseball Birthday Cake- these cakes have ice cream inside- I inherited a special hollow pan from Audera and they make the best ice cream cakes on the planet!
Blaine's 9th Birthday
Drew's 4th birthday party-some of my favorite kids and a football cupcake cake
Drew's soccer cake
These pictures have nothing to do with baking... walking through a quiet house one summer afternoon, this is how I found the kids.... too perfect not to photograph...
Blaine catching up on Narnia...he's cuddled up under a quilt that my great grandmother sewed and my mom quilted.
Drew fell asleep while reading to his stuffed animals- there's a batman quilt in the picture that I made while Blaine was little... and a bit of trivia for those Warmbrods out there- he's sleeping in Honey and Pa's old bed.
Blaine's Baseball Birthday Cake- these cakes have ice cream inside- I inherited a special hollow pan from Audera and they make the best ice cream cakes on the planet!
Blaine's 9th Birthday
Drew's 4th birthday party-some of my favorite kids and a football cupcake cake
Drew's soccer cakeThese pictures have nothing to do with baking... walking through a quiet house one summer afternoon, this is how I found the kids.... too perfect not to photograph...
Blaine catching up on Narnia...he's cuddled up under a quilt that my great grandmother sewed and my mom quilted.
Drew fell asleep while reading to his stuffed animals- there's a batman quilt in the picture that I made while Blaine was little... and a bit of trivia for those Warmbrods out there- he's sleeping in Honey and Pa's old bed.
Skillet Pizza Crusts
While I waited for my pumpkin yeast roll dough to rise on Sunday afternoon, I tried this recipe for Skillet Pizza Crusts- make the dough, slap into skillet for a couple minutes, then freeze. It was super easy. Drew and I make this little spinach pizza tonight and it was delicious. I'm making a few batches of pizza crusts to freeze again soon.
I used my standing mixer and used about 3- 5 cups flour to get to the right consistency.
Ingredients
3 (1/4 ounce) package active dry yeast
1 teaspoon sugar
3/4 cup warm water ( 105 115)
3 cups all-purpose flour
1 teaspoon salt
1/2 cup warm water ( 105-115)
2 tablespoons olive oil
vegetable oil cooking spray
1 tablespoon Italian spices (optional)
Directions
In a 2 c measuring cup or sm bowl, combine yeast, sugar and 3/4 c warm water; let stand 5 minutes.
Combine yeast mixture, flour, salt, water, and oil in lg bowl, stirring til well blended.
Turn out dough onto floured surface; knead 5 minutes.
Place in bowl coated w/ cooking spray, turning to grease top. Cover and let rise in a warm place (85 degrees), free from drafts, 30 mins or til dough is doubled in bulk.
Punch dough down; knead 4 – 5 times.
Divide dough into 6 equal portions; roll each into 8” circle.
Cook each round on each side in a non-stick 8” skillet coated w/ cooking spray over med heat about 2 mins per side or til dough rounds are lightly browned.
Cool crusts and freeze in an air-tight container up to 6 months.
Sunday, October 10, 2010
Knotted Pumpkin Yeast Rolls
Perfect for the holidays! I made two batches of these today- the kids helped me roll the dough and knot them- they each ate two and asked for more. Tommy came home and gave a major thumbs up as well. I froze most of them for fall dinner parties.
If you use canned pumpkin, one can of pumpkin will be enough for two batches- go ahead and make a double batch- you won't be sorry!
Ingredients
ROLLS
1/2 ounce active dry yeast ( 2 .25 oz packs)
1 cup warm 2% low-fat milk ( 110-115 degrees F)
1/3 cup unsalted butter, softened
1/2 cup sugar
1 cup canned pumpkin puree ( NOT pie filling)
2 eggs
1 teaspoon salt
5 1/2-6 cups flour, divided
EGG WASH
1 tablespoon cold water
1 eggs
Directions
In a large mixing bowl, dissolve the yeast in the warm milk. Add butter, sugar, pumpkin, 2 eggs, salt, and 3 cups flour. Stir in enough of remaining flour to form a soft dough. Turn onto a lightly floured surface----knead until smooth and elastic-like (should take about 5-7 minutes). Place in a large greased bowl and turn once to grease top. Cover with a clean towel or paper towels and let rise in a warm place until doubled---takes about 1 hour. Punch dough down; turn onto lightly floured surface; divide in half. Shape each portion into 12 balls (so you'll have 24 balls total). Roll each ball into about a 10" rope; tie into a knot and tuck ends under. Place 2 inches apart on greased baking sheets. Cover again with towels and let rise until doubled---takes about 30 minutes.
Wednesday, September 22, 2010
The (Somewhat) Abbreviated Version
I had major sinus surgery on Monday, September 13. Yes, it involved plastic surgery which was absolutely NOT an elective component. In summary, I couldn’t breathe, I was exhausted, I had migrane level headaches almost every day and I was thought to have an infection that, without surgery, would lead to the total collapse of the left maxillary sinus cavity and eye socket. Vain, maybe, but utter the words ‘facial deformity’ and I’m immediately in the surgery scheduler’s office begging to be worked in.
In June, after extensive evaluation with brilliant doctors at Vanderbilt, I was handed a list of standard ENT operative procedures and roughly HALF the list of procedures was check marked for me. Oh yeah, and to add an element of mystery to the process, I was told that I have nasal valve collapse which requires reconstructive surgery. I would still have ‘my nose’ but a version that would actually be able to breathe. I was given a folder containing about 20 pages with titles like ‘What to Expect after Surgery’ and ‘Home Care Instructions for Facial Plastic and/ or Reconstructive Surgery.’ I didn’t need Google to tell me this was a major undertaking and scary stuff. So I hired a housekeeping service, signed up for the personal shopper service at Harris Teeter grocery store, and stocked the freezer in anticipation of a long post-op recovery.
According to the specialists, I have never really been able to breathe because of my nasal anatomy. Until lately, I have found ways to function around the issue and perform at a relatively high level. In 2007, I had a newborn baby and a kindergartener, took my growing consulting business independent, and served as Board Chairman of one of the largest Habitat for Humanity affiliates in the world (during a period of record growth). It was both exhilarating and exhausting. I roared through 2008 & 2009 with equal gusto and somewhere along the way I got really tired…. really, really tired. I thought that it was my body telling me to slow down and take it easy, so I did… I cut out every extra activity possible on my busy agenda… amped up my workouts… but I was still exhausted. And I suddenly noticed that I was working and playing and managing the family through daily headaches and nasal conjestion and a general, miserable fog.
In May 2010, I was ending a very large, high profile project and decided to take a month off. I took three amazing young boys to Disney World for eight days as my last spur-of–the-moment hurrah and then visited Vanderbilt’s ASAP program to get an allergy/sinus assessment on May 21. Fast forward exactly four months later and here I sit- breathing freely through my nose for the first time ever in my life. Tears of joy to say the least!
More detail below if you are interested; I wrote this because there is very little info out there for folks in my condition and I hope this will help someone. Below is a post-surgery journal and an expanded explanation of my condition and the road to treatment.
In June, after extensive evaluation with brilliant doctors at Vanderbilt, I was handed a list of standard ENT operative procedures and roughly HALF the list of procedures was check marked for me. Oh yeah, and to add an element of mystery to the process, I was told that I have nasal valve collapse which requires reconstructive surgery. I would still have ‘my nose’ but a version that would actually be able to breathe. I was given a folder containing about 20 pages with titles like ‘What to Expect after
According to the specialists, I have never really been able to breathe because of my nasal anatomy. Until lately, I have found ways to function around the issue and perform at a relatively high level. In 2007, I had a newborn baby and a kindergartener, took my growing consulting business independent, and served as Board Chairman of one of the largest Habitat for Humanity affiliates in the world (during a period of record growth). It was both exhilarating and exhausting. I roared through 2008 & 2009 with equal gusto and somewhere along the way I got really tired…. really, really tired. I thought that it was my body telling me to slow down and take it easy, so I did… I cut out every extra activity possible on my busy agenda… amped up my workouts… but I was still exhausted. And I suddenly noticed that I was working and playing and managing the family through daily headaches and nasal conjestion and a general, miserable fog.
In May 2010, I was ending a very large, high profile project and decided to take a month off. I took three amazing young boys to Disney World for eight days as my last spur-of–the-moment hurrah and then visited Vanderbilt’s ASAP program to get an allergy/sinus assessment on May 21. Fast forward exactly four months later and here I sit- breathing freely through my nose for the first time ever in my life. Tears of joy to say the least!
