3 weeks post-op

It's been 3 weeks now.  I'm so pleased with how my recovery has gone.  My bruising has faded to the point that I'm not embarrassed to go out in public again, just little marks left around my cheekbones.  I feel good; there is little if any tenderness anymore, especially around my nose which seems to be where I felt it the most if I accidentally bumped it.  My vision is still not where it needs to be, but I'm able to see, just with a little more blurring than before.  I'm still using the antibiotic ointment at bedtime as I'm still seeing some swelling in my eyes. I'm also still using the nasal antibiotic spray each evening.  My incisions are incredibly nearly invisible. 

I'm still taking care not to blow my nose; I've given in to the urge a couple of times, only gently blowing it, but each time I've experienced small amounts of pinkish-blood in my Kleenex. There is obviously a reason I was warned not to blow my nose, so I'd better behave!  My doctor says this is only until the internal stitches are healed and stents come out. 

I've also been sneezing a lot - sometimes 5-6 times in a row!  Although I'm not completely conscious of it, there is a slight tickle up in my nose, most likely caused by the stents, and I think that is the cause.  The doctor had warned me to sneeze with an open mouth, so I've been following that advice (not very lady-like).    My nose feels stuffy a lot of the time...it is the change of seasons now and weather change always does that to me, so I blame the weather, not the surgery this time.

Post-surgical follow-up

My first follow-up appointment was scheduled for two weeks post-surgery.  The doctor actually seemed to want me to come in within a week later, but there simply wasn't time on his schedule.  We left the option for me to call if I felt something was wrong and he would see me immediately, otherwise we would follow-up at the first available opening.  That was on Tues, Sep 17th.  His nurse settled me in the examination room and ran me through a series of eye-chart tests.  I didn't do very well, and I knew that I wouldn't.

Once Dr. Michael came in, he carefully observed the surgical site, my eyes, my nose, and my general condition (bruising, etc.).  He asked me a series of questions about how I've been doing, checked whether I was still using meds he'd prescribed, whether I was experiencing tearing, and how I did with bleeding and pain.  I did mention that I'd had a couple of occasions of unexpected tears dropping, but it was no where near what I'd had pre-surgery.  He said his goal is to have no tearing.  He explained that the surgery had about a 90-95% success rate, and he wanted me to be one of those successes.  He asked about my vision, and I did explain that since the surgery, I've experienced a noticeable difference in my vision.  I haven't been wearing my contacts and my eyeglass prescription was a little outdated because I rarely used them, plus the fact that eye exams were always difficult given the amount of tearing that I was doing...I'd given up.  I know I need a new prescription for both glasses and contacts now, but I've decided to wait until all my follow-ups are completed. He agreed that I should wait until all healing was done. 

Small stents in place visible in corner of eye. 

He said my eyes were still swollen which will affect the vision.  I mentioned to him that I was totally surprised that the incisions were not on the sides of my nose, and he said that he intentionally placed them in the tear wells to help hide any scarring; he said in the long run it would be much less apparent.  He advised that I could begin using my contacts again and that it might actually help with minimizing the irritation from the stents. 

Dr. Michael advised that everything was looking very good for being only two weeks out.  He said to keep using the nasal spray and ointment, although I could cut back to ointment only at bedtime if I preferred.  We set our next follow-up for Nov. 12th (8 weeks out).  The stents will remain in place for now.

Day of Surgery and 1st Day of Recovery

On the early morning of 4th September 2013, I arrived on schedule to the Sacred Heart Outpatient Surgical Unit.  I was immediately taken to a small room with a bed, asked to gown up (I could leave my underwear on), and then settle into the bed.  Once settled, I underwent an EKG and had blood drawn for labs.  Both were done quickly and without incident by very efficient medical staff.  Shortly after, an IV was put in place on my hand, and a nurse began to monitor my vitals, including blood pressure, temperature and oxygen levels.  The nursing staff were all cheery folks with great personalities, which helped to keep me relaxed and entertained.  Before long, my anesthesiologist came in and asked me a series of questions.  He advised that he would be inserting a tube into my throat just before surgery so that they could manage my breathing and he said that I might come out of anesthesia with a sore throat, but that he didn't anticipate any problems. While he was talking to me, my surgeon came in to check with me and also wanted to to see if I had any questions.  I totally appreciated the personal visits by both and I knew I was in good hands.  As soon as they left the room, the anesthesiologist's surgical assistant came and advised he was going to do some final prep and then move me to the surgical unit.  He let me know he was going to give me something to relax me while he moved me, and warned me that I should be feeling that soon.  He and one of the nurses started pushing the bed into the hall and that was the last I remembered.  Anesthesia is magical!

