RA patients are commonly immunocompromised due to the drugs they take. Since RA is an autoimmune disease where the body’s immune system attacks itself, the drugs are often designed to slow down some part of the immune process. Read any of the side effect materials of biological or chemical treatments for RA and one of the first on the lists will be upper respiratory infections. That includes sinus infections which are ripe for problems given their moist, warm environment. Add any anatomical problems preventing drainage and infections are going to crop up. As previously documented in this blog, I’ve battled sinus infections pretty much ever since starting on RA treatments. That led to multiple treatments including antibiotics, decongestants, antihistamines, steroids (sprays and oral), and sinus irrigations which all failed to take care of the infections. That led to endoscopic sinus surgery on Tuesday. The surgery had four goals – correct a deviated septum, clean out the ethmoid sinuses, clean out the maxillary sinuses, and reduce the turbinates which are radiator-like flaps in the nose. There are no external cuts as the surgeon uses the scope and a camera to conduct the procedure.
After having three surgeries on my ankles for RA related issues, I had a pretty good idea about the process in general including anesthesia. But operating on the head near the eyes and brain was a new experience. My ear, nose, and throat (ENT) doctor is very experienced doing this kind of surgery so I had full trust in her capabilities. I reported at the outpatient surgery center in the morning and they immediately started me on large doses of Afrin spray which would reduce the bleeding during surgery since the nose and sinuses have some of the most blood vessels of anywhere in the body. You just have to love the wonderful clothing they make you wear which included a gown open in the back, footies, and a cap to cover my head. The anesthesiologist met with me and I told him about previous nausea from general anesthesia and he let me know he would give me everything he could to help manage that. I was led into the operating room which was very cold. I climbed onto the table and the anesthesiologist started an IV. They strapped me down to the table and after a few comments, I went to sleep pretty fast.
The next thing I remember was slowly waking up in a recovery room with an ice pack on my face. I could not breathe out of my nose as they had it packed to prevent bleeding. The nurse gave me some jello, cookies, and a drink. She also injected some fentanyl in my IV for pain. As soon as I could get up, I got dressed and my wife came back to be with me. By noon, I checked out and went home stopping at the pharmacy to pick up some Vicodin for pain and another round of antibiotics.
The first 24 hours were not pleasant. I could not breathe, had nausea from all the drugs and blood draining down my throat, and could not sleep. Add to that a terrible headache which I found out from the surgeon was common right after sinus surgery. I couldn’t wait until the next morning when I went to the doctor’s office to have the nasal packing removed. The gory details will be spared but all I can say is what a relief! I immediately felt much better. The bleeding and inflammation causes lots of pressure and pain that feel like a sinus infection but regular irrigation with saline solution has started to clear that out. I also added some oral prednisone that I use for RA flares. After 48 hours I can breathe through both sides of my nose for the first time in months!
During this time, RA symptoms have been pretty much under check. The copious amounts of pain meds and the prednisone probably help. Add to that the fact that physical activity has been curtailed and joints aren’t being used. Rest is ordered for the next couple of weeks.
My rheumatologist has great hopes for my long term ability to fight off sinus infections after having the surgery. She said that about 10% of her RA patients on biological medicines have recurring sinus infections and that sinus surgery provides relief for most of them. Stopping RA treatment is not a recommended option as the chances for long term damage is too great.
At least I have a great family and set of friends who are helping to care for me. And that includes one of my cats Bella who joined me on the couch this morning!