More detail below if you are interested; I wrote this because there is very little info out there for folks in my condition and I hope this will help someone. Below is a post-surgery journal and an expanded explanation of my condition and the road to treatment.
Post Surgery Journal
Post- Surgery Journal
Surgery Summary
Surgery Summary according to husband, Tommy: "Her nose is jacked up and the doctors are going to fix it."
Surgery Summary, paraphrased, from Surgical Report
Dr. Duncavage performs the computer-assisted stereotactic image-guided surgery, bilateral resection inferior terbinates, bilateral concha bullosectomies, and left endoscopic antrostomy with tissue removal. It went as expected EXCEPT the infection expected in the left maxillary sinus was actually a large CYST instead. This CYST was, according to Duncavage, the reason my sickness escalated.
Next up, Dr. Wm Russell Ries performs the repair of the vestibular stenosis via open approach with septoplasty and speader grafts placed. The cartilage would be harvested from the nasal septum. My septum was deviated to the left with a large spur posteriorly on the left.
Recovery Journal
Monday- surgery day; all apparently went well; Tommy brings me home around 5pm; gives me Oxycotin as soon as possible. I am a vision of beauty with my external nose cast, internal splints and mustache dressing (think folded gauze, taped hammock-style under nose). I eat soft serve ice cream and chicken noodle soup. I am suppose to keep my upper lip still which means no talking or smiling and very little chewing and that’s okay because these things are misery. Blaine (my 9 year old) comes in, eats dinner, showers, homework… calmly and quietly… because (as he tells me days later) he saw me and “he was so sad for me.” I doze in and out all night upright in the recliner; my sweet husband Tommy sleeps in a sleeping bag on the hardwood floor beside me- true love always. He wakes for medicating me, changing the nose dressing and anytime he hears a strange noise. My throat hurts during the night and my mouth is very dry. I drink lots of water. I decide to nasal mist my nose sometime during the night although the instructions say to start this on day two.
Tuesday- Don't expect anything witty or funny in this post becuase there is absolutely nothing charming about day two. Tommy walks Blaine to school. Nurse calls to check on me. Tommy asks for definition of ‘a lot of blood’…I don’t qualify… good…I eat bites of bagel for breakfast. My right nostril is now completely crusted over with blood and my mouth is the SAHARA… I am dozing with my mouth entirely open because I cannot breathe out of my nose. Tommy is working from home; he makes me a quesadilla for lunch. The Judds are on Oprah… very entertaining… Tommy and I have lots of Judd banter from various personal experience… have to keep banter at minimum today because I am not allowed to move my upper lip to laugh… summary of day:all I do is sit in the recliner and obsess about crusted over nose and inability to sleep without waking to a sandpaper mouth. Tommy takes Blaine to football practice at 5pm; I eat a few slices of ham; I phone the doctor on call…beg him to let me irrigate my nose because of the crusting. He doesn’t give me a very confident answer; thinks I could remove some of the crusting that SHOULD be there and he doesn’t believe that I have nostril clearance for true irrigating. I mumble something through my hammock-style mustache dressing about learning the virtue ‘patience’… we discuss a little more and agree that I can irrigate VERY gently to try to address the crusting on the opening of the nostrils.
Tuesday night- absolutely miserable; still must be upright in the recliner with upper lip still, breathing out my mouth; I am using saline spray as much as possible and VERY gently irrigating with what seems no results. Only sleeping an hour at a time due to Saudi condition of mouth. I have a love-hate relationship with Percocet. There is dried blood in back of throat from drainage. Good times. I become an insomniac- dreading sleep because I wake to sand dunes in my mouth. Sleeping in upright position is also getting to me. Bruising under the eyes and some swelling now. I text sis a photo of me-with bruising and cast and mustache dressing-apparently this look hasn’t made it to the runways this season and she finds the condition quite alarming… her shocked response is a simple ‘OMG.’ I reply back that I am actually more miserable than the photo reveals. I thank her for keeping Drew (my 4 year old) for me.
Wednesday- I call doctor’s office at 9am. COMPLETELY crusted over right nostril; some air clearance now on the left but not enough to get my body to shut my mouth to sleep. In fact, the left nostril makes funny whizzing/ gurgling noises when I attempt to sleep which furthers my insomnia. Ries’s nurse tells me that I can use saline spray several times a day but no irrigating. She is SUPER but she and surgeons are obviously not fans of irrigation. I’m swelling very much now. I look like a pig and I remind myself of some character from Lord of the Rings but through the Oxycotin haze I cannot recall which one. I’m in no condition to google for a photo of my lookalike….daily summary: there’s no normal activity for me at this point. I only leave the recliner to treat nose with saline spray and visit bathroom; I don’t even have enough energy to turn on NetFlix. I am in a poorly executed rotation of pain meds, doze, drink water, treat crusting, change mustache dressing…and… later… ice packs… sometime today I get smart enough to add ice packs to the rotation. Tommy gets August and September Vogue out of the mailbox and announces, “September Vogue is above your approved weight limit.” He’s not kidding…. 720+ pages weighs well over 2lbs. I got a free subscription with a recent purchase and I have been waiting on these to arrive…. September Vogue issue confirms no mustache dressings on the runway this year. Lisa brings Drew home around noon and I am crying when she gets here- my second cry after surgery….don’t fret it’s just a general misery cry. Lisa really wants to do something for me and I tell her that she has done SO much by keeping Drew. She offers to take him back but I tell her it’s okay that he needs to be at home after three nights away and it’s really going to be okay. Did I mention that it's going to be okay?
Tommy feeds the kids and gets prepared to put Drew to bed; Drew ‘writes’ me a four page get well message which he proudly orates to me… three feet from my recliner… as if he’s officially presenting to a Queen. I give him a thumbs up from my recliner since I cannot really talk or smile or laugh. I can tell that he loved it at Aunt Lisa’s house and I am so thankful for this gift from her. Tommy puts Drew to bed and he helps Blaine do homework…then they play basketball outside. When they come in, I am dozing upright in recliner… I hear Blaine whisper “Awwww…. She looks so pitiful.”
Thursday- morning is a little crazy… I overhear Tommy bribe drew with a trip to Chick Fil A for breakfast if he’ll just get in his uniform. I moved to another recliner sometime during Wednesday night…I thought I’d go absolutely mental if I slept in recliner #1 for one more minute…. After all, isn’t upright sleeping a torture technique we aren’t allowed to use on terrorists? … I might have googled this in a normal Janey state but I haven’t touched my iPhone in days...except for the one very long email that I sent out to colleagues on Tuesday night which Tommy suggested that I preface with ‘this is a Percocet email’…. I watch three episodes of The Tudors on NetFlix in the afternoon from recliner #2. I am careful to have the TV off when the kids get here so they don’t feel like I am ignoring them. I pay them what my friend Lortab insists is scads of attention between dozing off and applying ice packs... in reality I recall that I simply said “Hi” to Blaine and ask him how his day was… I hold Drew’s hands and rub his face for a few brief moments. This is fine with the kids because they are heading out with Daddy to football practice and they can tell that I am pathetic and loopy. I remind Lortab that I recently took them to Disney for eight days all by myself and I’m not always such a loser mom. Snap, snap.
Friday- Drew wakes up complaining about his leg and Tommy sees a red, hot irritated bump. So, in addition to work and tending me and the kids, Tommy's now tasked with carting Drew off to the clinic. He calls me mid morning with a report that he has seen the doc, they have administered antibiotic, and he is in route with Drew to preschool. With the house empty, the Lortab and I decide that now is the perfect time for my first shower. Really? Really. We somehow survive this insane act of independence. I am still in my routine of rotating ice packs, pain meds, sleep, saline spray and crust removal. Still obsessing with the crust removal. I have air clearance through the left nostril- still with uber-annoying whizzing sounds- less crusting on the right side but I’m still bleeding out of the right nostril. Insomnia has stepped up it’s game and sleep is less and less attainable. I am backing off on the Oxycotin and trying to only use Lortab. I watch Harold and Maude on Netflix in the afternoon which I have never seen… it’s a good compliment to my Lortab coma…let’s be honest that I am not really sleeping anymore and I’m really just in an intermittent Lortab coma… Tommy takes the kids to football practice and the Brentwood/ Ravenwood football game on Friday night… I flip through my Vogue magazines. When the family gets home, I announce that I am officially breaking it off with recliner #2 and have decided to move to the bed for the night… I will be beyond insane if I sleep in a chair for one more night. I sleep propped up in a nest of pillows and I get significantly more sleep than the usual Lortab coma allotment… but it is not without consequence…someone apparently batter-fried my mouth while I slept… a couple of times.