I woke up in recovery about 4 hours later with a nurse by my side trying to get me to talk to him, and advising mat everything went great.  Every few minutes he would speak to me again, and before long, I was able to focus and remember where I was and what I'd just been through.  After a short time, he and another nurse moved me back to my initial room, where my daughter was waiting for me.  I was pretty sedated, but remember that there really wasn't any pain.  At one point, I said that I was surprised that my eyes weren't covered and the nurse said that they weren't going to cover them...the doctor wanted the incisions exposed for better healing.  Dr. Michael came by and told me that everything went well, although he'd had a tougher time with my left eye than my right, but it went good.  I asked what that meant, and he said that it wasn't anything bad, it just took him longer to get through.  He reminded me that I'd undergone "a lot of surgery" and that I likely would be needing to stay with the pain medications for a couple of days, but more importantly, he wanted me to be sure to stay up on my antibiotics and steroid ointments.  He said I could go home as soon as I felt steady enough (which I already was feeling), but he suggested I eat something light soon just to keep me from experiencing nausea from the anesthesia.  He had a nurse bring me a juice and applesauce.  He gave me his personal cell phone number and said to call him immediately if I had questions, concerns, excessive bleeding or pain.  My instructions were to go home and sleep for the rest of the day.  Use ice packs for 10 minutes every hour to help reduce swelling and bruising.  Ointment in each eye and on the stitches morning and night.   Oral antibiotic morning and evening. Nasal spray (antibiotic) morning and evening, plus Afrin nasal spray for use only to control nose bleeds (addictive, I was warned). Pain meds every 4 hours as needed.  No blowing my nose; I could sniff, snort and spit if I felt the need, but I was definitely not to blow my nose.  I could expect to see blood when I spit but I should not have significant bleeding.  I could expect small spots of blood from my nose, but I should report immediately if I saw significant bleeding.  I should probably try to use two pillows or sit slightly up in the bed while sleeping, or sit in a reclining chair.  No bending or lifting for 48 hours.  No driving for 36 hours. I had no food restrictions.  Showers okay after the first 24 hours, but take care that the water doesn't spray onto my face. I should resume my blood pressure med the next morning and any vitamin, low dose aspirin and other nutritional supplements after 24 hours.

My daughter said that I chatted with her during the 30 minute drive home, but I recall very little of it.  I do remember finally pulling the visor mirror down and looking at my eyes and was totally startled by the bruising around my eyes.  I looked like I had been in a bar fight, plus my eyelids were pretty swollen and red.  But what was the biggest surprise to me was that I didn't see stitches where I'd expected them to be.  From all that I'd read online about this external DCR, surgeons typically made incisions on the side of the nose.  My surgeon did his incisions along the "tear well" under the eye, the natural line that follows the orbital bone.  I was amazed at the precision of his stitches...I could actually only see one or two stitches with each incision; the others were simply done in a way that they were not seen.  As painful as everything looked, I wasn't in pain.  I attributed that to the fact that I'd been medicated up during surgery and decided to follow the doctor's advice on being sure to "stay ahead of the pain", so took a pain pill at the time he advised me to, then went to bed and slept for about three hours.  When awake, I began doing the ice applications he'd suggested.  During recovery at the hospital, the nurse had brought me two tube-shaped disposable ice bags that I'd brought home with me which I continued to use.  One of those with ice was perfect for laying across my eyes.  The doctor had suggested using putting Karo syrup in a baggie and freezing it for a while to chill.  I prepped such a bag, but while it was mold-able and really held the cold without solidifying, I preferred the ice bags.  I followed the regiment of 10 minutes icing per hour for the first couple of hours, but found later that the ice applications helped me control the feeling of pressure and minor pain.  By the second day, I was using mostly ice treatments and Tylenol during the day, preferring to endure the doped up feeling the pain meds gave me.  I did take a pain pill at night.  Again, I had discomfort, but very little pain, actually.  While no external incision was visible on my nose, my nose was swollen and I experienced pain if I accidentally bumped it - obviously some surgery was done beneath the skin and I quickly learned to work around it as gently as the visible incisions.   I also had an area above my right eyebrow that was quite tender to the touch; a small bruise was there too, but I figured it was from something done during the procedure and not a surgical area itself.

On close examination, I could see very small silicone stents looped into each tear duct.  

Best of all...no tearing.