Saturday morning-5 days post-surgery- I complete my first normal task since surgery- I turn on the computer and place our weekly Harris Teeter grocery order. Tommy picks up ham biscuits from Brentwood market for our breakfast since we can’t make our usual Saturday morning breakfast trip there. Tommy then takes kids to football and soccer games and picks up groceries on the way home. I return to recliner #1 for TV and flipping through Vogue. I heat up homemade Italian meatball soup from the freezer. Tommy and the kids return mid afternoon. Blaine was triple teamed the entire football game so I didn’t miss much. Yes, tripled teamed and I tell him that he should be flattered by the opposing team's strategy. We order pizza from Nashville Pizza Co for dinner. On a whim, I call the doctor’s line… in the middle of my recitation of the list of surgeries I endured on Monday, I hear these words “You can irrigate.” What? Did I overdose on Lortab? Am I hallucinating? I say, “Excuse me? What did you say?” I hear it again “You can irrigate.” I babble about how I don’t understand why Duncavage and Reis don’t tell you this from the beginning, that I think that they are brillant but maybe they are just old school and not on the irrigation band wagon but it’s really sad because I am absolutely going crazy with this mouth breathing thing and I am near suicidal. He assures me that there’s “absolutely nothing that I am going to hurt by irrigating.” I will kiss this man on the mouth if I see him in the hallway at my next appointment. I irrigate. Which is not pretty but effective. I can suddenly breathe through BOTH nostrils. Tommy gets home with the pizza and I sit and eat with the family for the first time this week. In celebration, I have three slices of cheese pizza. About halfway through the meal, I issue a no talking warning… our normal family banter is making me laugh too much and I still must keep the upper lip still. Did I mention that I can now breathe out of both nostrils? I am so happy that I want to cry. I get out my crochet basket and Blaine, Tommy and I watch the Perfect Storm. I retire to my bed and although insomnia interferes at will, I sleep with my mouth closed for the first time in what seems a century. I log about 6 hours of random sleep.
Sunday- I MADE THE GRAVY. Getting up was hard, but much easier than days ago. We usually make a big breakfast on Sunday mornings and Tommy did most of the heavy lifting this morning but I MADE THE GRAVY. Let me give props to my Tommy here for a terrific breakfast- we had our usual Sunday morning sausage, biscuit, fried chicken with gravy, and omelets with peppers and onion. (Sidebar: we regularly keep a lot of the ingredients prepped in the freezer for these meals). I heart normalcy. I irrigate before we eat... amazing process. I eat at the family table and Drew tells me that I am soooo cute (I am holding ice packs on my face while I eat breakfast- and don't forget to paint the bruises and the nose cast into the picture). He is comic genius. Throughout the day, I begin to alternate Lortab and Tylenol. Drew plays matchbox cars in the room beside me as I rest- he separates them into teams- they play football…he insists that I clap and cheer at various times. I crochet throughout the day. I nap. I clip coupons. Tommy takes kids to park and during my afternoon nap time I can't sleep but I instead watch them play football from my bedroom window. I begin to wonder out loud what the nose will look like. In the evening, we watch the NFL Manning showdown: Payton vs. Eli. There’s a split screen of the brothers and I banter that it’s a split screen of my before and after nose shots- I propose that I originally had the Payton Manning nose and I’ll end up with the Eli Manning nose. I have to put my finger on top of my upper lip to keep my lip still while I laugh so hard that I cry. We watch Mad Men which is my absolute favorite TV hour of the week. Later, I get even more closed mouth sleep than the night before.
Monday- Drew sits on the bed with me in the morning before school- he knows this is very special because the bed has been off limits for him all week. I help him get dressed in his uniform and he is very careful and sweet with me. Tommy feeds the kids pancakes from the freezer stock and gets kids off to school. I have a new rotation....crochet, irrigate, ice pack, nap in bed, and breathe through my nose. Tommy has returned to work at the office today for the first time in a week. I spend the day distracted by crochet. Tree calls me and we have a great discussion… I sweep the floor while on the phone (again, I love normalcy). I take a long afternoon Jacuzzi bath with ice packs on my face. I now highly recommend this method even if you are not recovering from facial surgery. Later, it’s soccer practice night for Drew. Blaine is working out with Jack. I help Blaine through homework- we have to erase a lot so there are tears. I’m coming off the strong pain meds and am mostly converting to Tylenol and I am grumpy with everyone. Plus the stints and cast are finally getting to me. Tommy makes quesadillas for dinner at my request- I never knew he made such a MEAN quesadilla. YUM.
Tuesday- We are up at 6 am and I am in shower. I decide not to irrigate. I tell the kids that I am going to be grumpy because I haven't had medication all night and I have to wait to take a Lortab so it won’t wear off before they remove my cast and stints. We take kids through Chick Fil A drive through for breakfast and then drop them at school; we show up for my doctor’s appointment with Duncavage one hour early- and they take us back immediately. They spray my nose with numbing spray- it’s absolutely not bubble gum flavored. Icky. The nurse removes the cast. I mention casually that irrigation saved the day on Saturday and I can tell she thinks that I am talking about simple saline spray and I decide now is not the time to dive into details. Duncavage and his entourage enter the room, remove a couple of stitches and stints which is not very painful after all- I probably could have done without the Lortab. He then drives his video camera wand through my nose and along the way he uses a vacuum to suck out mucus and the like as he goes along. We discuss the large cyst in my left maxillary and how it was causing most of my sickly, horrible feelings. Duncavage tells me that I get an ‘A’ and I thank him and banter with him that most of the recovery instructions are against the Geneva convention…he finds this very amusing.
After the cast comes off, I think my nose looks like my nose only sculpted a bit. It's like Dr. Ries turned it into play dough...briefly...and decided to tidy it up a bit. I am suppose to keep the upper lip still and not touch the nose with any pressure for awhile. I see Dr. Ries next Tuesday for more instruction.
Blaine is off school at noon today...I crochet and help him with his practice math test and then play Contract Rummy with him in the afternoon. I take an hour long afternoon nap and then cook spaghetti... with Blaine as my assistant (hamburger meat was already prepped and in freezer). I tell Drew that he can stay home with me this evening instead of going with Dad and big brother to football practice. Tommy asks if I am sure and I tell him that I am just going to let him watch movies all evening. I write these blog entries beside him as he gleefully indulges in cartoon after cartoon on NetFlix. I ask Drew for a kiss at the end of the night and afterwards he says, “Mommy, we did kip lisses!” I said, “Yes, you have been really gentle with mommy and so sweet and we can do kip lisses (lip kisses) now because you are behaving like such a big boy.” He yells into the other room “Daddy! I can do kip lisses with mommy!”
Surgery Summary
Surgery Summary according to husband, Tommy: "Her nose is jacked up and the doctors are going to fix it."
Surgery Summary, paraphrased, from Surgical Report
Dr. Duncavage performs the computer-assisted stereotactic image-guided surgery, bilateral resection inferior terbinates, bilateral concha bullosectomies, and left endoscopic antrostomy with tissue removal. It went as expected EXCEPT the infection expected in the left maxillary sinus was actually a large CYST instead. This CYST was, according to Duncavage, the reason my sickness escalated.
Next up, Dr. Wm Russell Ries performs the repair of the vestibular stenosis via open approach with septoplasty and speader grafts placed. The cartilage would be harvested from the nasal septum. My septum was deviated to the left with a large spur posteriorly on the left.
Recovery Journal
Monday- surgery day; all apparently went well; Tommy brings me home around 5pm; gives me Oxycotin as soon as possible. I am a vision of beauty with my external nose cast, internal splints and mustache dressing (think folded gauze, taped hammock-style under nose). I eat soft serve ice cream and chicken noodle soup. I am suppose to keep my upper lip still which means no talking or smiling and very little chewing and that’s okay because these things are misery. Blaine (my 9 year old) comes in, eats dinner, showers, homework… calmly and quietly… because (as he tells me days later) he saw me and “he was so sad for me.” I doze in and out all night upright in the recliner; my sweet husband Tommy sleeps in a sleeping bag on the hardwood floor beside me- true love always. He wakes for medicating me, changing the nose dressing and anytime he hears a strange noise. My throat hurts during the night and my mouth is very dry. I drink lots of water. I decide to nasal mist my nose sometime during the night although the instructions say to start this on day two.
Tuesday- Don't expect anything witty or funny in this post becuase there is absolutely nothing charming about day two. Tommy walks Blaine to school. Nurse calls to check on me. Tommy asks for definition of ‘a lot of blood’…I don’t qualify… good…I eat bites of bagel for breakfast. My right nostril is now completely crusted over with blood and my mouth is the SAHARA… I am dozing with my mouth entirely open because I cannot breathe out of my nose. Tommy is working from home; he makes me a quesadilla for lunch. The Judds are on Oprah… very entertaining… Tommy and I have lots of Judd banter from various personal experience… have to keep banter at minimum today because I am not allowed to move my upper lip to laugh… summary of day:all I do is sit in the recliner and obsess about crusted over nose and inability to sleep without waking to a sandpaper mouth. Tommy takes Blaine to football practice at 5pm; I eat a few slices of ham; I phone the doctor on call…beg him to let me irrigate my nose because of the crusting. He doesn’t give me a very confident answer; thinks I could remove some of the crusting that SHOULD be there and he doesn’t believe that I have nostril clearance for true irrigating. I mumble something through my hammock-style mustache dressing about learning the virtue ‘patience’… we discuss a little more and agree that I can irrigate VERY gently to try to address the crusting on the opening of the nostrils.
Tuesday night- absolutely miserable; still must be upright in the recliner with upper lip still, breathing out my mouth; I am using saline spray as much as possible and VERY gently irrigating with what seems no results. Only sleeping an hour at a time due to Saudi condition of mouth. I have a love-hate relationship with Percocet. There is dried blood in back of throat from drainage. Good times. I become an insomniac- dreading sleep because I wake to sand dunes in my mouth. Sleeping in upright position is also getting to me. Bruising under the eyes and some swelling now. I text sis a photo of me-with bruising and cast and mustache dressing-apparently this look hasn’t made it to the runways this season and she finds the condition quite alarming… her shocked response is a simple ‘OMG.’ I reply back that I am actually more miserable than the photo reveals. I thank her for keeping Drew (my 4 year old) for me.
Wednesday- I call doctor’s office at 9am. COMPLETELY crusted over right nostril; some air clearance now on the left but not enough to get my body to shut my mouth to sleep. In fact, the left nostril makes funny whizzing/ gurgling noises when I attempt to sleep which furthers my insomnia. Ries’s nurse tells me that I can use saline spray several times a day but no irrigating. She is SUPER but she and surgeons are obviously not fans of irrigation. I’m swelling very much now. I look like a pig and I remind myself of some character from Lord of the Rings but through the Oxycotin haze I cannot recall which one. I’m in no condition to google for a photo of my lookalike….daily summary: there’s no normal activity for me at this point. I only leave the recliner to treat nose with saline spray and visit bathroom; I don’t even have enough energy to turn on NetFlix. I am in a poorly executed rotation of pain meds, doze, drink water, treat crusting, change mustache dressing…and… later… ice packs… sometime today I get smart enough to add ice packs to the rotation. Tommy gets August and September Vogue out of the mailbox and announces, “September Vogue is above your approved weight limit.” He’s not kidding…. 720+ pages weighs well over 2lbs. I got a free subscription with a recent purchase and I have been waiting on these to arrive…. September Vogue issue confirms no mustache dressings on the runway this year. Lisa brings Drew home around noon and I am crying when she gets here- my second cry after surgery….don’t fret it’s just a general misery cry. Lisa really wants to do something for me and I tell her that she has done SO much by keeping Drew. She offers to take him back but I tell her it’s okay that he needs to be at home after three nights away and it’s really going to be okay. Did I mention that it's going to be okay?
Tommy feeds the kids and gets prepared to put Drew to bed; Drew ‘writes’ me a four page get well message which he proudly orates to me… three feet from my recliner… as if he’s officially presenting to a Queen. I give him a thumbs up from my recliner since I cannot really talk or smile or laugh. I can tell that he loved it at Aunt Lisa’s house and I am so thankful for this gift from her. Tommy puts Drew to bed and he helps Blaine do homework…then they play basketball outside. When they come in, I am dozing upright in recliner… I hear Blaine whisper “Awwww…. She looks so pitiful.”
Thursday- morning is a little crazy… I overhear Tommy bribe drew with a trip to Chick Fil A for breakfast if he’ll just get in his uniform. I moved to another recliner sometime during Wednesday night…I thought I’d go absolutely mental if I slept in recliner #1 for one more minute…. After all, isn’t upright sleeping a torture technique we aren’t allowed to use on terrorists? … I might have googled this in a normal Janey state but I haven’t touched my iPhone in days...except for the one very long email that I sent out to colleagues on Tuesday night which Tommy suggested that I preface with ‘this is a Percocet email’…. I watch three episodes of The Tudors on NetFlix in the afternoon from recliner #2. I am careful to have the TV off when the kids get here so they don’t feel like I am ignoring them. I pay them what my friend Lortab insists is scads of attention between dozing off and applying ice packs... in reality I recall that I simply said “Hi” to Blaine and ask him how his day was… I hold Drew’s hands and rub his face for a few brief moments. This is fine with the kids because they are heading out with Daddy to football practice and they can tell that I am pathetic and loopy. I remind Lortab that I recently took them to Disney for eight days all by myself and I’m not always such a loser mom. Snap, snap.
Friday- Drew wakes up complaining about his leg and Tommy sees a red, hot irritated bump. So, in addition to work and tending me and the kids, Tommy's now tasked with carting Drew off to the clinic. He calls me mid morning with a report that he has seen the doc, they have administered antibiotic, and he is in route with Drew to preschool. With the house empty, the Lortab and I decide that now is the perfect time for my first shower. Really? Really. We somehow survive this insane act of independence. I am still in my routine of rotating ice packs, pain meds, sleep, saline spray and crust removal. Still obsessing with the crust removal. I have air clearance through the left nostril- still with uber-annoying whizzing sounds- less crusting on the right side but I’m still bleeding out of the right nostril. Insomnia has stepped up it’s game and sleep is less and less attainable. I am backing off on the Oxycotin and trying to only use Lortab. I watch Harold and Maude on Netflix in the afternoon which I have never seen… it’s a good compliment to my Lortab coma…let’s be honest that I am not really sleeping anymore and I’m really just in an intermittent Lortab coma… Tommy takes the kids to football practice and the Brentwood/ Ravenwood football game on Friday night… I flip through my Vogue magazines. When the family gets home, I announce that I am officially breaking it off with recliner #2 and have decided to move to the bed for the night… I will be beyond insane if I sleep in a chair for one more night. I sleep propped up in a nest of pillows and I get significantly more sleep than the usual Lortab coma allotment… but it is not without consequence…someone apparently batter-fried my mouth while I slept… a couple of times.
Saturday morning-5 days post-surgery- I complete my first normal task since surgery- I turn on the computer and place our weekly Harris Teeter grocery order. Tommy picks up ham biscuits from Brentwood market for our breakfast since we can’t make our usual Saturday morning breakfast trip there. Tommy then takes kids to football and soccer games and picks up groceries on the way home. I return to recliner #1 for TV and flipping through Vogue. I heat up homemade Italian meatball soup from the freezer. Tommy and the kids return mid afternoon. Blaine was triple teamed the entire football game so I didn’t miss much. Yes, tripled teamed and I tell him that he should be flattered by the opposing team's strategy. We order pizza from Nashville Pizza Co for dinner. On a whim, I call the doctor’s line… in the middle of my recitation of the list of surgeries I endured on Monday, I hear these words “You can irrigate.” What? Did I overdose on Lortab? Am I hallucinating? I say, “Excuse me? What did you say?” I hear it again “You can irrigate.” I babble about how I don’t understand why Duncavage and Reis don’t tell you this from the beginning, that I think that they are brillant but maybe they are just old school and not on the irrigation band wagon but it’s really sad because I am absolutely going crazy with this mouth breathing thing and I am near suicidal. He assures me that there’s “absolutely nothing that I am going to hurt by irrigating.” I will kiss this man on the mouth if I see him in the hallway at my next appointment. I irrigate. Which is not pretty but effective. I can suddenly breathe through BOTH nostrils. Tommy gets home with the pizza and I sit and eat with the family for the first time this week. In celebration, I have three slices of cheese pizza. About halfway through the meal, I issue a no talking warning… our normal family banter is making me laugh too much and I still must keep the upper lip still. Did I mention that I can now breathe out of both nostrils? I am so happy that I want to cry. I get out my crochet basket and Blaine, Tommy and I watch the Perfect Storm. I retire to my bed and although insomnia interferes at will, I sleep with my mouth closed for the first time in what seems a century. I log about 6 hours of random sleep.
Sunday- I MADE THE GRAVY. Getting up was hard, but much easier than days ago. We usually make a big breakfast on Sunday mornings and Tommy did most of the heavy lifting this morning but I MADE THE GRAVY. Let me give props to my Tommy here for a terrific breakfast- we had our usual Sunday morning sausage, biscuit, fried chicken with gravy, and omelets with peppers and onion. (Sidebar: we regularly keep a lot of the ingredients prepped in the freezer for these meals). I heart normalcy. I irrigate before we eat... amazing process. I eat at the family table and Drew tells me that I am soooo cute (I am holding ice packs on my face while I eat breakfast- and don't forget to paint the bruises and the nose cast into the picture). He is comic genius. Throughout the day, I begin to alternate Lortab and Tylenol. Drew plays matchbox cars in the room beside me as I rest- he separates them into teams- they play football…he insists that I clap and cheer at various times. I crochet throughout the day. I nap. I clip coupons. Tommy takes kids to park and during my afternoon nap time I can't sleep but I instead watch them play football from my bedroom window. I begin to wonder out loud what the nose will look like. In the evening, we watch the NFL Manning showdown: Payton vs. Eli. There’s a split screen of the brothers and I banter that it’s a split screen of my before and after nose shots- I propose that I originally had the Payton Manning nose and I’ll end up with the Eli Manning nose. I have to put my finger on top of my upper lip to keep my lip still while I laugh so hard that I cry. We watch Mad Men which is my absolute favorite TV hour of the week. Later, I get even more closed mouth sleep than the night before.
Monday- Drew sits on the bed with me in the morning before school- he knows this is very special because the bed has been off limits for him all week. I help him get dressed in his uniform and he is very careful and sweet with me. Tommy feeds the kids pancakes from the freezer stock and gets kids off to school. I have a new rotation....crochet, irrigate, ice pack, nap in bed, and breathe through my nose. Tommy has returned to work at the office today for the first time in a week. I spend the day distracted by crochet. Tree calls me and we have a great discussion… I sweep the floor while on the phone (again, I love normalcy). I take a long afternoon Jacuzzi bath with ice packs on my face. I now highly recommend this method even if you are not recovering from facial surgery. Later, it’s soccer practice night for Drew. Blaine is working out with Jack. I help Blaine through homework- we have to erase a lot so there are tears. I’m coming off the strong pain meds and am mostly converting to Tylenol and I am grumpy with everyone. Plus the stints and cast are finally getting to me. Tommy makes quesadillas for dinner at my request- I never knew he made such a MEAN quesadilla. YUM.
Tuesday- We are up at 6 am and I am in shower. I decide not to irrigate. I tell the kids that I am going to be grumpy because I haven't had medication all night and I have to wait to take a Lortab so it won’t wear off before they remove my cast and stints. We take kids through Chick Fil A drive through for breakfast and then drop them at school; we show up for my doctor’s appointment with Duncavage one hour early- and they take us back immediately. They spray my nose with numbing spray- it’s absolutely not bubble gum flavored. Icky. The nurse removes the cast. I mention casually that irrigation saved the day on Saturday and I can tell she thinks that I am talking about simple saline spray and I decide now is not the time to dive into details. Duncavage and his entourage enter the room, remove a couple of stitches and stints which is not very painful after all- I probably could have done without the Lortab. He then drives his video camera wand through my nose and along the way he uses a vacuum to suck out mucus and the like as he goes along. We discuss the large cyst in my left maxillary and how it was causing most of my sickly, horrible feelings. Duncavage tells me that I get an ‘A’ and I thank him and banter with him that most of the recovery instructions are against the Geneva convention…he finds this very amusing.
After the cast comes off, I think my nose looks like my nose only sculpted a bit. It's like Dr. Ries turned it into play dough...briefly...and decided to tidy it up a bit. I am suppose to keep the upper lip still and not touch the nose with any pressure for awhile. I see Dr. Ries next Tuesday for more instruction.
Blaine is off school at noon today...I crochet and help him with his practice math test and then play Contract Rummy with him in the afternoon. I take an hour long afternoon nap and then cook spaghetti... with Blaine as my assistant (hamburger meat was already prepped and in freezer). I tell Drew that he can stay home with me this evening instead of going with Dad and big brother to football practice. Tommy asks if I am sure and I tell him that I am just going to let him watch movies all evening. I write these blog entries beside him as he gleefully indulges in cartoon after cartoon on NetFlix. I ask Drew for a kiss at the end of the night and afterwards he says, “Mommy, we did kip lisses!” I said, “Yes, you have been really gentle with mommy and so sweet and we can do kip lisses (lip kisses) now because you are behaving like such a big boy.” He yells into the other room “Daddy! I can do kip lisses with mommy!”
My Nasal Condition and the Road to Treatment
My Condition and the Road to Treatment
Monday, September 13, 2010
Monday morning- surgery day. Four year old Drew is overnighting at Aunt Lisa’s for a few days. He’s known for awhile that September is the “mumph” that mommy will have nose surgery. “We’ll have to be gentle with her and she won’t be able to talk very much at first… no ‘kip lisses’…, but she’ll feel better in October.” According to daddy, upon arriving in Belvidere yesterday, he bounded out of the car- eager to get his first big boy spend the night adventure underway. Early reports tell us that he’s riding the gator, he’s visiting cows and pigs, playing in the dirt with his cousins and he’s loving farm adventures.
We dropped Blaine off at school at 8am and immediately Tommy and I are headed to Vanderbilt. Surgery is traumatic enough in itself, but I joke that a trip downtown without makeup or hair product can be equally traumatic.
Wondering why I am here? I don’t really have a choice. According to the CT scan, there is an infection that won’t drain and negative pressure in my left maxillary sinus cavity. This will eventually cause the sinus cavity under my left eye to collapse. If it collapses, my eye socket will follow. I intend to grow old gracefully, but let’s draw the line at facial deformity. In addition, I’m having migrane type headaches, can barely breathe out of my nose, and I am exhausted.
I have never really been able to breathe and I never really cared to notice. Until lately, I have found ways to function around the issue and perform at a relatively high level. Example: in 2007, I had a newborn baby and a kindergartener, took my growing consulting business independent, and served as Board Chairman of one of the largest Habitat for Humanity affiliates in the world (during a period of record growth). It was both exhilarating and exhausting. I roared through 2008 & 2009 with equal gusto and somewhere along the way I got really tired…. really, really tired. I thought that it was my body telling me to slow down and take it easy, so I did… I cut out every extra activity possible on my busy agenda… amped up my workouts… but I was still exhausted. And I suddenly noticed that I was working and playing and managing the family through daily headaches and nasal conjestion and a general, miserable fog.
In May 2010, I was ending a very large, high profile project and decided to take a month off. I took three amazing young boys to Disney World for eight days as my last spur-of –the-moment hurrah and then visited Vanderbilt’s ASAP program to get an allergy/sinus assessment on May 21. This is officially the first time I have ever attempted to get treated for sinus issues… I always just assumed that I was ‘allergic to everything’ and my condition only recently became unbearable. Within 3 hours of my visit, I had allergy test results (only allergic to mold, mildly) and was looking at a CT scan of my sinuses. We can see what appears to be a sinus infection in the left maxillary sinus, and as legend now has it, the largest concha bullosa that they have ever seen- greatly inhibiting my breathing and likely contributing to the headaches. The ASAP docs give me some nasal sprays, an irrigation bottle with instructions to irrigate twice daily, steroids, and antibiotic. I am told to come back in a month for follow up. It is likely my anatomy causing the issues, but we should give meds a shot to solve the problem before we sign up for a complicated surgery. If things aren’t better in a month, I’ll need to see an ENT.
One week later, I call Tina, my PA at Vanderbilt ASAP, and tell her that I am absolutely miserable and my headaches have become unbearable. She and I both agree it’s likely an anatomy issue and it’s time to go ahead and schedule the ENT visit. She refers me to Dr. Duncavage who can’t see me until June 30.
I go ahead with my ASAP one month follow up appointment on June 25. The follow up CT scan reveals that the left maxillary sinus is WORSE even after steroids and antibiotic. There is now negative pressure in the cavity. Tina and I agree that we did the right thing by scheduling the ENT appointment. She pats me on the leg and says, “You know that I look at a lot of noses… and… your poor nose…” I agree to keep her posted.
I see Dr. James Duncavage a few days later. Duncavage is a nasal sinus disease specialist, a Vanderbilt professor, and considered one of the best. Here’s an article on Duncavage http://www.mc.vanderbilt.edu/reporter/index.html?ID=1220. The first thing that he said to me when I saw him in June: “Most people in your condition are only able to sleep sitting up in a recliner.” He says that I have no room to breathe, there’s no way that I am sleeping, and the headaches are likely migranes from lack of sleep. He writes ‘silent sinus syndrome’ on a business card and tells me to google it. He explains the likelihood that the maxillary sinus cavity (the one under the left eye) will eventually collapse, and that surgery is the only option. He and a room full of students send a camera wand up my nose, marveling at the size of the concha bullosa, etc.
Duncavage tells me that I likely have nasal valve collapse as well and wants to refer me to Dr. Ries. I hear the words ‘plastic surgeon’ and I cringe. He emails Ries’s nurse immediately…asks her to call me to schedule an appointment. Duncavage insists that if Ries needs to treat the nasal valve collapse, he’ll also do the septoplasty.
I leave Duncavage’s office with a sheet of paper that has checkmarks beside the following diagnosises: deviated septum; hypertrophic turbinates; chronic maxillary sinusitis; concha bullosa; nasal congestion; vestibular stenosis. The following operative procedures are also marked: nasal septoplasty; computer assisted, stereotactic image guided surgery; submucous resection inferior terbinates- right and left, concha bullosectomy- right and left, endoscopic maxillary antrostomy; possible nasal vestibular stenosis (referred to Dr. Ries). I note that about half of the list of available operative procedures are selected for me. This seems like a lot.
I left with a folder full of paperwork- what to expect after surgery for all five procedures. I was overwhelmed, but I already knew three things from this first meeting with Duncavage: 1. Our next meeting would be pre-op; 2. I had no choice; 3. I was in the care of the right person.
I saw Dr. William Russell Ries a few days later in his Vanderbilt office. Here’s a write up on Dr. Ries http://www.mc.vanderbilt.edu/reporter/index.html?ID=2035 As it turns out, Ries will perform the septoplasty for my deviated septum and nasal vestibular stenosis. You can google these terms to find out more, but I’ll oversimplify nasal valve collapse/ nasal vestibular stenosis for you: I need permanent breathe right strips installed inside my nose to make it work. This will alter the appearance somewhat, but it should still be my nose. I’m obviously nervous about this idea. I understand that he will have to cut my nose externally to do the procedure and I’ll have recovery much like that from plastic surgery. This is a hugely invasive process. He examines my nose and then pulls up the CT scans. “You really don’t have any room to breathe… and that’s the ‘good’ side… yes, this is a very large concha bullosa… it’s curved around like you have an elf’s shoe shoved up your nose.” I leave his office with a couple pages entitled ‘What to Expect After Septoplasty/ Repair of nasal vestibular stenosis’ and ‘Home Care Instructions for Facial Plastic and/ or Reconstructive Surgery.’ I stop by the surgery scheduler’s office on the way out on the off chance that I can secure a surgery date- I am very nervous about all this but I am also miserable. September 13 will be my surgery day.
I realize that I need to take some drastic measures if I am to continue to work and function anywhere near normal until September 13. I collect all of the information on my condition and decide that the best that I can do is try to keep the tissue in my nose from swelling as much as possible and get plenty of rest. For the remainder of the summer, I avoid all outdoor activities and almost anything that will make me hot. This is drastically different than my normal routine, but the entire family realizes it is temporary and we make it work.
Pre-Op, Surgery Day
Duncavage tells Tommy that his wife has never been able to breathe, and gets caught up in reviewing the CT scan with him to show him where the problems are and what is to be done. I can tell that Tommy is graciously nodding through a dictation of medical terms, and that’s okay because I have done the research and I follow most of what Duncavage says. He tells us that a few folks will be observing today and his ‘five year’, Dr. Chris Mantle, will be assisting. I tell Duncavage in prep-op that I have also googled him; I ask him if he knows that he’s “world renowned.” He smiles.
Ries comes in and begins almost immediately evaluating my nose- he’s poking around it and I can tell that he is beginning to sculpt it. To repair the nasal valve collapse, the lower portion of my nose must be widened. He says something about angling up the tip of the nose. I tell him to go ahead and shave off as much of the hump as he can since he has to shave it for the septoplasty anyway. I begin to babble, and he seems slightly annoyed that I am still not sure what my nose will look like after this. “Didn’t we go over it? You want YOUR nose, but a variation that works, right?” I agree and that’s the end of it. He continues again to poke around, talks through some of the sculpting verbally to Dr. Mantle, and examines the nose. I decide to trust him and his skills.
He reminds us that Tommy must do everything for me for the first few weeks, that I am not to lift anything over 2 lbs, keep my upper lip still, stay away from anything that could injure my nose (rambunctious 4 year old), etc.
Dr. Mantle comes in and talks to us about post surgery care. He mentions a cast on the nose. “Are you the five year?” I ask. He nods affirmatively. “This is the first that I have heard about a cast on the exterior. I’ve heard about stints on the interior.” He informs me that I will have both. Wow. This is more invasive than I thought.
The Operating Room
I have the surgical report, I have read it thoroughly and googled terms like Killian submucous resection and Metzenbaum swinging door procedure. I’ll be happy to share if you are interested. Here’s an overview of my procedures:
Duncavage performs the computer-assisted stereotactic image-guided surgery, bilateral resection inferior terbinates, bilateral concha bullosectomies, and left endoscopic antrostomy with tissue removal. It went as expected EXCEPT the infection expected in the left maxillary sinus was actually a large CYST instead. This CYST was according to Duncavage the reason my sickness escalated.
Next up, Dr. Ries performs the repair of the vestibular stenosis via open approach with septoplasty and speader grafts placed. The cartilage would be harvested from the nasal septum. My septum was deviated to the left with a large spur posteriorly on the left.
Recovery Room
“I... bruise... easily.” These are the first words that I recall speaking as they wheel me out of surgery. I can’t make out all of her words, but the nurse seems slightly alarmed about my appearance; a male voice says something about this being a regular occurrence in young, female patients. I assume it’s bruising, but I find out later that it’s a strange bump on the top left forehead- something to do with the anesthesia.
“Socks... off.” This is my next recovery room sentence.
Monday, September 13, 2010
Monday morning- surgery day. Four year old Drew is overnighting at Aunt Lisa’s for a few days. He’s known for awhile that September is the “mumph” that mommy will have nose surgery. “We’ll have to be gentle with her and she won’t be able to talk very much at first… no ‘kip lisses’…, but she’ll feel better in October.” According to daddy, upon arriving in Belvidere yesterday, he bounded out of the car- eager to get his first big boy spend the night adventure underway. Early reports tell us that he’s riding the gator, he’s visiting cows and pigs, playing in the dirt with his cousins and he’s loving farm adventures.
We dropped Blaine off at school at 8am and immediately Tommy and I are headed to Vanderbilt. Surgery is traumatic enough in itself, but I joke that a trip downtown without makeup or hair product can be equally traumatic.
Wondering why I am here? I don’t really have a choice. According to the CT scan, there is an infection that won’t drain and negative pressure in my left maxillary sinus cavity. This will eventually cause the sinus cavity under my left eye to collapse. If it collapses, my eye socket will follow. I intend to grow old gracefully, but let’s draw the line at facial deformity. In addition, I’m having migrane type headaches, can barely breathe out of my nose, and I am exhausted.
I have never really been able to breathe and I never really cared to notice. Until lately, I have found ways to function around the issue and perform at a relatively high level. Example: in 2007, I had a newborn baby and a kindergartener, took my growing consulting business independent, and served as Board Chairman of one of the largest Habitat for Humanity affiliates in the world (during a period of record growth). It was both exhilarating and exhausting. I roared through 2008 & 2009 with equal gusto and somewhere along the way I got really tired…. really, really tired. I thought that it was my body telling me to slow down and take it easy, so I did… I cut out every extra activity possible on my busy agenda… amped up my workouts… but I was still exhausted. And I suddenly noticed that I was working and playing and managing the family through daily headaches and nasal conjestion and a general, miserable fog.
In May 2010, I was ending a very large, high profile project and decided to take a month off. I took three amazing young boys to Disney World for eight days as my last spur-of –the-moment hurrah and then visited Vanderbilt’s ASAP program to get an allergy/sinus assessment on May 21. This is officially the first time I have ever attempted to get treated for sinus issues… I always just assumed that I was ‘allergic to everything’ and my condition only recently became unbearable. Within 3 hours of my visit, I had allergy test results (only allergic to mold, mildly) and was looking at a CT scan of my sinuses. We can see what appears to be a sinus infection in the left maxillary sinus, and as legend now has it, the largest concha bullosa that they have ever seen- greatly inhibiting my breathing and likely contributing to the headaches. The ASAP docs give me some nasal sprays, an irrigation bottle with instructions to irrigate twice daily, steroids, and antibiotic. I am told to come back in a month for follow up. It is likely my anatomy causing the issues, but we should give meds a shot to solve the problem before we sign up for a complicated surgery. If things aren’t better in a month, I’ll need to see an ENT.
One week later, I call Tina, my PA at Vanderbilt ASAP, and tell her that I am absolutely miserable and my headaches have become unbearable. She and I both agree it’s likely an anatomy issue and it’s time to go ahead and schedule the ENT visit. She refers me to Dr. Duncavage who can’t see me until June 30.
I go ahead with my ASAP one month follow up appointment on June 25. The follow up CT scan reveals that the left maxillary sinus is WORSE even after steroids and antibiotic. There is now negative pressure in the cavity. Tina and I agree that we did the right thing by scheduling the ENT appointment. She pats me on the leg and says, “You know that I look at a lot of noses… and… your poor nose…” I agree to keep her posted.
I see Dr. James Duncavage a few days later. Duncavage is a nasal sinus disease specialist, a Vanderbilt professor, and considered one of the best. Here’s an article on Duncavage http://www.mc.vanderbilt.edu/reporter/index.html?ID=1220. The first thing that he said to me when I saw him in June: “Most people in your condition are only able to sleep sitting up in a recliner.” He says that I have no room to breathe, there’s no way that I am sleeping, and the headaches are likely migranes from lack of sleep. He writes ‘silent sinus syndrome’ on a business card and tells me to google it. He explains the likelihood that the maxillary sinus cavity (the one under the left eye) will eventually collapse, and that surgery is the only option. He and a room full of students send a camera wand up my nose, marveling at the size of the concha bullosa, etc.
Duncavage tells me that I likely have nasal valve collapse as well and wants to refer me to Dr. Ries. I hear the words ‘plastic surgeon’ and I cringe. He emails Ries’s nurse immediately…asks her to call me to schedule an appointment. Duncavage insists that if Ries needs to treat the nasal valve collapse, he’ll also do the septoplasty.
I leave Duncavage’s office with a sheet of paper that has checkmarks beside the following diagnosises: deviated septum; hypertrophic turbinates; chronic maxillary sinusitis; concha bullosa; nasal congestion; vestibular stenosis. The following operative procedures are also marked: nasal septoplasty; computer assisted, stereotactic image guided surgery; submucous resection inferior terbinates- right and left, concha bullosectomy- right and left, endoscopic maxillary antrostomy; possible nasal vestibular stenosis (referred to Dr. Ries). I note that about half of the list of available operative procedures are selected for me. This seems like a lot.
I left with a folder full of paperwork- what to expect after surgery for all five procedures. I was overwhelmed, but I already knew three things from this first meeting with Duncavage: 1. Our next meeting would be pre-op; 2. I had no choice; 3. I was in the care of the right person.
I saw Dr. William Russell Ries a few days later in his Vanderbilt office. Here’s a write up on Dr. Ries http://www.mc.vanderbilt.edu/reporter/index.html?ID=2035 As it turns out, Ries will perform the septoplasty for my deviated septum and nasal vestibular stenosis. You can google these terms to find out more, but I’ll oversimplify nasal valve collapse/ nasal vestibular stenosis for you: I need permanent breathe right strips installed inside my nose to make it work. This will alter the appearance somewhat, but it should still be my nose. I’m obviously nervous about this idea. I understand that he will have to cut my nose externally to do the procedure and I’ll have recovery much like that from plastic surgery. This is a hugely invasive process. He examines my nose and then pulls up the CT scans. “You really don’t have any room to breathe… and that’s the ‘good’ side… yes, this is a very large concha bullosa… it’s curved around like you have an elf’s shoe shoved up your nose.” I leave his office with a couple pages entitled ‘What to Expect After Septoplasty/ Repair of nasal vestibular stenosis’ and ‘Home Care Instructions for Facial Plastic and/ or Reconstructive Surgery.’ I stop by the surgery scheduler’s office on the way out on the off chance that I can secure a surgery date- I am very nervous about all this but I am also miserable. September 13 will be my surgery day.
I realize that I need to take some drastic measures if I am to continue to work and function anywhere near normal until September 13. I collect all of the information on my condition and decide that the best that I can do is try to keep the tissue in my nose from swelling as much as possible and get plenty of rest. For the remainder of the summer, I avoid all outdoor activities and almost anything that will make me hot. This is drastically different than my normal routine, but the entire family realizes it is temporary and we make it work.
Pre-Op, Surgery Day
Duncavage tells Tommy that his wife has never been able to breathe, and gets caught up in reviewing the CT scan with him to show him where the problems are and what is to be done. I can tell that Tommy is graciously nodding through a dictation of medical terms, and that’s okay because I have done the research and I follow most of what Duncavage says. He tells us that a few folks will be observing today and his ‘five year’, Dr. Chris Mantle, will be assisting. I tell Duncavage in prep-op that I have also googled him; I ask him if he knows that he’s “world renowned.” He smiles.
Ries comes in and begins almost immediately evaluating my nose- he’s poking around it and I can tell that he is beginning to sculpt it. To repair the nasal valve collapse, the lower portion of my nose must be widened. He says something about angling up the tip of the nose. I tell him to go ahead and shave off as much of the hump as he can since he has to shave it for the septoplasty anyway. I begin to babble, and he seems slightly annoyed that I am still not sure what my nose will look like after this. “Didn’t we go over it? You want YOUR nose, but a variation that works, right?” I agree and that’s the end of it. He continues again to poke around, talks through some of the sculpting verbally to Dr. Mantle, and examines the nose. I decide to trust him and his skills.
He reminds us that Tommy must do everything for me for the first few weeks, that I am not to lift anything over 2 lbs, keep my upper lip still, stay away from anything that could injure my nose (rambunctious 4 year old), etc.
Dr. Mantle comes in and talks to us about post surgery care. He mentions a cast on the nose. “Are you the five year?” I ask. He nods affirmatively. “This is the first that I have heard about a cast on the exterior. I’ve heard about stints on the interior.” He informs me that I will have both. Wow. This is more invasive than I thought.
The Operating Room
I have the surgical report, I have read it thoroughly and googled terms like Killian submucous resection and Metzenbaum swinging door procedure. I’ll be happy to share if you are interested. Here’s an overview of my procedures:
Duncavage performs the computer-assisted stereotactic image-guided surgery, bilateral resection inferior terbinates, bilateral concha bullosectomies, and left endoscopic antrostomy with tissue removal. It went as expected EXCEPT the infection expected in the left maxillary sinus was actually a large CYST instead. This CYST was according to Duncavage the reason my sickness escalated.
Next up, Dr. Ries performs the repair of the vestibular stenosis via open approach with septoplasty and speader grafts placed. The cartilage would be harvested from the nasal septum. My septum was deviated to the left with a large spur posteriorly on the left.
Recovery Room
“I... bruise... easily.” These are the first words that I recall speaking as they wheel me out of surgery. I can’t make out all of her words, but the nurse seems slightly alarmed about my appearance; a male voice says something about this being a regular occurrence in young, female patients. I assume it’s bruising, but I find out later that it’s a strange bump on the top left forehead- something to do with the anesthesia.
“Socks... off.” This is my next recovery room sentence.
Saturday, June 12, 2010
Disney Photo Book 2010
In early May, I booked a spontaneous Disney trip with three of my favorite boys. Tommy could not be away from work at this time, but we got such an amazing deal that it was too good for me to pass up! Our photo book just arrived today, and here it is in digital format...We won't have a video this time because I forgot the video camera (we were rushing out a day early because of the floods).
Tuesday, March 16, 2010
Thursday, February 11, 2010
Winter Warmbrod Adventures
I'm still buried with work.... very stressed that Go Live Day for a very large project is in one week and the production server is slower than Christmas.... so pardon me as I ramble on crazily....about our Christmas Trip to the Keys and other adventures... I'm too tired to edit.
February Adventure
the first time on a snow ramp for at least two of us Warmbrods
This was a great day filled with friends and fun. I threw together a feast for four families in between outings and the whole day was good times, laughter, and good people. It was the first day since our Christmas vacation that I did not work at all.
December Adventure- This is the oceanside picnic after our kayak adventure in the Keys. If you look closely- waaaaaayyyyy out to sea- you see a very small island where we had just kayaked to and fro. There are full grown trees on that island- this should give you a sense of how far a Warmbrod is willing to sea kayak.
Didn't think that you could afford a private island in the keys? Consider renting this little jewel from Banana Bay Resort on Key Marathon. Warmbrods kayaked all the way around it- twice (after our jaunt to the little island mentioned above), and we're considering it for a return trip.
This is my favorite of holiday spirit in the Keys- Santa's rope beard! We were charmed by the tackiest of Florida Christmas decorations. Christmas lights on palm trees and boats- hard to photograph but very fun to see!.
More from our Key West Trip on the side bar....but I warn you, we're not great with a camera...
February Adventure
the first time on a snow ramp for at least two of us Warmbrods
This was a great day filled with friends and fun. I threw together a feast for four families in between outings and the whole day was good times, laughter, and good people. It was the first day since our Christmas vacation that I did not work at all.
December Adventure- This is the oceanside picnic after our kayak adventure in the Keys. If you look closely- waaaaaayyyyy out to sea- you see a very small island where we had just kayaked to and fro. There are full grown trees on that island- this should give you a sense of how far a Warmbrod is willing to sea kayak. 
Didn't think that you could afford a private island in the keys? Consider renting this little jewel from Banana Bay Resort on Key Marathon. Warmbrods kayaked all the way around it- twice (after our jaunt to the little island mentioned above), and we're considering it for a return trip. 
This is my favorite of holiday spirit in the Keys- Santa's rope beard! We were charmed by the tackiest of Florida Christmas decorations. Christmas lights on palm trees and boats- hard to photograph but very fun to see!. More from our Key West Trip on the side bar....but I warn you, we're not great with a camera...
Wednesday, January 27, 2010
Potpourri
My every breath is consumed with giving a very large project wings, but I took a little time out this evening to update the look of my neglected blog....
During December, it was either launder clothing/ pack for vacation or send Christmas cards. You know which one I picked. So here are some shots that I call 'The Lost Christmas Card Photos'
Since the new blog theme is LOVE, I should post my favorite video on the subject...
I love how it's an entire video of just the two of us focused on celebrating all the happiness to come....
In other news...
What less than desirable traits did Pappy pass down to Blaine?
Extra, extra wide feet and ...
a desire to snap the occasional tasteless photo... this one starring mom and dad. He received a mild scolding, but deep down...I know that... one day... I'll look back and think it was a rather flattering angle:)
And here are some lists from last Decade that we meant to share earlier...drum roll, please...
Warmbrod's Not- So- Ordinary List of the Decade's Top Movies (or at least ones that we can remember):
Talking Letter Factory- the must-have, preschool, educational movie of the decade. Both our boys learned ALL their letter sounds by watching this. Drew's preschool is now addicted, too- I recently ordered them a copy.
Band of Brothers (Janey)- I literally watch this HBO series over and over
Blair Witch Project (Tommy and Janey)- I'm still weirded out when I go into a home with 'southern charm' and I find one of those little hide and seek dolls in the corner.
Dodge Ball (Tommy)
Brother Bear Drew's favorite. It's a brother thing.
Walk the Line (Janey)
Ice Age and the Harry Potter Movies (Blaine)
Love in the Time of Cholera (Aunt Lisa)- not really... an inside joke here between sis and I...she'll get a huge laugh here.
Revolutionary Road- voted most disturbing movie of the decade by Tommy and Janey. Especially Tommy.
Action Hero- Blaine and cousin Joe...a movie made by a local teen a few years ago and the kids WAIL when they watch it. It scored extra points when Blaine realized that 'Narcolectic Sidekick' actor was a bag boy at our local Publix.
Warmbrod Extra- Unordinary Song List of the Decade
Disclaimer: In all fairness to my metal loving hubbie, this is Janey's mostly girly version of our random songs...young Warmbrod boys spend music appreciate time with the likes of Metallica, Beastie Boys, and Nirvana- none of which are from this decade.
Lady Marmalade and I Hope You Dance- these were popular songs when Blaine was born in 2001.
Boom Da Boom- Goldo- Our Disney Vacation 2008 Theme Song
Relating to a Psychopath- Macy Gray- and others from her The Id album. Janey hearts Macy Gray.
Big Baby J- Jazzy the Giant- great song about the big bro/ little bro dynamic
Lady - Lenny Kravitz
The Only Promise that Remains- J. Timberlake and Reba; Reba has been a great supporter of Habitat locally and this is a great collaboration; JT wrote this with her vocals in mind
Candy Coated Valentine- Robinella- because it's almost Valentine's day; any Robinella track is a delight.
Song for a Winter's Night- Sarah McLachlan
Starfish and Coffee- Matthew Nathanson version
Folsom Daycare Blues- because I spent most of the decade driving someone to 'baby school'
Who's Your Daddy- a Blaine and Cousin Joe favorite in the early 2000s
Jackson- Reese Witherspoon and Joaquin Phoenix version
And in the spirit of full disclosure....
Lookin Boy- Hotstylz- a Tommy/ Blaine favorite
Hit the Floor- Twista and Pitbull- if you've never done Zumba to a Pitbull number, then you've never really done Zumba.
Single Ladies- Beyonce- Drew likes to sing about single ladies
Courtesy of the Red, White and Blue- Toby Keith
Girlfriend- Avril- a Tommy favorite, believe it or not.
During December, it was either launder clothing/ pack for vacation or send Christmas cards. You know which one I picked. So here are some shots that I call 'The Lost Christmas Card Photos'
Since the new blog theme is LOVE, I should post my favorite video on the subject...
I love how it's an entire video of just the two of us focused on celebrating all the happiness to come....
In other news...
What less than desirable traits did Pappy pass down to Blaine?
Extra, extra wide feet and ...
a desire to snap the occasional tasteless photo... this one starring mom and dad. He received a mild scolding, but deep down...I know that... one day... I'll look back and think it was a rather flattering angle:)And here are some lists from last Decade that we meant to share earlier...drum roll, please...
Warmbrod's Not- So- Ordinary List of the Decade's Top Movies (or at least ones that we can remember):
Talking Letter Factory- the must-have, preschool, educational movie of the decade. Both our boys learned ALL their letter sounds by watching this. Drew's preschool is now addicted, too- I recently ordered them a copy.
Band of Brothers (Janey)- I literally watch this HBO series over and over
Blair Witch Project (Tommy and Janey)- I'm still weirded out when I go into a home with 'southern charm' and I find one of those little hide and seek dolls in the corner.
Dodge Ball (Tommy)
Brother Bear Drew's favorite. It's a brother thing.
Walk the Line (Janey)
Ice Age and the Harry Potter Movies (Blaine)
Love in the Time of Cholera (Aunt Lisa)- not really... an inside joke here between sis and I...she'll get a huge laugh here.
Revolutionary Road- voted most disturbing movie of the decade by Tommy and Janey. Especially Tommy.
Action Hero- Blaine and cousin Joe...a movie made by a local teen a few years ago and the kids WAIL when they watch it. It scored extra points when Blaine realized that 'Narcolectic Sidekick' actor was a bag boy at our local Publix.
Warmbrod Extra- Unordinary Song List of the Decade
Disclaimer: In all fairness to my metal loving hubbie, this is Janey's mostly girly version of our random songs...young Warmbrod boys spend music appreciate time with the likes of Metallica, Beastie Boys, and Nirvana- none of which are from this decade.
Lady Marmalade and I Hope You Dance- these were popular songs when Blaine was born in 2001.
Boom Da Boom- Goldo- Our Disney Vacation 2008 Theme Song
Relating to a Psychopath- Macy Gray- and others from her The Id album. Janey hearts Macy Gray.
Big Baby J- Jazzy the Giant- great song about the big bro/ little bro dynamic
Lady - Lenny Kravitz
The Only Promise that Remains- J. Timberlake and Reba; Reba has been a great supporter of Habitat locally and this is a great collaboration; JT wrote this with her vocals in mind
Candy Coated Valentine- Robinella- because it's almost Valentine's day; any Robinella track is a delight.
Song for a Winter's Night- Sarah McLachlan
Starfish and Coffee- Matthew Nathanson version
Folsom Daycare Blues- because I spent most of the decade driving someone to 'baby school'
Who's Your Daddy- a Blaine and Cousin Joe favorite in the early 2000s
Jackson- Reese Witherspoon and Joaquin Phoenix version
And in the spirit of full disclosure....
Lookin Boy- Hotstylz- a Tommy/ Blaine favorite
Hit the Floor- Twista and Pitbull- if you've never done Zumba to a Pitbull number, then you've never really done Zumba.
Single Ladies- Beyonce- Drew likes to sing about single ladies
Courtesy of the Red, White and Blue- Toby Keith
Girlfriend- Avril- a Tommy favorite, believe it or not.
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